Discontinuing Surveillance of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms in Routine Practice: An External Application of the "Trivial" Criteria and the Resources it Would Release in Fourteen Health Systems.
4 affiliations
- 1Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- 2Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 3Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- 4Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Abstract
Background
Surveillance of low-risk branch-duct intraductal papillary mucinous neoplasms is usually lifelong. Criteria to stop it after 5 years of stability in older patients have not been tested outside the center that devised them, nor has their economic value been measured.Objective
To test these criteria in an independent cohort and measure the lesions missed and the resources released.Methods
Single-center cohort of patients with a low-risk lesion at diagnosis was followed for at least 12 months with cross-sectional imaging at baseline and during surveillance. The outcome was any new worrisome feature or high-risk stigma. Risk after stability was estimated by conditional analysis. Released resources were valued at the marginal cost beyond the fifth year and priced with fourteen tariffs. Sensitivity analyses addressed discounting, horizon, adherence and basket composition.Results
Among 392 patients followed for 2375 person-years, 66 (16.8%) developed a new feature; three had high-grade dysplasia or carcinoma, and none died of the neoplasm. The 5-year risk of a new feature did not fall with stability (14.3% after 2 years, 12.5% after five), but no resection and no high-grade lesion occurred after 4 years. Discontinuation would have discharged 101 patients (25.8%), releasing 298 person-years and 79,316 euro per 1000 patients entering surveillance, with no high-grade lesion missed. Across health systems, the same rule released 42,000 to 170,000 euros.Conclusion
Discontinuation missed no high-grade lesion, although the upper bound of that rate remained 0.84 per 100 person-years. The resources released varied more than fourfold between health systems and must be recomputed locally.
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BibTeX
@article{ricci2026discontinuing,
title = {{Discontinuing Surveillance of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms in Routine Practice: An External Application of the "Trivial" Criteria and the Resources it Would Release in Fourteen Health Systems.}},
author = {Claudio Ricci and Vincenzo D'Ambra and Martina Casarotto and Laura Alberici and Carlo Ingaldi and Marco Fichera and Cristina Mosconi and Marina Migliori and Riccardo Casadei},
journal = {United European gastroenterology journal},
year = {2026},
month = oct,
doi = {10.1002/ueg2.70304},
url = {https://europepmc.org/article/MED/42852691},
note = {CC BY},
}
RIS
TY - JOUR
TI - Discontinuing Surveillance of Low-Risk Branch-Duct Intraductal Papillary Mucinous Neoplasms in Routine Practice: An External Application of the "Trivial" Criteria and the Resources it Would Release in Fourteen Health Systems.
AU - Claudio Ricci
AU - Vincenzo D'Ambra
AU - Martina Casarotto
AU - Laura Alberici
AU - Carlo Ingaldi
AU - Marco Fichera
AU - Cristina Mosconi
AU - Marina Migliori
AU - Riccardo Casadei
PY - 2026
DA - 2026/10/01
JO - United European gastroenterology journal
DO - 10.1002/ueg2.70304
UR - https://europepmc.org/article/MED/42852691
AB - Background Surveillance of low-risk branch-duct intraductal papillary mucinous neoplasms is usually lifelong. Criteria to stop it after 5 years of stability in older patients have not been tested outside the center that devised them, nor has their economic value been measured.Objective To test these criteria in an independent cohort and measure the lesions missed and the resources released.Methods Single-center cohort of patients with a low-risk lesion at diagnosis was followed for at least 12 months with cross-sectional imaging at baseline and during surveillance. The outcome was any new worrisome feature or high-risk stigma. Risk after stability was estimated by conditional analysis. Released resources were valued at the marginal cost beyond the fifth year and priced with fourteen tariffs. Sensitivity analyses addressed discounting, horizon, adherence and basket composition.Results Among 392 patients followed for 2375 person-years, 66 (16.8%) developed a new feature; three had high-grade dysplasia or carcinoma, and none died of the neoplasm. The 5-year risk of a new feature did not fall with stability (14.3% after 2 years, 12.5% after five), but no resection and no high-grade lesion occurred after 4 years. Discontinuation would have discharged 101 patients (25.8%), releasing 298 person-years and 79,316 euro per 1000 patients entering surveillance, with no high-grade lesion missed. Across health systems, the same rule released 42,000 to 170,000 euros.Conclusion Discontinuation missed no high-grade lesion, although the upper bound of that rate remained 0.84 per 100 person-years. The resources released varied more than fourfold between health systems and must be recomputed locally.
SN - 2050-6406
SN - 2050-6414
ER -