Sporadic non-functional neuroendocrine pancreatic incidentalomas (NF-NEI) ≤ 2 cm: risk of progression over 3 years. Results of the prospective multicenter French national study IPANEMA

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Aims To assess the incidence of malignancy in NF-NEI ≤2 cm and identify the 3 years progression rate of non-operated lesions. Methods Multicenter prospective study, included between December 2016 and June 2019 all patients with NF-NEI ≤2 cm and confirmed diagnosis by a positive EUS-guided FNA/FNB or SRI. Excluded grade G3 tumor and MEN 1 syndrome. Based on management, 2 groups of patients were defined: non-surgical and surgical. The diagnosis of malignancy was retained if: G3 tumor, presence of lymph node and/or distant metastases, doubling in size of the tumor during the 36 months of FU, performed by imaging and EUS. Results 111 patients were included ([ Table 1 ]). 19 (17%) patients were operated within a median time of 2.76 months (IQR 1.6-4.6) after inclusion (14 G1(73.7%) pT1N0, 5 G2 pT1N0/N1(2)). 92 (83%) patients had active surveillance. The median FU was respectively 38.4 (95% CI, 26, 3-43.6) and 37.8 (36.1-39.7) months in the surgery and surveillance groups. Due to the significant increase in size of the tumor, 4 patients in the surveillance group were operated in a median time of 17.1 months (IQR 11.7-20.8) after inclusion (3G1 pT1N0, 1G2 pT1N1). 4(3.6%) patients presented malignancy criteria: 3pN+ on the surgical specimen; 1 patient developed metastatic disease at M12. During FU, 2(2%) unrelated deaths occurred.The incidence of malignancy and 3 year rate of progression were 3.6% and 4.5% respectively. Table 1 Characteristics of patients at baseline in IPANEMA study. Conclusions Our study shows a low rate of baseline malignancy among small (≤2cm) NF-NEI and in terms of progression over a 3-year timeframe and highlight the need for identification of more accurate predictors of disease progression to better determine the management. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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