{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:16:57Z","timestamp":1783707417998,"version":"3.55.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate whether cyst shrinkage in intraductal papillary mucinous neoplasm (IPMN) is paradoxically associated with a higher risk of concomitant pancreatic ductal adenocarcinoma (PDAC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective cohort included 1103 patients with pathologically or cytologically confirmed branch-duct or mixed-type IPMN followed for \u2265 1 year. Patients were classified by annual cyst size change rate per the 2024 Kyoto guideline thresholds: shrinkage (&lt;\u20090\u2009mm\/year), stable (0 to &lt; 2.5\u2009mm\/year), and growth (\u2265 2.5\u2009mm\/year). The primary outcome was concomitant PDAC, with IPMN-derived carcinoma as a competing event. Multivariable Fine-Gray regression compared shrinkage with a pre-specified merged non-shrinkage reference; cause-specific Cox regression served as sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1103 patients (541 men, 562 women; mean age, 67.3\u2009\u00b1\u20099.8 years), 282 (25.6%) showed shrinkage, 728 (66.0%) remained stable, and 93 (8.4%) showed growth. Concomitant PDAC was most frequent in shrinkage (6\/282, 2.1%), followed by stable (8\/728, 1.1%), with no events in growth (0\/93). IPMN-derived carcinoma was most frequent in growth (9\/93, 9.7%). Adjusted for age, sex, initial cyst size, and main pancreatic duct diameter, shrinkage was independently associated with concomitant PDAC (subdistribution hazard ratio 4.46; 95% CI 1.62\u201312.30;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004); cause-specific Cox regression yielded a concordant estimate (hazard ratio 4.54; 95% CI 1.52\u201313.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In this single-center retrospective cohort, cyst shrinkage was associated with an increased incidence of concomitant PDAC, contrary to the prevailing assumption that shrinkage reflects a benign course. Given the modest number of concomitant PDAC events (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914), these findings are hypothesis-generating and exploratory; external validation in multicenter prospective cohorts is required before clinical surveillance practice is modified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Cyst shrinkage during intraductal papillary mucinous neoplasm surveillance is considered reassuring, but its association with concomitant pancreatic cancer risk remains unclear.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Shrinkage was paradoxically associated with higher concomitant pancreatic cancer risk (subdistribution hazard ratio 4.46); the growth group\u2019s 0% rate reflected competing risks from IPMN-derived carcinoma.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Radiologists should not reduce surveillance intensity for shrinking intraductal papillary mucinous neoplasm cysts, as these patients carry an elevated risk of concomitant pancreatic cancer developing independently of the monitored cyst.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12740-z","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:56:44Z","timestamp":1783706204000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Shrinkage paradox in intraductal papillary mucinous neoplasms is associated with higher concomitant pancreatic cancer risk"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6330-2482","authenticated-orcid":false,"given":"Hideyuki","family":"Fukui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teppei","family":"Yoshioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhiko","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Makino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromitsu","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Nakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feier","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Enchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisaku","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunari","family":"Fukuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidetoshi","family":"Eguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kodama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyuki","family":"Tomiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"12740_CR1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1159\/000090023","volume":"6","author":"M Tanaka","year":"2006","unstructured":"Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. 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The present study addresses a fundamentally different research question\u2014whether cyst shrinkage paradoxically indicates higher risk of concomitant pancreatic cancer\u2014using distinct analytical methodology (competing risk analysis) and outcome classification (explicit distinction between concomitant and IPMN-derived cancers). These aspects were not examined in the previous publications.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}