Background and Aims
The International Consensus Guidelines updated in 2017 recommended surgery to all
main duct intraductal papillary mucinous neoplasms (MD-IPMNs) with the main pancreatic
duct (MPD) of 10 mm or more and those with mural nodules regardless of size. The aim
of the present study was to identify predictors of malignancy in MD-IPMN among preoperative
factors including MPD and mural nodule size.
Methods
Twenty-six benign MD-IPMNs (7 resected and 19 nonresected) and 32 malignant MD-IPMNs
(31 resected and 1 nonresected) were included in the study. MRCP, CT, EUS, and cytology
were performed using pancreatic juice collected by endoscopic retrograde pancrestography
(ERP). Resected IPMNs were classified as benign or malignant by histologic examination
and nonresected MD-IPMNs by imaging, cytology, and observation. Cutoff values of candidate
parameters were determined by receiver operating characteristic curves. Univariate
and multivariate analyses by regression model were performed.
Results
MPD and mural nodule size and cytology results differed significantly between benign
and malignant groups. Cutoff values of MPD and mural nodule sizes were 15 mm and 10 mm
with areas under the curve of .66 and .86, respectively. Mural nodules of 10 mm or
more (odds ratio, 8.32; 95% confidence interval, 1.13-61.2; P = .038) and positive cytology (odds ratio, 42.5; 95% confidence interval, 4.10-439;
P = .002) were shown to be independent predictors of malignancy by multivariate analysis.
When MD-IPMNs with either predictor were diagnosed to be malignant, sensitivities,
specificities, and overall accuracy for malignancy were 94%, 85%, and 90%, respectively.
Conclusions
Mural nodules of 10 mm or more and positive cytology were independent predictors of
malignancy in MD-IPMN.
Graphical abstract
Graphical Abstract
Abbreviations:
BD-IPMN (branch duct intraductal papillary mucinous neoplasm), ERP (endoscopic retrograde pancreatography), IPMN (intraductal papillary mucinous neoplasm), MD-IPMN (main duct intraductal papillary mucinous neoplasm), MPD (main pancreatic duct)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 30, 2021
Accepted:
August 17,
2021
Received:
June 23,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
See CME section, p. 372.
Identification
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© 2022 by the American Society for Gastrointestinal Endoscopy
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Access this article on ScienceDirectLinked Article
- Main duct intraductal papillary mucinous neoplasm: resect or not resect, that is the questionGastrointestinal EndoscopyVol. 95Issue 2
- PreviewIn this issue of Gastrointestinal Endoscopy, Uehara et al1 report on the predictive value of imaging and pancreatic juice cytologic analysis to diagnose malignant degeneration of main duct (MD) intraductal papillary mucinous neoplasia (IPMN).1 Although it might not be surprising that a positive result of cytologic analysis was identified as an independent predictor of malignancy, this series adds evidence to the association between the size of a mural nodule and the likelihood of malignant degeneration of MD-IPMN.
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