Predictors of malignancy in main duct intraductal papillary mucinous neoplasm of the pancreas

Published:August 30, 2021DOI:https://doi.org/10.1016/j.gie.2021.08.016

      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

      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)
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      Linked Article

      • Main duct intraductal papillary mucinous neoplasm: resect or not resect, that is the question
        Gastrointestinal EndoscopyVol. 95Issue 2
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          In 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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