title: Validating a simple scoring system to predict malignancy and invasiveness of intraductal papillary mucinous neoplasms of the pancreas.
abstract: BACKGROUND
  The objective of the present study was to identify reliable preoperative factors predicting malignancy or invasiveness of intraductal papillary mucinous neoplasm (IPMN) of the pancreas and the effectiveness of a diagnostic scoring system based on these factors.
  
  
  METHODS
  Between August 1994 and December 2007, 204 patients underwent pancreatic resection for IPMN at a single institute. Medical records were reviewed retrospectively, and a new diagnostic scoring system for predicting malignant IPMN preoperatively was designed.
  
  
  RESULTS
  Univariate analysis revealed nine significant predictors of both malignant and invasive IPMN: age > or =60 years, history of pancreatitis, presence of mural nodule(s), diameter of main pancreatic duct (MPD) >6 mm, main duct or mixed type, total bilirubin >1.2 mg/dl, CA-19-9 >37 U/ml, tumor location in the pancreatic head, and tumor size >30 mm. Multivariate analysis showed that age, pancreatitis, mural nodule(s), and MPD diameter were independent predictors of invasive IPMN, and that all these parameters, plus elevated carbohydrate antigen-19-9 (CA-19-9), were independent predictors of malignant IPMN. A scoring system based on these five factors, each assigned 1 point, and with a cut-off of 3 points, could predict malignant IPMN with a sensitivity of 50.7% and a specificity of 90.1%. The 5-year survival rates of patients with benign and malignant IPMN were 95.0% and 64.0%, respectively.
  
  
  CONCLUSIONS
  Our scoring system using five independent factors (age > or =60 years, history of pancreatitis, presence of mural nodule(s), elevated level of CA-19-9, and MPD diameter >6 mm) may be helpful for predicting malignancy and postoperative survival.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Sang H
authors.initials: SH
authors.lastname: Shin
authors.forename: Duck J
authors.initials: DJ
authors.lastname: Han
authors.forename: Kwan T
authors.initials: KT
authors.lastname: Park
authors.forename: Young H
authors.initials: YH
authors.lastname: Kim
authors.forename: Jae B
authors.initials: JB
authors.lastname: Park
authors.forename: Song C
authors.initials: SC
authors.lastname: Kim
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002278:Carcinoma in Situ / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor