The carcinoembryonic antigen level in pancreatic juice and mural nodule size are predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms of the pancreas.
OBJECTIVE
Identification of predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms (IPMN).


BACKGROUND
Main duct type IPMN has been recommended for resection. However, the indications for resection of the branch duct type IPMN have been controversial.


METHODS
We retrospectively analyzed the clinicopathological factors of 134 patients undergoing resection for branch duct type IPMN, excluding main duct type IPMN, to identify predictors of the malignant behavior of this neoplasm. The cutoff values of tumor size, main pancreatic duct (MPD) size, mural nodule size, and carcinoembryonic antigen (CEA) level in the pancreatic juice obtained during preoperative endoscopic retrograde pancreatography (ERP) were analyzed using receiver-operator characteristic curves.


RESULTS
We found 7 significant predictors for malignancy in the branch duct type IPMN in a univariate analysis; jaundice, tumor occupying the pancreatic head, MPD size >5 mm, mural nodule size >5 mm, serum carbohydrate antigen (CA)19-9 level, positive cytology in the pancreatic juice, and CEA level in the pancreatic juice >30 ng/mL. In a multivariate analysis, a mural nodule size >5 mm and a CEA level in the pancreatic juice >30 ng/mL were independent factors associated with malignancy. The positive predictive value of a mural nodule size >5 mm and a CEA level in the pancreatic juice >30 ng/mL was 100%, and the negative predictive value was 96.3%.


CONCLUSIONS
We identified 2 useful predictive factors for malignancy in branch duct type IPMN; a mural nodule size >5 mm and a CEA level in the pancreatic juice obtained by preoperative ERP >30 ng/mL.
Second Department of Surgery, Wakayama Medical University, School of Medicine, Kimiidera, Wakayama, Japan.
Seiko
S
Hirono
Masaji
M
Tani
Manabu
M
Kawai
Ken-ichi
K
Okada
Motoki
M
Miyazawa
Atsushi
A
Shimizu
Yuji
Y
Kitahata
Hiroki
H
Yamaue
D002288:Adenocarcinoma, Mucinous / Q000276:immunology* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D021441:Carcinoma, Pancreatic Ductal / Q000276:immunology* / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000276:immunology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010189:Pancreatic Juice / Q000737:chemistry*; D010190:Pancreatic Neoplasms / Q000276:immunology* / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D002272:Carcinoembryonic Antigen