title: Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers.
abstract: OBJECTIVE
  The present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas.
  
  
  METHODS
  The subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings were analyzed in logistic regression analyses. Endoscopic ultrasonography measurements were essential for the size of mural nodules, and a central review was conducted for pathological diagnosis.
  
  
  RESULTS
  Pathological diagnosis was benign IPMN in 150 cases and malignant in 160 (noninvasive carcinoma, n = 100; invasive, n = 60). In multivariate analysis, size of mural nodules, diameter of main pancreatic duct, and cyst size of branch pancreatic duct were independent predictors of malignancy, and areas under the receiver operating characteristic curve for these 3 factors were 0.798, 0.643, and 0.601, respectively. With 7 mm taken as the cutoff value for the size of mural nodules, the diagnosis of malignant IPMN had sensitivity of 74.3% and specificity of 72.7%. Carcinoma without nodules was present in 15 patients (15/160 [9.4%]).
  
  
  CONCLUSIONS
  The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability. However, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.
authors.affiliation: Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. yshimizu@aichi-cc.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Manabu
authors.initials: M
authors.lastname: Osanai
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.forename: Waki
authors.initials: W
authors.lastname: Hosoda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shinohara
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity