title: Decision making for pancreatic resection in patients with intraductal papillary mucinous neoplasms.
abstract: OBJECTIVE
  To identify a practical approach for preoperative decision-making in patients with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.
  
  
  METHODS
  Between March 1999 and November 2006, the clinical characteristics, pathological data and computed tomography/magnetic resonance imaging (CT/MRI) of 54 IPMNs cases were retrieved and analyzed. The relationships between the above data and decision-making for pancreatic resection were analyzed using SPSS 13.0 software. Univariate analysis of risk factors for malignant or invasive IPMNs was performed with regard to the following variables: carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9) and the characteristics from CT/MRI images. Receiver operating characteristic (ROC) curve analysis for pancreatic resection was performed using significant factors from the univariate analysis.
  
  
  RESULTS
  CT/MRI images, including main and mixed duct IPMNs, tumor size > 30 mm or a solid component appearance in the lesion, and preoperative serum CA19-9 > 37 U/mL had good predictive value for determining pancreatic resection (P < 0.05), but with limitations. Combining the above factors (CT/MRI images and CA19-9) improved the accuracy and sensitivity for determining pancreatic resection in IPMNs. Using ROC analysis, the area under the curve reached 0.893 (P < 0.01, 95%CI: 0.763-1.023), with a sensitivity, specificity, positive predictive value and negative predictive value of 95.2%, 83.3%, 95.2% and 83.3%, respectively.
  
  
  CONCLUSIONS
  Combining preoperative CT/MRI images and CA19-9 level may provide useful information for surgical decision-making in IPMNs.
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
authors.forename: Wei-Xing
authors.initials: WX
authors.lastname: Ding
authors.forename: Da-Yong
authors.initials: DY
authors.lastname: Jin
authors.forename: Dan-Song
authors.initials: DS
authors.lastname: Wang
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Lou
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
keywords: Carbohydrate antigen 19-9; Computed tomography/magnetic resonance imaging; Intraductal papillary mucinous neoplasms; Predictor; Surgical decision-making
references.citation: Asia Pac J Clin Oncol. 2010 Jun;6(2):98-105
references.pmid: 20565421
references.citation: Am J Surg. 2006 Feb;191(2):191-7
references.pmid: 16442944
references.citation: World J Gastroenterol. 2007 Jan 14;13(2):289-93
references.pmid: 17226911
references.citation: World J Surg. 2011 May;35(5):1103-9
references.pmid: 21416173
references.citation: Clin Gastroenterol Hepatol. 2008 Jul;6(7):815-9; quiz 719
references.pmid: 18602036
references.citation: Chirurg. 2010 Aug;81(8):755-68; quiz 769
references.pmid: 20694789
references.citation: Cancer Cytopathol. 2010 Feb 25;118(1):1-13
references.pmid: 20043327
references.citation: Ann Surg. 2010 Jan;251(1):70-5
references.pmid: 20009749
references.citation: Langenbecks Arch Surg. 2012 Jan;397(1):93-102
references.pmid: 20640860
references.citation: Hepatogastroenterology. 2010 Jul-Aug;57(101):698-705
references.pmid: 21033213
references.citation: World J Gastroenterol. 2010 Apr 21;16(15):1890-5
references.pmid: 20397268
references.citation: Chirurg. 2009 Jan;80(1):7-13
references.pmid: 19082569
references.citation: Clin Gastroenterol Hepatol. 2009 Dec;7(12):1373-6
references.pmid: 19577006
references.citation: Curr Opin Gastroenterol. 2010 Sep;26(5):506-12
references.pmid: 20625288
references.citation: Arch Surg. 2003 Jun;138(6):610-7; discussion 617-8
references.pmid: 12799331
references.citation: Nat Clin Pract Gastroenterol Hepatol. 2007 Mar;4(3):148-59
references.pmid: 17339852
references.citation: Eur J Radiol. 2010 Jan;73(1):96-101
references.pmid: 19008065
references.citation: Arch Surg. 2009 May;144(5):448-54
references.pmid: 19451487
references.citation: Gut. 2007 Aug;56(8):1086-90
references.pmid: 17127707
references.citation: Pancreatology. 2010;10(2-3):144-50
references.pmid: 20484954
references.citation: Nat Rev Gastroenterol Hepatol. 2011 Jan;8(1):56-60
references.pmid: 21212775
references.citation: Ann Surg Oncol. 2005 Feb;12(2):124-32
references.pmid: 15827792
references.citation: Med Princ Pract. 2006;15(4):245-52
references.pmid: 16763389
references.citation: Eur J Surg Oncol. 2007 Aug;33(6):678-84
references.pmid: 17207960
references.citation: Am J Surg Pathol. 2000 Oct;24(10):1372-7
references.pmid: 11023098
references.citation: Pancreatology. 2006;6(1-2):17-32
references.pmid: 16327281
references.citation: Radiology. 2006 Feb;238(2):560-9
references.pmid: 16436817
references.citation: Surgery. 2010 Jun;147(6):812-7
references.pmid: 20060146
references.citation: Ann Surg. 2010 Mar;251(3):470-6
references.pmid: 20142731
references.citation: World J Surg. 2005 Dec;29(12):1650-7
references.pmid: 16311856
references.citation: Cancer. 2010 Jul 15;116(14):3369-77
references.pmid: 20564064