title: Can long-term follow-up strategies be determined using a nomogram-based prediction model of malignancy among intraductal papillary mucinous neoplasms of the pancreas?
abstract: OBJECTIVE
  This study investigated whether a risk assessment nomogram can predict the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) and provide valuable information for the follow-up and counseling strategies of such patients.
  
  
  METHODS
  We studied 126 of 589 patients with IPMN who were followed up for at least 36 months with annual endoscopic ultrasonography. We analyzed scores derived from our nomogram, incorporating the parameters of sex, lesion type, mural nodule height, and pancreatic juice cytology determined at the initial IPMN evaluation.
  
  
  RESULTS
  The rate of malignant IPMNs was 5.5% (7/126). The initial average nomogram score was 19.8 (range, 0-55), and the final follow-up average was 23.8 (range, 0-109). When a cutoff score was set at 35 points, the sensitivity, specificity, and accuracy of the nomogram to assess malignancy risk were 87.5%, 96.6%, and 96%, respectively. The area under the receiver operating characteristic curve of malignant IPMN prediction during follow-up was 0.865.
  
  
  CONCLUSIONS
  The ability of the nomogram to predict malignancy in patients with IPMN was validated. Our findings can suggest that a follow-up for patients at high and low risk for cancer progression could be scheduled every 3 to 6 and 12 months, respectively.
authors.affiliation: From the Departments of *Gastroenterology, and †Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan; ‡Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt; §Department of Medical Hepatology, Institute of Liver and Biliary Sciences, Delhi, India; and ∥Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Hijioka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Nobumasa
authors.initials: N
authors.lastname: Mizuno
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaoka
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mekky
authors.forename: Vikram
authors.initials: V
authors.lastname: Bhatia
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Nagashio
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Akihide
authors.initials: A
authors.lastname: Shinagawa
authors.forename: Masanari
authors.initials: M
authors.lastname: Sekine
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishihara
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamao
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000000981:diagnostic imaging*; D018450:Disease Progression; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors