title: "High-risk stigmata" of the 2012 international consensus guidelines correlate with the malignant grade of branch duct intraductal papillary mucinous neoplasms of the pancreas.
abstract: OBJECTIVE
  The 2012 international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas stratified patients into 2 clinical categories, "high-risk stigmata" and "worrisome features," and recommended different therapeutic strategies for these groups. The aim of this study was to elucidate the significance of these categories in terms of predicting malignant IPMNs.
  
  
  METHODS
  The medical records of 100 consecutive patients who underwent pancreatectomy for IPMNs were retrospectively reviewed. Seventy patients with branch duct IPMNs (BD-IPMNs) were stratified into 3 groups. The relationships between the number of predictive factors and histopathologic grade were investigated.
  
  
  RESULTS
  The prevalence rates of malignant IPMN, invasive carcinoma, and lymph node metastasis in the high-risk group were 80%, 55%, and 20%, respectively, with these percentages significantly increasing in a stepwise manner according to the number of predictive factors. In contrast, there was no significant correlation between the number of worrisome features and grade of malignancy in patients stratified as having worrisome BD-IPMNs.
  
  
  CONCLUSIONS
  The number of high-risk stigmata correlated significantly with the grade of malignancy of BD-IPMNs. The presence of at least 1 high-risk stigma in patients with BD-IPMNs indicates a need for pancreatectomy with lymphadenectomy.
authors.affiliation: From the Departments of *Surgery and Oncology, †Medicine and Bioregulatory Science, ‡Anatomic Pathology, and §Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Aso
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Taketo
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Hideyo
authors.initials: H
authors.lastname: Kimura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Koji
authors.initials: K
authors.lastname: Tamura
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Takashi
authors.initials: T
authors.lastname: Osoegawa
authors.forename: Shunnichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Koji
authors.initials: K
authors.lastname: Shindo
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ushijima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mizumoto
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000145:classification / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000145:classification / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary; D003952:Diagnostic Imaging; D019468:Disease Management; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000592:standards; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000145:classification / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies