title: Predictors of malignancy in pure branch duct type intraductal papillary mucinous neoplasm of the pancreas: A nationwide multicenter study.
abstract: OBJECTIVE
  Prediction of malignancy in patients with BD-IPMNs is critical for the management. The aim of this study was to elucidate predictors of malignancy in patients with 'pure' BD-IPMNs who had a main pancreatic duct (MPD) diameter of ≤5 mm according to the most recent international consensus criteria and in whom MPD involvement was excluded on postoperative histology.
  
  
  METHODS
  We identified 177 patients with 'pure' BD-IPMNs based on preoperative imaging and postoperative histology from 15 tertiary referral centers in Korea. BD-IPMNs with low-grade (n = 72) and moderate-grade (n = 66) dysplasia were grouped as benign and BD-IPMNs with high-grade dysplasia (n = 10) and invasive carcinoma (n = 29) were grouped as malignancy.
  
  
  RESULTS
  On univariate analysis, particular symptoms (jaundice and clinical pancreatitis), CT findings (cyst size > 3 cm, the presence of enhancing mural nodules) and EUS features (the presence of mural nodules, the mural nodule size > 5 mm) were significant risk factors predicting malignant BD-IPMNs. Multivariate analysis revealed that the cyst size > 3 cm (odds ratio = 9.9), the presence of enhancing mural nodules on CT (odds ratio = 19.3) and the mural nodule size > 5 mm on EUS (odds ratio = 14.9) were the independent risk factors for the presence of malignancy in BD-IPMNs (p < 0.001).
  
  
  CONCLUSIONS
  The cyst size > 3 cm, the presence of enhancing mural nodules on CT, the mural nodule size > 5 mm on EUS are three independent predictors of malignancy in patients with 'pure' BD-IPMNs.
authors.affiliation: Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea.
authors.forename: Tae Hyeon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Bundang, Republic of Korea.
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Guri, Republic of Korea.
authors.forename: Kyo-Sang
authors.initials: KS
authors.lastname: Yoo
authors.affiliation: Pancreatobiliary Cancer Clinic, Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Woo-Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kwang-Hyuck
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seok-Ho
authors.initials: SH
authors.lastname: Dong
authors.affiliation: Department of Internal Medicine, Chonnam University College of Medicine, Kwangju, Republic of Korea.
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: Eun-Taek
authors.initials: ET
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Republic of Korea.
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.
authors.forename: Ho-Gak
authors.initials: HG
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
authors.forename: Kwang Bum
authors.initials: KB
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea.
authors.forename: Hong-Ja
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea.
authors.forename: Seung-Ok
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Digestive Disease Center, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Koog
authors.initials: YK
authors.lastname: Cheon
authors.affiliation: Department of Public Health, Wonkwang University Graduate School, Iksan, Republic of Korea.
authors.forename: Jeong Mi
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: mhkim@amc.seoul.kr.
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D018300:Papilloma, Intraductal / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor
keywords: Branch duct type intraductal papillary mucinous neoplasm; Endoscopic ultrasonography; Malignancy; Multicenter study; Pancreas; Risk factors