The International Consensus Guidelines that were updated in 2017 recommended surgery to all main duct intraductal papillary mucinous neoplasms (MD-IPMNs), with the main pancreatic duct (MPD) of 10 mm of more and those with mural nodules, regardless of size. To identify predictors of malignancy in MD-IPMN among preoperative factors, including MPD and mural nodule size, 26 benign MD-IPMNs (7 resected and 19 nonresected), and 32 malignant MD-IPMNs (31 resected and 1 nonresected), were included in this study.
MRCP, CT, EUS and cytology were performed using pancreatic juice collected by ERCP. Resected IPMNs were classified as benign or malignant by histologic examination and nonresected MDIPMNs by imaging, cytology, and observation. Cutoff values of candidate parameters were determined by receiver operating characteristic curves. Univariate and multivariate analyses by regression model were performed.
MPD and mural nodule size, as well as cytology results differed significantly between benign and malignant groups. Cutoff values of MPD and mural nodule sizes were 15 mm and 10
mm with areas under the curve of 0.66 and 0.86, respectively. Mural nodules of 10 mm or more (OR 8.32), and positive cytology (OR 42.5), were shown to be independent predictors of malignancy on multivariate analysis. When MD-IPMNs with either predictor were diagnosed to be malignant, sensitivities, specificities and overall accuracy for malignancy were 94%, 85%, and 90%, respectively. It was concluded that mural nodules of 10 mm or more and positive cytology were independent predictors of malignancy in MD-IPMN.
“Predictors of Malignancy in Main Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas.” Uehara, H., Abe, Y., Kai, Y., et al. Gastroenterology 2022; 95:291-296.