J Korean Med Sci.  2011 Jun;26(6):740-746. 10.3346/jkms.2011.26.6.740.

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

• Hwang DW
• Jang JY
• Lim CS
• Lee SE
• Yoon YS
• Ahn YJ
• Han HS
• Kim SW
• Kim SG
• Yun YK
• Han SS
• Park SJ
• Lim TJ
• Kang KJ
• Sim MS
• Choi SH
• Heo JS
• Choi DW
• Hur KY
• Lee DS
• Yun SS
• Kim HJ
• Cho CK
• Kim HJ
• Yu HC
• Cho BH
• Song IS

• KMID: 1785958
• DOI: http://doi.org/10.3346/jkms.2011.26.6.740

Abstract

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.

Keyword

Branch Duct Type Intraductal Papillary Mucinous Neoplasm (IPMN); Cyst Size; Mural Nodule; CEA; Malignancy; Invasive Carcinoma

MeSH Terms

Adenocarcinoma, Mucinous/*pathology
Adult
Aged
Aged, 80 and over
Carcinoembryonic Antigen/blood
Carcinoma, Pancreatic Ductal/*pathology
Carcinoma, Papillary/*pathology
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Pancreatic Neoplasms/*pathology
Predictive Value of Tests
ROC Curve
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curve between the malignancy-predicting score and malignancy. Considering sensitivity and specificity, 14 points was the optimal cutoff value.

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  Fig. 2 Receiver operating characteristic (ROC) curve of calculated score, related to invasiveness. In distinguishing noninvasive IPMN and invasive IPMN, 21 was the most reliable cutoff value.

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