Tae Hyeon Kim1, Tae Jun Song2, Jin-Hyeok Hwang3, Kyo-Sang Yoo4, Woo-Jin Lee5, Kwang-Hyuck Lee6, Seok-Ho Dong7, Chang-Hwan Park8, Eun-Taek Park9, Jong-Ho Moon10, Ho-Gak Kim11, Eun-Young Kim11, Kwang Bum Cho12, Hong-Ja Kim13, Seung-Ok Lee14, Young Koog Cheon15, Jeong Mi Lee16, Dong Wook Oh2, Myung-Hwan Kim17. 1. Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Republic of Korea. 2. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. 3. Department of Internal Medicine, Seoul National University College of Medicine, Bundang, Republic of Korea. 4. Department of Internal Medicine, Hanyang University College of Medicine, Guri, Republic of Korea. 5. Pancreatobiliary Cancer Clinic, Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea. 6. Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 7. Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea. 8. Department of Internal Medicine, Chonnam University College of Medicine, Kwangju, Republic of Korea. 9. Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea. 10. Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon, Republic of Korea. 11. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea. 12. Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. 13. Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea. 14. Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea. 15. Digestive Disease Center, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea. 16. Department of Public Health, Wonkwang University Graduate School, Iksan, Republic of Korea. 17. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: mhkim@amc.seoul.kr.
Abstract
BACKGROUND/ OBJECTIVES: 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.
BACKGROUND/ OBJECTIVES: 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.