A Nomogram for Predicting the Probability of Carcinoma in Patients with Intraductal Papillary‐Mucinous Neoplasm

Lee²,

et al. 2014

Pancreas

Objective: We evaluated the accuracy of a new endoscopic ultrasonography (EUS) scoring system to predict malignancy in branch duct-type intraductal papillary mucinous neoplasms (BD-IPMNs).Methods: We performed a retrospective multicenter study of patients who underwent EUS within 3 months before surgery and were diagnosed as having BD-IPMNs by postoperative pathologies at 8 hospitals in Korea from August 2002 to December 2011. To predict the malignancy, we applied the EUS scoring system consisting of pancreatic cyst size, height of mural nodules, main duct dilatation, septal thickening, and patulous orifice. We evaluated the diagnostic accuracy of the new EUS scoring system and compared it with previous individual risk factors.Results: Eighty-four patients (male-to-female ratio, 55:29; mean [SD] age, 64.7 [7.1] years) had 68 benign BD-IPMNs and 16 malignant intraductal papillary mucinous neoplasms. The EUS scoring system showed 75.0% sensitivity and 94.1% specificity at 7 points. This system (area under the curve, 0.939; 95% confidence interval, 0.884-0.994) resulted in a more accurate prediction than the previous known other factors including Sendai criteria, dilatation of ducts, size of the cyst, and presence of septal thickening and mural nodules.Conclusions: The EUS scoring system predicted BD-IPMN malignancy more accurately than the Sendai criteria and individual risk factors.Key Words: endoscopic ultrasonography, branch duct-type intraductal papillary mucinous neoplasm, malignancy, diagnostic accuracy (Pancreas 2014;43: 1306-1311 I ntraductal papillary mucinous neoplasms (IPMNs) of the pancreas are grossly detectable, mucin-producing, and potentially malignant pancreatic cystic neoplasms. Intraductal papillary mucinous neoplasms are pathologically graded according to the most atypical area in the lesion such as low-grade adenoma, moderate dysplasia, carcinoma in situ, and invasive carcinoma. The prognosis of low-grade adenoma and moderate dysplasia is good but that of carcinoma is similar to pancreatic cancers.If the IPMN involves the main pancreatic duct, the risk for malignancy is 57% to 92%. However, in the case of branch duct-type IPMN (BD-IPMN), the risk for malignancy varies. Several factors have been suggested to discriminate a malignancy from benign BD-IPMN. 1 Abdominal pain, jaundice, pancreatitis, and abrupt onset diabetes mellitus are clinically related with malignancy. In radiological findings, the risk for malignancy is high if a large cyst (>30 mm) is present, the main pancreatic duct is dilated, and solid components such as mural nodules, infiltrative mass, or a thickened septum exist.Several criteria for surgically managing a pancreatic cystic neoplasm have been suggested, but predicting the malignancy of BD-IPMN before surgery is still challenging. The Sendai criteria are the most widely accepted to determine whether a surgical resection of BD-IPMN is indicated, but the frequency of malignancy is 28% when they are applied to resected cases. 2 Endoscopic ultrasonography (EUS) is the best ...

Section: Discussionmentioning

confidence: 99%

Prediction of Malignancy With Endoscopic Ultrasonography in Patients With Branch Duct–Type Intraductal Papillary Mucinous Neoplasm

Lee²,

et al. 2014

Pancreas

“…Many recent clinicopathological studies have shown that IPMNs arising in the main pancreatic duct (MPD) are more aggressive than those arising in the branch pancreatic duct (BPD), and the malignancy rate of main duct type IPMN has been reported to be 57% to 92%, [4][5][6]10 whereas that of branch duct type IPMN has been reported to be 6% to 58%. [10][11][12][13][14] Therefore, although most clinicians agree that surgical resection is required for all main duct type IPMNs, the management of branch duct type IPMNs remains controversial, because branch duct type IPMN generally has a low risk of malignancy.…”

mentioning

confidence: 99%

The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

Hirono

Tani²,

Kawai³

et al. 2012

Annals of Surgery

130

107

“…html) [36]. Genetic risk may differ by ethnicity or nationality, so that risk-assessment tools, such as a nomogram [37] based on multivariables, will be needed in the future for the Japanese population.…”

Section: Abbreviationsmentioning

confidence: 99%

Familial pancreatic cancer and hereditary syndromes: screening strategy for high-risk individuals

Matsubayashi

2011

J Gastroenterol

Globally, and almost evenly across nations, a familial disposition can be found in 4-10% of patients with pancreatic cancer (PC). A family history of PC is a risk for this disease and the risk level changes in correlation with the number of affected relatives. Several hereditary syndromes with potential germline mutation also have a high risk for PC; however, little is yet known regarding the genes responsible for familial pancreatic cancer (FPC). Characteristics of FPC cases are similar to those of other familial tumors, including younger onset than in sporadic cases and an ethnic difference (Ashkenazi Jewish > other Caucasian). Other risks resemble those of sporadic cases and include smoking and diabetes mellitus. People with several genetic syndromes, including Peutz-Jeghers syndrome, hereditary pancreatitis, breast-ovarian cancer syndrome, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis also have an increased risk of PC. In many countries, but not yet in Japan, screening of these high-risk individuals is now ongoing for the detection of early PC under established familial pancreatic cancer registries. In addition to the ordinary risk factors, such as smoking, diabetes, pancreatitis, cysts, duct ectasia, and intraductal papillary mucinous neoplasm (IPMN), individuals with a family history of PC and hereditary syndromes are expected to be entered into the screening protocol.