A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: a multicenter EUROPEAN validation

Abstract

Purpose A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort. Methods An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included. Results A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%. Conclusion Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.

Intraductal papillary mucinous neoplasms of the pancreas: Uncommon imaging presentation, evolution and comparison of guidelines

“…The 5-year survival was also different based on the Shin scoring system ranging from 94.4 % in score 0–1 group, to 71.8 % in score 4–5 group. The Shin scoring system was later validated in a European cohort involving 11 countries and 567 patients overall: sensitivity and specificities for predicting malignancy were respectively 57.3 % and 64.4 % for a Shin score of 3, 21.7 % and 90.4 % for a Shin score of 4 %, and 4.2 % and 98.6 % for a Shin score of 5 [33] . Authors conclude that a Shin score of 1 or less should be monitored, while those with scores of 4 or more should undergo surgery [33] .…”