Validation of a Nomogram for Predicting the Probability of Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasm in 180 Pancreatic Resection Patients at 3 High-Volume Centers

Shimizu, Yasuhiro; Yamaue, Hiroki; Maguchi, Hiroyuki; Yamao, Kenji; Hirono, Seiko; Osanai, Manabu; Hijioka, Susumu; Kanemitsu, Yukihide; Sano, Tsuyoshi; Senda, Yoshiki; Bhatia, Vikram; Yanagisawa, Akio

doi:10.1097/mpa.0000000000000269

Cited by 39 publications

(37 citation statements)

References 26 publications

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“…The algorithm suggested by International Consensus Guidelines for treatment of IPMN cannot predict malignancy risk for individual patients with various characteristics. To overcome this limitation, several nomograms or scoring systems to predict malignancy in IPMN have been proposed. Most of these, however, were based on small numbers of enrolled patients and the results were not validated externally.…”

Section: Discussionmentioning

confidence: 99%

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Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Jung

Park

Kim

et al. 2019

British Journal of Surgery

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Background Intraductal papillary mucinous neoplasm (IPMN) is premalignant pancreatic lesion. International guidelines offer limited predictors of individual risk. A nomogram to predict individual IPMN malignancy risk was released, with good diagnostic performance based on a large cohort of Asian patients with IPMN. The present study validated a nomogram to predict malignancy risk and invasiveness of IPMN using both Eastern and Western cohorts. Methods Clinicopathological and radiological data from patients who underwent pancreatic resection for IPMN at four centres each in Eastern and Western countries were collected. After excluding patients with missing data for at least one malignancy predictor in the nomogram (main pancreatic duct diameter, cyst size, presence of mural nodule, serum carcinoembryonic antigen and carbohydrate antigen (CA) 19‐9 levels, and age). Results In total, data from 393 patients who fit the criteria were analysed, of whom 265 were from Eastern and 128 from Western institutions. Although mean age, sex, log value of serum CA19‐9 level, tumour location, main duct diameter, cyst size and presence of mural nodule differed between the Korean/Japanese, Eastern and Western cohorts, rates of malignancy and invasive cancer did not differ significantly. Areas under the receiver operating characteristic (ROC) curve values for the nomogram predicting malignancy were 0·745 for Eastern, 0·856 for Western and 0·776 for combined cohorts; respective values for the nomogram predicting invasiveness were 0·736, 0·891 and 0·788. Conclusions External validation of the nomogram showed good performance in predicting cancer in both Eastern and Western patients with IPMN lesions.

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Section: Discussionmentioning

confidence: 99%

“…A nomogram to predict IPMN malignancy was first suggested in 2010, and validated using a cohort from three hospitals in Japan. Four factors – sex, type of lesion, size of mural nodule and pancreatic juice cytology – were selected for the nomogram.…”

Section: Discussionmentioning

confidence: 99%

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Jung

Park

Kim

et al. 2019

British Journal of Surgery

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“…Our study was specifically performed as an audit of real world clinical practice at multiple major academic institutions, and highlights a continued role for EUS-FNA in the management of a select population of higher-risk PCNs. While current studies are exploring molecular markers 31 34, as well as developing nomograms for predicting the probability of high-risk PCNs 35, our data emphasize the continued need to individualize treatment of PCNs until additional higher-quality prospective multicenter studies are performed.…”

Section: Resultsmentioning

confidence: 88%

Evaluation of the 2015 AGA guidelines on pancreatic cystic neoplasms in a large surgically confirmed multicenter cohort

Muthusamy

Gaddam

et al. 2017

Endosc Int Open

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Absract Background and study aims The American Gastroenterological Association (AGA) recently published guidelines for the management of asymptomatic pancreatic cystic neoplasms (PCNs). We aimed to evaluate the diagnostic characteristics of the AGA guidelines in appropriately recommending surgery for malignant PCNs. Patients and methods A retrospective multicenter study was performed of patients who underwent endoscopic ultrasound (EUS) for evaluation of PCNs who ultimately underwent surgical resection from 2004 – 2014. Demographics, EUS characteristics, fine-needle aspiration (FNA) results, type of resection, and final pathologic diagnosis were recorded. Patients were categorized into 2 groups (surgery or surveillance) based on what the AGA guidelines would have recommended. Performance characteristics for the diagnosis of cancer or high-grade dysplasia (HGD) on surgical pathology were calculated. Results Three hundred patients underwent surgical resection for PCNs, of whom the AGA guidelines would have recommended surgery in 121 (40.3 %) and surveillance in 179 (59.7 %) patients. Among patients recommended for surgery, 45 (37.2 %) had cancer, whereas 76 (62.8 %) had no cancer/HGD. Among patients recommended for surveillance, 170 (95.0 %) had no cancer/HGD; however, 9 (5.0 %) patients had cancer that would have been missed. For the finding of cancer/HGD on surgical pathology, the AGA guidelines had 83.3 % sensitivity (95 % CI 70.7 – 92.1), 69.1 % specificity (95 % CI 62.9 – 74.8), 37.2 % positive predictive value (95 % CI 28.6 – 46.4), 95.0 % negative predictive value (95 % CI 90.7 – 97.7), and 71.7 % accuracy (95 % CI 67.4 – 74.6). Conclusions The 2015 AGA guidelines would have resulted in 60 % fewer patients being referred for surgical resection, and accurately recommended surveillance in 95 % of patients with asymptomatic PCNs. Future prospective studies are required to validate these guidelines.Meeting presentations: Presented in part at Digestive Diseases Week 2016

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“…Besides expert opinion‐based guidelines, several efforts have been made to establish a nomogram as a more rational system with which to predict malignant IPMN, as listed in Table 3 8, 25, 26, 27, 28, 29. Shimizu et al27 first reported a nomogram for IPMN, which covered both MD‐IPMN and BD‐IPMN simultaneously.…”

Section: Prediction Of Malignant Ipmn By Nomogrammentioning

confidence: 99%

“…External evaluation of the nomogram is recommended because of objectivity and repeatability 34. Three studies assessed their nomograms by external validation,8, 26, 28 and one study used internal validation,25 and one used no validation 29. The concordance index and area under the curve derived from validation are used to estimate validity of the nomogram.…”

Section: Prediction Of Malignant Ipmn By Nomogrammentioning

confidence: 99%

Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines?

Nakamura

Miyasaka

Sadakari

et al. 2017

Annals of Gastroent Surgery

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Management of intraductal papillary mucinous neoplasm is controversial, and several guidelines have aimed to establish an adequate strategy for surgical resection and surveillance. We compared various intraductal papillary mucinous neoplasm guidelines and considered new matters that are pivotal for improved treatment of intraductal papillary mucinous neoplasm. We identified and compared 11 published guidelines, three of which were major guidelines that mainly referred to the diagnosis and treatment of intraductal papillary mucinous neoplasm (International Association of Pancreatology 2012 guidelines, European Study Group on Cystic Tumours of the Pancreas 2013 guidelines, and American Gastroenterological Association 2015 guidelines). The main concerns of these three guidelines were indication for surgery and follow up of non‐resected lesions. Among the differences between the three guidelines, the period of surveillance recommended was the most controversial matter. Meanwhile, several nomograms have been proposed to improve the diagnosis of intraductal papillary mucinous neoplasm from the level of experts' experiences to that of rational systems. We discuss the adequate strategy of surveillance for intraductal papillary mucinous neoplasm with and without pancreatectomy and nomograms aiming to predict the risk of malignancy in patients with intraductal papillary mucinous neoplasm.

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Validation of a Nomogram for Predicting the Probability of Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasm in 180 Pancreatic Resection Patients at 3 High-Volume Centers

Abstract: This nomogram for predicting the probability of carcinoma in patients with IPMN was accurate in an external validation patient cohort.

Cited by 39 publications

References 26 publications

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less

Evaluation of the 2015 AGA guidelines on pancreatic cystic neoplasms in a large surgically confirmed multicenter cohort

Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines?

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