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

Abstract

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.

Risk prediction for malignant intraductal papillary mucinous neoplasm of the pancreas: logistic regression versus machine learning

“…The overall performance of the LR models was 0.725 (see Fig. 3), slightly lower than previous studies (0.72-0.85) 3,5,11 . To increase the performance, we hypothesized that prediction models based on different statistical techniques, such as the ML technique, can be potentially used as an alternative method for prediction and classification 12 .…”

Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm

“…This nomogram was based on a large eastern cohort, includes both radiologic and laboratory findings, and it has the advantage of easy access. In addition, studies have recently been published, showing that it also has good external validity for western cohorts [15]. The current study demonstrated the MP-N to have good calibration with the Hosmer-Lemeshow goodness-of-fit test, and that it had a good AUC value of 0.8033 in patients with IPMN and main duct dilatation of 10 mm or less.…”

CT-Based Radiomics Analysis to Predict Malignancy in Patients with Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas

“…Using CT or MRI features only, the presence of an enhancing mural nodule, main pancreatic duct size, abrupt main pancreatic duct caliber change, and lymphadenopathy were more common in malignant than benign IPMNs resulting in AUCs of 0.83 and 0.86 with CT and MRI, respectively [52]. Besides recommendations, nomograms have been tested and validated in Eastern and Western patients, with AUC for combined cohorts in the range of previous works (0.776) [53].…”