Importance of each high-risk stigmata and worrisome features as a predictor of high-grade dysplasia in intraductal papillary mucinous neoplasms of the pancreas |
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| Institution: | 1. Department of Surgery, Institute of Gastroenterology, Tokyo Woman’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan;2. Department of Investigative Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan;1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore;2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;3. Duke National University of Singapore Medical School, Singapore;4. Department of Oncologic Imaging, National Cancer Center Singapore, Singapore;5. Department of Radiology, Singapore General Hospital, Singapore;6. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore;1. Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;3. Cancer Center, Massachusetts General Hospital, Boston, MA, USA;4. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;1. Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan;2. Department of Pathology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan;1. Clinique chirurgicale digestive et endocrinienne, CHU, 1, place A-Ricordeau, 44093 Nantes, France;2. Chirurgie hépatique et pancréatique, Hôpital Beaujon, Clichy, France;3. Chirurgie viscérale, Hôpital Rangueil, Toulouse, France;4. Chirurgie digestive et hépato-biliaire, Hôpital Pontchaillou, Rennes, France;5. Chirurgie digestive et générale, Hôpital c Huriez, Rennes, France;6. Chirurgie digestive, Hospices Civils de Lyon, UCBL1, hôpital E Herriot, Lyon, France;7. Chirurgie digestive, CHU Nord, Marseille, France;8. IPC Paoli-Calmettes, Marseille, France;9. Chirurgie viscérale et digestive, CHU, Amiens, France;10. Département de chirurgie hépato-biliaire et pancréatique, IHU, hôpital civil, Strasbourg, France;11. Service de chirurgie digestive, CHU Saint Antoine, Paris, France;12. CHU Haut Lévêque, Bordeaux, France;13. Service de médecine nucléaire, CHU, Nantes, France |
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| Abstract: | BackgroundHigh-risk stigmata (HRS) and ‘worrisome features’ (WFs) are defined as predictive factors for malignancies of intraductal papillary mucinous neoplasms (IPMNs). We performed this study to determine the importance and odds ratio (OR) of each HRS and WFs as predictors for high-grade dysplasia (HGD).MethodsWe analyzed 295 patients who underwent pancreatectomy for branch duct and mixed-type IPMN, and evaluated the association between HRS and WFs (as defined by the ‘2017 Fukuoka Consensus Guidelines’) and HGD.ResultsThe proportions of patients with low-grade dysplasia (LGD), HGD, and invasive carcinoma were 47%, 28%, and 25%, respectively. Multivariate analysis comparing patients with LGD and HGD using all HRS and WFs revealed that an enhancing mural nodule ≥5 mm (OR: 4.1), pancreatitis (OR: 2.2), and thickened/enhancing cyst walls (OR: 2.2) were independent predictive factors for HGD. Based on the OR (the former factor is two points and the latter two factors are each one point), the incidence of HGD in patients with none (n = 43), one (n = 82), two (n = 25), three (n = 52), and four (n = 19) of these predictive factors were 9%, 26%, 52%, 62%, and 63%, respectively. Assuming a score of one or higher as a surgical indication, the sensitivity, specificity, positive predict value, and negative predict value of HGD were 95, 38, 44, and 91%.ConclusionsOur derived scoring system using more important factors in HRS and WFs may be useful for predicting HGD and determining surgical indications of IPMN. |
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| Keywords: | High-grade dysplasia Intraductal papillary mucinous neoplasm Pancreas High-risk stigmata Worrisome features |
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