Predictors of malignancy in pure branch duct type intraductal papillary mucinous neoplasm of the pancreas: A nationwide multicenter study

Abstract

Background/Objectives: Prediction of malignancy in patients with BD-IPMNs is critical for the management. The aim of this study was to elucidate predictors of malignancy in patients with 'pure' BD-IPMNs who had a main pancreatic duct #MPD# diameter of ˂= 5 mm according to the most recent international consensus criteria and in whom MPD involvement was excluded on postoperative histology# Methods: We identified 177 patients with 'pure' BD-IPMNs based on preoperative imaging and postoperative histology from 15 tertiary referral centers in Korea# BD-IPMNs with low-grade #n = 72# and moderate-grade #n = 66# dysplasia were grouped as benign and BD-IPMNs with high-grade dysplasia #n = 10# and invasive carcinoma #n = 29# were grouped as malignancy# Results: On univariate analysis, particular symptoms #jaundice and clinical pancreatitis#, CT findings #cyst size ˃ 3 cm, the presence of enhancing mural nodules# and EUS features #the presence of mural nodules, the mural nodule size ˃ 5 mm# were significant risk factors predicting malignant BD-IPMNs# Multivariate analysis revealed that the cyst size ˃ 3 cm #odds ratio = 9#9#, the presence of enhancing mural nodules on CT #odds ratio = 19#3# and the mural nodule size ˃ 5 mm on EUS #odds ratio = 14.9# were the independent risk factors for the presence of malignancy in BD-IPMNs #p ˂ 0.001#. Conclusions: The cyst size ˃ 3 cm, the presence of enhancing mural nodules on Cl, the mural nodule size ˃ 5 mm on EUS are three independent predictors of malignancy in patients with 'pure' BD-IPMNs. Copyright #C# 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.