Pre-operative nomogram predicting malignant potential in the patients with intraductal papillary mucinous neoplasm of the pancreas: focused on imaging features based on revised international guideline

초록

Objective To clarify the pre-operative imaging and clinical features differentiating malignant from benign intraductal papillary mucinous neoplasm (IPMN) of the pancreas and develop a nomogram for estimating the individualized risk of malignant IPMN. Methods One hundred twenty-six patients with IPMN (72 benign and 54 malignant) who underwent pre-operative contrast-enhanced CT or MRI from 2010 to 2018 were retrospectively evaluated in two tertiary institutions. All lesions were pathologically proven by surgery or biopsy. Significant imaging and clinical findings for malignancy were assessed by univariate and multivariable logistic regression analyses. Based on the significant variables in the multivariable analysis, we developed a nomogram to predict malignant potential in patients with IPMNs, and the area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic value. Results Multivariable analysis revealed that enhancing mural nodule >= 5 mm (odds ratio (OR), 48.30; 95% confidence interval (CI), 11.69-199.49), increased serum carbohydrate antigen 19-9 (CA19-9) (OR, 8.69; 95% CI, 2.04-36.92), main pancreatic duct (MPD) diameter >= 10 mm (OR, 6.34; 95% CI, 1.21-33.30), and acute pancreatitis (OR, 4.77; 95% CI, 1.12-20.36) were independent significant parameters to predict malignant IPMN. Among them, enhancing mural nodule >= 5 mm showed the highest OR and predictor point on the nomogram. The AUC for the nomogram was 0.955 (95% CI, 0.903-0.984). Conclusions Pre-operative imaging findings could aid in predicting malignant potential of IPMN using the significant findings of enhancing mural nodule >= 5 mm, increased serum CA19-9, MPD diameter >= 10 mm, and acute pancreatitis.

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