EVALUATION OF PREDICTIVE FACTORS OF MALIGNANCY IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM OF THE PANCREAS AND COMPARISON TO INTERNATIONAL GUIDELINES

Aims This retrospective monocentric study aimed to assess predictive value of risk factors for intraductal papillary mucinous neoplasm (IPMN) malignancy according to available international guidelines (American/European guidelines and international consensus) and to assess yield of imaging at Nancy University Hospital.

Methods All consecutive patients with an operated IPMN between January 2013 and April 2021 were included.

Results Among 102 patients, 68% (69/102) had malignant lesions and 32% (33/102) had benign lesions. Predictive values for malignancy of the following risk factors were obstructive jaundice (Se=19%, Sp=100%), elevation of blood CA19.9 levels (Se=55%, Sp=100%), nodule≥5mm (Se=64%, Sp=87%), main pancreatic duct (MPD)≥10mm (Se=38%, Sp=77%), and suspicious cytology (Se=59% and Sp=100). According to available guidelines, international consensus had best yield with high sensitivity (86%) and specificity (64%). Except thickened/enhancing cyst walls (p<0.001), all risk criteria were present in the same proportions in computerized tomography (CT), magnetic resonance imaging (MRI) and endoscopy ultrasound (EUS). Respectively in CT, MRI and EUS, thickened/enhancing cyst walls had a sensitivity of 21%, 39%, and 62% with a specificity of 76%, 60%, 30%.

Fig. 1

Conclusions Our cohort demonstrates that useful predictive factors of malignancy are obstructive jaundice, a nodule≥5mm, and parenchymal tissue mass. The international consensus of 2017 seems to be the best with high sensitivity and specificity, and the European guidelines favor surgery, resulting in low specificity.

Publication History

Article published online:
14 April 2022