Aims:
To develop a risk score for early prediction of invasive cancer of BD-IPMN according
to morphological characterization in EUS, using the surgical specimens as gold standard.
Methods:
Retrospective multicenter observational study in patients with BD-IPMN who underwent
EUS and a surgical treatment between 2005 and 2017. Morphological features by EUS
were evaluated. A score using a logistic regression model was performed to assess
the risk of invasive cancer.
Results:
One-hundred and thirty-one patients (50% men, mean age: 66 ± 11 years) were included.
The presentation was incidental in 40% of cases and contrast enhancement was performed
in 34.6%. The low-intermediate grade dysplasia, high grade dysplasia and invasive
cancer rates were and 51.9%, 24.4% and 23.7% respectively.
Size≥30 mm (p = 0.011), enhancing nodules (p < 0.001), pancreatic duct ≥10 mm (p < 0.001), lymph nodes (p
< 0.001) and abrupt change (p < 0.001) were associated with cancer in univariable
analysis. By multivariable analysis, lymph nodes [OR: 16.612 (CI95%:2.554 – 108.058), p = 0.003, 4 score points], pancreatic duct ≥10 mm [OR: 8.220 (CI95%:1.774 – 38.087), p = 0.007, 2 score points], abrupt change [OR: 5.890 (CI95%:1.417 – 24.482), p = 0.015, 1.5 score point], and enhancing nodules [OR: 4.276 (CI95%:1.303 – 14.032), p = 0.017, 1 score point], were independent factors associated with invasive cancer. The Nagelkerke
index of the model was 0.539. The Area under the curve was 0.857 (p < 0.001) with
a sensitivity and specificity of 84% and 70% respectively in an internal validation
of the model. The following categories of the score (0 – 8.5points): A (0 – 1), B
(1.5 – 3), C (3.5 – 5), D (5.5 – 8.5 points) presented a positive predictive value
of 8.5%, 42.1%, 57.1% and 100% rates of invasive cancer.
Conclusions:
This EUS predictive score estimates the risk of invasive cancer in patients with BD-IPMN
with a high accuracy.
