Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Pancreas. 2013 Jul;42(5):883-8. doi: 10.1097/MPA.0b013e31827a7b84.
The present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas.
The subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings were analyzed in logistic regression analyses. Endoscopic ultrasonography measurements were essential for the size of mural nodules, and a central review was conducted for pathological diagnosis.
Pathological diagnosis was benign IPMN in 150 cases and malignant in 160 (noninvasive carcinoma, n = 100; invasive, n = 60). In multivariate analysis, size of mural nodules, diameter of main pancreatic duct, and cyst size of branch pancreatic duct were independent predictors of malignancy, and areas under the receiver operating characteristic curve for these 3 factors were 0.798, 0.643, and 0.601, respectively. With 7 mm taken as the cutoff value for the size of mural nodules, the diagnosis of malignant IPMN had sensitivity of 74.3% and specificity of 72.7%. Carcinoma without nodules was present in 15 patients (15/160 [9.4%]).
The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability. However, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.
本研究回顾性分析了胰腺内导管乳头状黏液性肿瘤（IPMN）恶变的预测因素。
研究对象为在 3 家高容量中心接受胰腺切除术的 310 名患者。采用逻辑回归分析对术前实验室和影像学检查结果进行分析。超声内镜测量对于壁结节的大小至关重要，并且对病理诊断进行了中心审查。
病理诊断良性 IPMN 150 例，恶性 160 例（非浸润性癌 100 例；浸润性癌 60 例）。多因素分析显示，壁结节大小、主胰管直径和分支胰管囊肿大小是恶性的独立预测因素，这 3 个因素的受试者工作特征曲线下面积分别为 0.798、0.643 和 0.601。以壁结节大小 7mm 为截断值，恶性 IPMN 的诊断敏感度为 74.3%，特异度为 72.7%。无结节的癌 15 例（15/160[9.4%]）。
超声内镜测量的壁结节大小具有较高的预测能力。然而，约 10%的癌患者没有结节，此类病例的诊断处理是未来的一个问题。
