Yu Songfeng, Takasu Naoki, Watanabe Toshihiro, Fukumoto Tsuyoshi, Okazaki Shinji, Tezuka Koji, Sugawara Shuichiro, Hirai Ichiro, Kimura Wataru
From the *Faculty of Medicine, Department of Gastroenterological, General, Breast and Thyroid Surgery, Yamagata University, Yamagata City, Japan; and †Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Pancreas. 2017 Aug;46(7):936-942. doi: 10.1097/MPA.0000000000000874.
The 2012 Fukuoka consensus guideline has stratified the risks of malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas into "high-risk stigmata" (HRS) and "worrisome feature" (WF). This study aimed to evaluate its clinical validity based on a single institution experience.
Eighty-nine patients who underwent surgical resection with pathological diagnosis of IPMN were retrospectively studied.
High-risk stigmata was significantly correlated with the prevalence of malignant IPMN as compared with WF. The positive predictive values of HRS and WF were 66.7% and 35.7% for branch duct IPMN and 80% and 38.1% for main duct IPMN, respectively. Univariate analysis indicated that all the factors in HRS and WF had statistical significance. Whereas multivariate analysis revealed only enhanced solid component (odds ratio [OR], 50.01; P = 0.008), presence of mural nodule (OR, 73.83; P < 0.001) and lymphadenopathy (OR, 20.85; P = 0.03) were independent predictors. Scoring HRS and WF by different numbers of positive factors resulted in improved predictive value. The area under the curve of HRS score was significantly lower than that of WF or HRS + WF score (0.680 vs 0.900 or 0.902, respectively; P < 0.001).
As supplementary to the 2012 Fukuoka guideline, we suggest that calculating scores of WF and HRS may have superior diagnostic accuracy in predicting malignant IPMN.
2012年福冈共识指南已将胰腺导管内乳头状黏液性肿瘤（IPMN）的恶性风险分为“高危特征”（HRS）和“可疑特征”（WF）。本研究旨在基于单一机构的经验评估其临床有效性。
回顾性研究89例接受手术切除且病理诊断为IPMN的患者。
与WF相比，高危特征与恶性IPMN的患病率显著相关。对于分支导管IPMN，HRS和WF的阳性预测值分别为66.7%和35.7%；对于主胰管IPMN，分别为80%和38.1%。单因素分析表明，HRS和WF中的所有因素均具有统计学意义。而多因素分析显示，仅实性成分增强（比值比[OR]，50.01；P = 0.008）、壁结节的存在（OR，73.83；P < 0.001）和淋巴结病（OR，20.85；P = 0.03）是独立预测因素。通过不同数量的阳性因素对HRS和WF进行评分可提高预测价值。HRS评分的曲线下面积显著低于WF或HRS + WF评分（分别为0.680对0.900或0.902；P < 0.001）。
作为对2012年福冈指南的补充，我们建议计算WF和HRS评分在预测恶性IPMN方面可能具有更高的诊断准确性。
