Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
Department of Radiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Medicine (Baltimore). 2024 Aug 16;103(33):e39323. doi: 10.1097/MD.0000000000039323.
The aim of this study was to evaluate the cutoff value for identifying malignance in main pancreatic duct (MPD)-involved intraductal papillary mucinous neoplasm (IPMN) with an MPD diameter ranging from 5 to 10 mm. Clinical-radiological characteristics of 142 patients, including MPD-involved IPMNs (n = 53) and branch-duct (BD)-IPMNs (n = 89) were analyzed. Logistic regression analysis was used to determine the risk factors of malignant IPMNs and invasive carcinoma. ROC curves were used to identify different cutoffs in terms of preoperative MPD values to predict the presence of invasive carcinoma as well as malignant IPMNs, and the prediction performance was evaluated. For MPD-involved IPMNs (5 mm < MPD < 10 mm), MPD diameter of 7.5 mm for discriminating malignant IPMNs (area under curve [AUC] = 0.67) and 7.7 mm for discriminating invasive IPMNs (AUC = 0.56) were found to be the optimal cutoff values at receiver operating characteristic curve (ROC) analysis. MPD > 7.5 mm and carbohydrate antigen19-9 (Ca19-9) > 37 U/ml were found to be predictors of malignant IPMNs at univariate, and MPD > 7.5 mm was a predictor in multivariate analysis in MPD-involved IPMNs. The AUC of the ROC curve of MPD (7.5 mm) combined with Ca19-9 in identifying malignant IPMNs was 0.73 in MPD-involved IPMNs. MPD (7.5 mm) combined with Ca19-9 performed well in identifying malignant IPMNs in MPD-involved IPMNs.
本研究旨在评估主胰管（MPD）直径为 5 至 10mm 的累及胰管内乳头状黏液性肿瘤（IPMN）的截断值，以识别恶性肿瘤。分析了 142 例患者的临床影像学特征，包括 MPD 受累 IPMN（n=53）和分支胰管（BD）-IPMN（n=89）。采用 logistic 回归分析确定恶性 IPMN 和浸润性癌的危险因素。ROC 曲线用于确定术前 MPD 值的不同截断值，以预测浸润性癌以及恶性 IPMN 的存在，并评估预测性能。对于 MPD 受累的 IPMN（5mm<MPD<10mm），MPD 直径为 7.5mm 可用于区分恶性 IPMN（AUC=0.67），7.7mm 用于区分浸润性 IPMN（AUC=0.56），这是 ROC 分析中发现的最佳截断值。单因素分析发现 MPD>7.5mm 和 CA19-9>37U/ml 是 MPD 受累 IPMN 恶性的预测因子，多因素分析发现 MPD>7.5mm 是 MPD 受累 IPMN 的预测因子。MPD（7.5mm）联合 CA19-9 在识别 MPD 受累 IPMN 恶性肿瘤中的 ROC 曲线 AUC 为 0.73。MPD（7.5mm）联合 CA19-9 可有效识别 MPD 受累 IPMN 中的恶性 IPMN。
