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Clinicopathological Meaning of Size of Main-Duct Dilatation in Intraductal Papillary Mucinous Neoplasm of Pancreas: Proposal of a Simplified Morphological Classification Based on the Investigation on the Size of Main Pancreatic Duct

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Abstract

Background

The 2012 consensus guideline on intraductal papillary mucinous neoplasm of the pancreas (IPMN) described a three-stage criteria involving main pancreatic duct (MPD) size with definitions of malignancy relevant for treatment decisions. Re-evaluation and simplification of this classification for clinicians are warranted.

Methods

Data from the Seoul National University Hospital of 375 consecutive patients with pathology-confirmed IPMN after surgery were analyzed. The association between clinicopathologic characteristics of IPMN and MPD size was assessed. The cut-off value of MPD size for a current definition of malignancy prediction was calculated.

Results

Diagnostic accuracy for malignancy was highest when the cut-off value of MPD size was 7 mm (area under the curve = 0.7126). Dichotomizing IPMN into MPD ≤7 mm versus MPD >7 mm, patient age (p = 0.039), sex (p = 0.001), presence of mural nodule (p < 0.001), and invasiveness risk (13.2 vs. 39.8 %, p < 0.001) resulted in significantly different results. Mural nodule-negative patients with MPD >7 mm had a significantly lower 5-year survival rate than those with MPD ≤7 mm (78.4 vs. 91.4 %, p = 0.006). Among patients with MPD size ≤7 mm, elevated serum CA 19-9 and mural nodule were independent risk factors of malignancy. Patients with MPD size ≤7 mm without these risk factors had malignancy risk of 2.6 %.

Conclusion

Using the definition of malignancy provided in the 2012 guideline, the MPD size >7 mm criterion was statistically driven. The current morphologic classification of IPMN can be simplified as branch-duct-predominant IPMN (MPD ≤7 mm)’ and main-duct-predominant IPMN (MPD >7 mm). Patients who are determined to have main-duct-predominant IPMN and branch-duct-predominant IPMN with elevated serum CA 19-9 or mural nodule are recommended to undergo surgical treatment.

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Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (No. HI14C2640).

Conflicts of interest

The authors disclose no conflicts.

Author information

Authors and Affiliations

  1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea

    Mee Joo Kang, Jin-Young Jang & Sun-Whe Kim

  2. Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea

    Selyeong Lee & Taesung Park

  3. Department of Mathematics and Statistics, Sejong University College of Natural Sciences, Seoul, Korea

    Seung Yeoun Lee

Authors
  1. Mee Joo Kang
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  2. Jin-Young Jang
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  3. Selyeong Lee
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Corresponding author

Correspondence to Jin-Young Jang.

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Supplement Figure 1

Maximum balanced accuracy obtained when the cut-off value of 0.24 is used as the prediction probability for malignancy (TIFF 71 kb)

Supplement Figure 2

Sensitivity, specificity and balanced accuracy of malignancy prediction at the main duct diameter of 7 mm were 53.8, 80.7 and 67.2 %, respectively (TIFF 63 kb)

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Kang, M.J., Jang, JY., Lee, S. et al. Clinicopathological Meaning of Size of Main-Duct Dilatation in Intraductal Papillary Mucinous Neoplasm of Pancreas: Proposal of a Simplified Morphological Classification Based on the Investigation on the Size of Main Pancreatic Duct. World J Surg 39, 2006–2013 (2015). https://doi.org/10.1007/s00268-015-3062-0

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