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Comparison with surgically resected mucinous cystic neoplasm of pancreas and branch-duct type intraductal papillary mucinous neoplasm considering clinico-radiological high-risk features: a reassessment of current guidelines

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Abstract

Purpose

To perform a comparative analysis of surgically resected mucinous cystic neoplasm (MCN) of pancreas and branch-duct type intraductal papillary mucinous neoplasms (BD-IPMN) considering clinico-radiological high-risk predictors for malignant tumors using the current management guidelines.

Materials and methods

224 patients who underwent surgical resection and had histopathologically confirmed MCNs (benign 73; malignant 17) or BD-IPMNs (benign 110; malignant 24) and had pre-operative CT or MRI were retrospectively reviewed. Tumors classified as either high-grade dysplasia or invasive carcinoma were considered malignant, whereas those with low-grade dysplasia were considered benign. Imaging features were analyzed by two radiologists based on selected high-risk stigmata or worrisome features proposed by prevalent guidelines except tumors with main pancreatic duct dilatation (> 5 mm) were excluded.

Results

MCNs and BD-IPMNs showed significant differences in aspects like tumor size, location, the presence and size of enhancing mural nodules, the presence of wall or septal thickening, and multiplicity. Multivariate analyses revealed tumor size (OR, 1.336; 95% CI, 1.124–1.660, p = 0.002) and the presence of enhancing mural nodules (OR, 67.383; 95% CI, 4.490-1011.299, p = 0.002) as significant predictors of malignant MCNs. The optimal tumor size differentiating benign from malignant tumor was 8.95 cm, with a 70.6% sensitivity, 89% specificity, PPV of 27.6%, and NPV of 96.9%, demonstrating superior specificity than the guideline-suggested threshold of 4.0 cm. For malignant BD-IPMNs, the presence of enhancing mural nodules (OR, 15.804; 95% CI, 4.439–56.274, p < 0.001) and CA 19 − 9 elevation (OR, 19.089; 95%CI, 2.868-127.068, p = 0.002) as malignant predictors, with a size of enhancing mural nodule threshold of 5.5 mm providing the best malignancy differentiation.

Conclusion

While current guidelines may be appropriate for managing BD-IPMNs, our results showed a notably larger optimal threshold size for malignant MCNs than that suggested by current guidelines. This warrants reconsidering existing guideline thresholds for initial risk stratification and management of MCNs.

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Data availability

The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    HeeSoo Kim, Jung Hoon Kim & Jin Sol Choi

  2. Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jung Hoon Kim

  3. Department of Radiology, Sun Medical Center, 93, Bugyuseong-daero, Yuseong-gu, Daejeon, South Korea

    Jihae An

  4. Department of Radiology, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea

    Jung Hoon Kim

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Contributions

Conceptualization: Jung Hoon Kim. Data curation: HeeSoo Kim, Jihae An. Formal analysis: HeeSoo Kim, Jin Sol Choi. Funding acquisition: N/A. Investigation: Jihae An, HeeSoo Kim, Jin Sol Choi, Jung Hoon Kim. Methodology: HeeSoo Kim, Jung Hoon Kim. Project administration: HeeSoo Kim, Jung Hoon Kim. Resources: HeeSoo Kim, Jihae An, HeeSoo Kim. Software: HeeSoo Kim, Jihae An, Jin Sol Choi. Supervision: Jung Hoon Kim. Validation: HeeSoo Kim, Jihae An, Jin Sol Choi. Visualization: HeeSoo Kim, Jung Hoon Kim. Writing-original draft: HeeSoo Kim, Jihae An, Jung Hoon Kim. Writing-review & editing: HeeSoo Kim, Jihae An, Jin Sol Choi, Jung Hoon Kim.

Corresponding author

Correspondence to Jung Hoon Kim.

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IRB statement

This retrospective study was approved by Seoul National University Hospital Institutional our institutional review board (IRB No. No 2210-130-1372), and patient informed consent was waived.

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The authors of this manuscript have nothing to disclose.

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Kim, H., Kim, J.H., An, J. et al. Comparison with surgically resected mucinous cystic neoplasm of pancreas and branch-duct type intraductal papillary mucinous neoplasm considering clinico-radiological high-risk features: a reassessment of current guidelines. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04364-y

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