Development, validation, and comparison of a nomogram based on radiologic findings for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: An international multicenter study

Hyeong Seok Kim, Wookyeong Song, Wonho Choo, Sungyoung Lee, Youngmin Han, Claudio Bassi, Roberto Salvia, Giovanni Marchegiani, Christopher L. Wolfgang, Jin He, Alex B. Blair, Michael D. Kluger, Gloria H. Su, Song Cheol Kim, Ki Byung Song, Masakazu Yamamoto, Takashi Hatori, Ching Yao Yang, Hiroki Yamaue, Seiko HironoSohei Satoi, Tsutomu Fujii, Satoshi Hirano, Wenhui Lou, Yasushi Hashimoto, Yasuhiro Shimizu, Marco Del Chiaro, Roberto Valente, Matthias Lohr, Dong Wook Choi, Seong Ho Choi, Jin Seok Heo, Fuyuhiko Motoi, Ippei Matsumoto, Woo Jung Lee, Chang Moo Kang, Yi Ming Shyr, Shin E. Wang, Ho Seong Han, Yoo Seok Yoon, Marc G. Besselink, Nadine C.M. van Huijgevoort, Masayuki Sho, Hiroaki Nagano, Sang Geol Kim, Goro Honda, Yinmo Yang, Hee Chul Yu, Jae Do Yang, Jun Chul Chung, Yuichi Nagakawa, Hyung Il Seo, Seungyeoun Lee, Hongbeom Kim, Wooil Kwon, Taesung Park, Jin Young Jang

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although we previously proposed a nomogram to predict malignancy in intraductal papillary mucinous neoplasms (IPMN) and validated it in an external cohort, its application is challenging without data on tumor markers. Moreover, existing nomograms have not been compared. This study aimed to develop a nomogram based on radiologic findings and to compare its performance with previously proposed American and Korean/Japanese nomograms. Methods: We recruited 3708 patients who underwent surgical resection at 31 tertiary institutions in eight countries, and patients with main pancreatic duct >10 mm were excluded. To construct the nomogram, 2606 patients were randomly allocated 1:1 into training and internal validation sets, and area under the receiver operating characteristics curve (AUC) was calculated using 10-fold cross validation by exhaustive search. This nomogram was then validated and compared to the American and Korean/Japanese nomograms using 1102 patients. Results: Among the 2606 patients, 90 had main-duct type, 900 had branch-duct type, and 1616 had mixed-type IPMN. Pathologic results revealed 1628 low-grade dysplasia, 476 high-grade dysplasia, and 502 invasive carcinoma. Location, cyst size, duct dilatation, and mural nodule were selected to construct the nomogram. AUC of this nomogram was higher than the American nomogram (0.691 vs 0.664, P =.014) and comparable with the Korean/Japanese nomogram (0.659 vs 0.653, P =.255). Conclusions: A novel nomogram based on radiologic findings of IPMN is competitive for predicting risk of malignancy. This nomogram would be clinically helpful in circumstances where tumor markers are not available. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.

Original languageEnglish (US)
JournalJournal of Hepato-Biliary-Pancreatic Sciences
DOIs
StateAccepted/In press - 2021

Keywords

  • cancer
  • intraductal papillary mucinous neoplasms of the pancreas
  • malignancy prediction
  • nomogram
  • radiology

ASJC Scopus subject areas

  • Surgery
  • Hepatology

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