Study finds, Predictors of malignancy in main duct Intraduct
The aim of the present study is to identify predictors of malignancy in MD-IPMN among preoperative factors including sizes of MPD and mural nodule. The international consensus guidelines updated in 2017 recommended surgery to all main duct intraductal papillary mucinous neoplasms (MD-IPMNs) with the main pancreatic duct (MPD) of 10 mm or more and those with mural nodule regardless of its size.

26 benign MD-IPMNs and 32 malignant MD-IPMNs were enrolled. Magnetic resonance cholangiopancreatography (MRCP), computed tomography (CT), endoscopic ultrasonography (EUS), and cytology was performed using pancreatic juice collected by endoscopic retrograde pancrestography (ERP). Resected IPMNs were classified as benign or malignant by histological examination; nonresected MD-IPMNs by imaging, cytology, and observation.

--Sizes of MPD and mural nodule and result of cytology differed significantly between benign and malignant groups.

--Cutoff values of MPD and mural nodule sizes were 15 mm and 10 mm with areas under the curve (AUC) of 0.66 and 0.86, respectively.

--Mural nodule of 10 mm or more (OR, 8.32) and positive cytology (OR, 42.5) were shown to be independent predictors of malignancy by multivariate analysis.

--When MD-IPMNs that had either of the predictors were diagnosed to be malignant, sensitivities, specificities, and overall accuracy for malignancy were 94%, 85%, and 90%, respectively.

Finally, in MD-IPMN, a mural nodule of 10 mm or greater and positive cytology were found to be independent predictors of malignancy.