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Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram.
Ann Surg Oncol 2013; 20(13):4348-55AS

Abstract

BACKGROUND

Clinical decision making for patients with intraductal papillary mucinous neoplasms (IPMN) of the pancreas is challenging. Even with strict criteria for resection, most resected lesions lack high-grade dysplasia (HGD) or invasive carcinoma.

METHODS

We evaluated patients who underwent resection of histologically confirmed IPMN and had preoperative imaging available for review. A hepatobiliary radiologist blinded to histopathologic subtype reviewed preoperative imaging and recorded cyst characteristics. Patients with mixed-type IPMN were grouped with main-duct lesions for this analysis. Based on an ordinal logistic regression model, we devised two independent nomograms to predict the findings of adenoma, high-grade dysplasia (HGD-CIS), and invasive carcinoma, separately in both main and branch-duct IPMN. Bootstrap validation was used to evaluate the performance of these models, and a concordance index was derived from this internal validation.

RESULTS

There were 219 patients who met criteria for this study. Branch-duct IPMN (bdIPMN) comprised 56 % of the resected lesions. The proportion of HGD-CIS was 15 % for bdIPMN and 33 % for main-duct lesions (mdIPMN); P = 0.003. Invasive carcinoma was identified in 15 % of bdIPMN and 41 % of main-duct lesions (P < 0.001). On multivariate regression, patient gender, history of prior malignancy, presence of solid component, and weight loss were found to be significantly associated with the ordinal outcome for patients with mdIPMN and built into the nomogram (concordance index 0.74). For patients with bdIPMN weight loss, solid component, and lesion diameter were associated with the outcome; (concordance index 0.74).

CONCLUSION

Based on the analysis of patients selected for resection, two nomograms were created that predict a patient's individual likelihood of harboring HGD or invasive malignancy in radiologically diagnosed IPMN. External validation is ongoing.

Authors+Show Affiliations

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24046103

Citation

Correa-Gallego, Camilo, et al. "Predicting Dysplasia and Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Development of a Preoperative Nomogram." Annals of Surgical Oncology, vol. 20, no. 13, 2013, pp. 4348-55.
Correa-Gallego C, Do R, Lafemina J, et al. Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Ann Surg Oncol. 2013;20(13):4348-55.
Correa-Gallego, C., Do, R., Lafemina, J., Gonen, M., D'Angelica, M. I., DeMatteo, R. P., ... Allen, P. J. (2013). Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Annals of Surgical Oncology, 20(13), pp. 4348-55. doi:10.1245/s10434-013-3207-z.
Correa-Gallego C, et al. Predicting Dysplasia and Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Development of a Preoperative Nomogram. Ann Surg Oncol. 2013;20(13):4348-55. PubMed PMID: 24046103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. AU - Correa-Gallego,Camilo, AU - Do,Richard, AU - Lafemina,Jennifer, AU - Gonen,Mithat, AU - D'Angelica,Michael I, AU - DeMatteo,Ronald P, AU - Fong,Yuman, AU - Kingham,T Peter, AU - Brennan,Murray F, AU - Jarnagin,William R, AU - Allen,Peter J, Y1 - 2013/09/18/ PY - 2013/04/18/received PY - 2013/9/19/entrez PY - 2013/9/21/pubmed PY - 2014/6/28/medline SP - 4348 EP - 55 JF - Annals of surgical oncology JO - Ann. Surg. Oncol. VL - 20 IS - 13 N2 - BACKGROUND: Clinical decision making for patients with intraductal papillary mucinous neoplasms (IPMN) of the pancreas is challenging. Even with strict criteria for resection, most resected lesions lack high-grade dysplasia (HGD) or invasive carcinoma. METHODS: We evaluated patients who underwent resection of histologically confirmed IPMN and had preoperative imaging available for review. A hepatobiliary radiologist blinded to histopathologic subtype reviewed preoperative imaging and recorded cyst characteristics. Patients with mixed-type IPMN were grouped with main-duct lesions for this analysis. Based on an ordinal logistic regression model, we devised two independent nomograms to predict the findings of adenoma, high-grade dysplasia (HGD-CIS), and invasive carcinoma, separately in both main and branch-duct IPMN. Bootstrap validation was used to evaluate the performance of these models, and a concordance index was derived from this internal validation. RESULTS: There were 219 patients who met criteria for this study. Branch-duct IPMN (bdIPMN) comprised 56 % of the resected lesions. The proportion of HGD-CIS was 15 % for bdIPMN and 33 % for main-duct lesions (mdIPMN); P = 0.003. Invasive carcinoma was identified in 15 % of bdIPMN and 41 % of main-duct lesions (P < 0.001). On multivariate regression, patient gender, history of prior malignancy, presence of solid component, and weight loss were found to be significantly associated with the ordinal outcome for patients with mdIPMN and built into the nomogram (concordance index 0.74). For patients with bdIPMN weight loss, solid component, and lesion diameter were associated with the outcome; (concordance index 0.74). CONCLUSION: Based on the analysis of patients selected for resection, two nomograms were created that predict a patient's individual likelihood of harboring HGD or invasive malignancy in radiologically diagnosed IPMN. External validation is ongoing. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/24046103/Predicting_dysplasia_and_invasive_carcinoma_in_intraductal_papillary_mucinous_neoplasms_of_the_pancreas:_development_of_a_preoperative_nomogram_ L2 - https://dx.doi.org/10.1245/s10434-013-3207-z DB - PRIME DP - Unbound Medicine ER -