Decision making for pancreatic resection in patients with intraductal papillary mucinous neoplasms

Abstract

Aim: To identify a practical approach for preoperative decision-making in patients with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.

Methods: Between March 1999 and November 2006, the clinical characteristics, pathological data and computed tomography/magnetic resonance imaging (CT/MRI) of 54 IPMNs cases were retrieved and analyzed. The relationships between the above data and decision-making for pancreatic resection were analyzed using SPSS 13.0 software. Univariate analysis of risk factors for malignant or invasive IPMNs was performed with regard to the following variables: carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9) and the characteristics from CT/MRI images. Receiver operating characteristic (ROC) curve analysis for pancreatic resection was performed using significant factors from the univariate analysis.

Results: CT/MRI images, including main and mixed duct IPMNs, tumor size > 30 mm or a solid component appearance in the lesion, and preoperative serum CA19-9 > 37 U/mL had good predictive value for determining pancreatic resection (P < 0.05), but with limitations. Combining the above factors (CT/MRI images and CA19-9) improved the accuracy and sensitivity for determining pancreatic resection in IPMNs. Using ROC analysis, the area under the curve reached 0.893 (P < 0.01, 95%CI: 0.763-1.023), with a sensitivity, specificity, positive predictive value and negative predictive value of 95.2%, 83.3%, 95.2% and 83.3%, respectively.

Conclusion: Combining preoperative CT/MRI images and CA19-9 level may provide useful information for surgical decision-making in IPMNs.

Keywords: Carbohydrate antigen 19-9; Computed tomography/magnetic resonance imaging; Intraductal papillary mucinous neoplasms; Predictor; Surgical decision-making.

Figure 1

Characteristics of computed tomography/magnetic resonance imaging. Receiver operating characteristic analysis showed that non-branch duct intraductal papillary mucinous neoplasms (IPMNs), lesion size > 30 mm and a solid component appearance in the lesion had great significance for predicting pancreatic resection, and the area under the curve reached 0.76 (P = 0.012, 95%CI: 0.569-0.964), 0.867 (P = 0.001, 95%CI: 0.758-0.976) and 0.76 (P < 0.01, 95%CI: 0.623-0.910), respectively.

Figure 2

The predictors of malignant intraductal papillary mucinous neoplasms. Receiver operating characteristic analysis showed that γ-GT > 50 U/L, alkaline phosphatase (ALP) > 115 U/L or carbohydrate antigen 19-9 (CA19-9) > 37 U/mL effectively predicted malignant intraductal papillary mucinous neoplasms. However, the area under the curve for CA19-9 > 37 U/mL was the largest among the three indices and reached 0.939 (P < 0.01, 95%CI: 0.843-1.035).

Figure 3

The predictive value of the combination of carbohydrate antigen 19-9 and computed tomography/magnetic resonance imaging (criterion-F). The area under the curve by receiver operating characteristic analysis reached 0.893 (P < 0.01, 95%CI: 0.763-1.023).