Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis

Abstract

The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01–1.79), size ≥ 3 cm (OR 1.90, CI 1.51–2.40), cystic wall thickening (OR 2.53, CI 1.50–4.27), mural nodule (OR 4.10, CI 3.38–4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11–4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49–22.06), lymphadenopathy (OR 8.55, CI 3.25–22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55–6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60–2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid.

Branch-duct intraductal papillary mucinous neoplasm (IPMN): Are cyst volumetry and other novel imaging features able to improve malignancy prediction compared to well-established resection criteria?

“…However, cystic diameter still represents a controversial issue. There is indeed no agreement upon whether larger cysts may be associated with a higher risk of malignancy [5][6][7][8], and HGD/INV may be encountered even in smaller cysts [9]. Therefore, it is unclear whether the maximal cystic diameter can provide enough information for risk stratification.…”

The Ratio of C-Reactive Protein to Albumin Is an Independent Predictor of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas

“…Features previously suggested to predict malignancy (HGD or invasive carcinoma) in IPMNs include: an association with symptoms; cyst wall thickening; mural nodules; MPD dilation; abrupt pancreatic duct caliber changes; lymphadenopathy; and higher than normal CA19-9 or CEA serum levels [ 17 ]. The rate of pointless surgical procedures for overestimated pancreatic lesions remains high, however, which is why new, specific biomarkers are needed for a better clinical management of patients with IPMNs.…”

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

“…Abrupt change in the caliber of the pancreatic duct is also suggestive of malignancy in BD or MT IPMN. A recent meta-analysis of 40 articles, including 6301 patients with pathologically proven IPMN found an abrupt change in the caliber of the MPD was strongly predictive of HGD or pancreatic cancer (OR 7.41, CI 2.49–22.06) [ 82 ]. It has therefore been included as a worrisome feature in the International Consensus guidelines [ 30 ].…”