The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas
The Carcinoembryonic Antigen Level in Pancreatic Juice and Mural Nodule Size Are Predictors of Malignancy for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas
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DOI：
10.1097/sla.0b013e3182444231
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发表时间：
2012-03-01
影响因子：
9
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
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作者：
Hirono, Seiko;Tani, Masaji;Yamaue, Hiroki
目的：探讨分支管型导管内乳头状粘液性肿瘤(IPMN)的恶性预测因素。背景：主管型IPMN已被推荐切除。方法：对134例支管型IPMN患者的临床病理资料进行回顾性分析，分析不包括主管型IPMN的分支管型IPMN的临床病理因素，找出影响IPMN恶性行为的因素。结果：在单因素分析中发现了7个预测IPMN型IPMN恶性的有意义的因素：黄疸、肿瘤占位、主胰管大小>5 mm、壁结节>5 mm、壁结节>5 mm、血清糖类抗原19~9水平、胰液细胞学阳性、胰液CEA水平30 ng/mL。在多变量分析中，壁结节大小<5 mm和胰液中CEA水平<30 ng/mL是与恶性肿瘤相关的独立因素。附壁结节大小<5 mm和胰液CEA水平30 ng/m L的阳性预测值为100%，阴性预测值为96.3%。结论：我们确定了2个对IPMN分支管型的恶性有价值的预测因子：附壁结节大小<5 mm和胰液CEA水平。
Objective: Identification of predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms (IPMN).Background: Main duct type IPMN has been recommended for resection. However, the indications for resection of the branch duct type IPMN have been controversial.Methods: We retrospectively analyzed the clinicopathological factors of 134 patients undergoing resection for branch duct type IPMN, excluding main duct type IPMN, to identify predictors of the malignant behavior of this neoplasm. The cutoff values of tumor size, main pancreatic duct (MPD) size, mural nodule size, and carcinoembryonic antigen (CEA) level in the pancreatic juice obtained during preoperative endoscopic retrograde pancreatography (ERP) were analyzed using receiver-operator characteristic curves.Results: We found 7 significant predictors for malignancy in the branch duct type IPMN in a univariate analysis; jaundice, tumor occupying the pancreatic head, MPD size >5 mm, mural nodule size >5 mm, serum carbohydrate antigen (CA) 19-9 level, positive cytology in the pancreatic juice, and CEA level in the pancreatic juice >30 ng/mL. In a multivariate analysis, a mural nodule size >5 mm and a CEA level in the pancreatic juice >30 ng/mL were independent factors associated with malignancy. The positive predictive value of a mural nodule size >5 mm and a CEA level in the pancreatic juice >30 ng/mL was 100%, and the negative predictive value was 96.3%.Conclusions: We identified 2 useful predictive factors for malignancy in branch duct type IPMN; a mural nodule size >5 mm and a CEA level in the pancreatic juice obtained by preoperative ERP >30 ng/mL.