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JOURNAL ARTICLE

The usefulness of septal thickness measurement on endoscopic ultrasound as a predictor of malignancy of branched duct and mixed type intraductal papillary mucinous neoplasm of the pancreas

Hiromichi Iwaya, Susumu Hijioka, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Masahiro Tajika, Tsutomu Tanaka, Makoto Ishihara, Yutaka Hirayama, Sachiyo Onishi, Ayako Ito, Naosuke Kuraoka, Shinpei Matsumoto, Petcharee Polmanee, Yasuhiro Shimizu, Yasushi Yatabe, Yasumasa Niwa, Kiichi Tamada, Akio Ido, Kazuo Hara
Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society 2019 March 28
30920028

OBJECTIVES: Septal thickness (ST) can predict a malignant branch duct (BD) and mixed type intraductal papillary mucinous neoplasm (IPMN) of the pancreas, but its cut-off value has not been established. The aim was to determine the optimal ST cut-off value to predict malignancy using endoscopic ultrasound (EUS).

METHODS: We retrospectively identified 200 patients with IPMN, including 132 with BD- and mixed-IPMN, who underwent surgical resection between 1989 and 2017. ST was defined as the septum or lesion wall with the maximum diameter in BD- and mixed-IPMN. The possibility of ST as a malignant predictor was examined, and the diagnostic ability of ST combined with mural nodule (MN) height for malignant IPMN.

RESULTS: Among the 132 IPMN patients, the pathologic diagnosis was benign in 81 (61.4%) and malignant in 51 (38.6%). The area under the curve (AUC) for the diagnosis of malignancy using ST was 0.74 for pathological specimens, 0.70 for EUS and 0.56 for computed tomography (CT). Multivariate analysis showed that the odds ratios (ORs) for ST ≥2.5 mm and MN height ≥5 mm were 3.51 [95% confidence interval (CI), 1.55-7.97, p = 0.003] and 3.36 (95% CI, 1.52-7.45, p = 0.003), respectively.

CONCLUSIONS: ST was an independent predictive factor similar to MN height for malignant IPMN on a multivariate analysis. The ST on EUS appeared to be the thickness of a fibrotic septum associated with the malignant transformation of IPMN. An ST cut-off 2.5 mm might provide an accurate prediction of malignant IPMN. This article is protected by copyright. All rights reserved.

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