1. Asymptotic 95% Confidence Interval
Validation of the Fukuokas International Consensus for Intraductal Papillary Mucinous Tumor of the Pancreas Pacheco, Débora1; Ardengh, José C.1; Taglieri, Eloy1; Micelli-Neto, Otávio 1; Kemp, Rafael2; dos Santos, Jose Sebastiao S.2 1. Hospital July 9 and Hospital Ipiranga, Sao Paulo, Brazil. 2. Endoscopy Section of Surgery , Endoscopy Section of Surgery and Anatomy of the Hospital das Clínicas of the Faculty of Medicine, Ribeirão Preto, Brazi, Brazil.
Background and aims
The anatomic classification of intraductal papillary mucinous tumor (IPMT) is difficult to understand. Despite the involvement of the main pancreatic duct (MPD) having a greater chance of malignancy, the branch duct remains a major challenge in relation to diagnosis and the decision of the treatment to be performed. There are several factors to predict the presence of malignancy, but they are still intense debate about, there are many questions regarding; which is the best malignancy predictor? The aim of this study was to evaluate the effectiveness and accuracy of the latest international consensus to predict malignancy of IPMT.
Methods
Data from 203 patients with pancreatic mucinous neoplasm identified by imaging and referred to the endoscopy department were prospectively collected to undergo endosonography-guided fine needle aspiration (EUS-FNA), between January 2008 and April We evaluated and compared the malignancy predictors factors described by the Fukuoka´s International Consensus described in 2012. 1
CASUISTIC
The median age was 65 years (57-73), female (64%). Tumor localization: head (44.3%), body
(29%), tail (6.4%) and diffuse (19%).
Area Under the Curve
Test Result Variable(s)
Area
Asymptotic Sig.
Asymptotic 95% Confidence Interval
Lower Bound
Upper Bound
Fna Cea Intracystic
0,53
0,527
0,43
0,64
Fna Ca19-9
0,54
0,483
Fna Amilase
0,557
Results
According to the EUS images, results of laboratory tests and microhistology obtained by EUS-FNA, it was observed that the larger cysts > 2.5 cm have a higher chance of malignancy (50% versus 19%; p <0.001), with sensitivity and a specificity of 70% and 69.2%, respectively. The solid component was present in 30% of malignant tumors compared to 11.9% of benign (p = 0.006). The presence of solid component cysts larger than 2.5 cm has preditive positive value (PPV) 68% (p = 0.001) while his absence of cysts of any size has a PPV of 88% (p = 0.006). The MPD was normal in patients with no invasion (86% vs 60%, p <0.0001). The BD-IPMT had more results benignity (88.1%) while the MD-IPMN had the highest frequency among malignant lesions (41.2%) [p <0001]. The presence of one major criteria is associated with the presence of tumor by 55% (p<0.001).
AUC= 0.73 (0.64 – 0.82)
Conclusion
The frequency of malignancy found in patients with MPD diameter between 5-9mm and also in cysts 2.5cm in diameter suggests that there is space for discussion of reducing the cutoff for the diameter lesions were classified as at high risk for malignancy. Furthermore, the presence of vegetation within cysts larger than 2.5 cm has a high PPV for the presence of malignancy, validating the proposed consensus.