Gut Liver.  2018 Sep;12(5):583-590. 10.5009/gnl17582.

Predictors of Malignancy in “Pure” Branch-Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas without Enhancing Mural Nodules on CT Imaging: A Nationwide Multicenter Study

  • 1Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.
  • 2Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea.
  • 4Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea.
  • 5Pancreatobiliary Cancer Clinic, Center for Liver Cancer, National Cancer Center, Goyang, Korea.
  • 6Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Chonnam University College of Medicine, Gwangju, Korea.
  • 9Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
  • 10Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea.
  • 11Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
  • 12Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
  • 13Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 14Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
  • 15Digestive Disease Center, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
  • 16Department of Public Health, Wonkwang University Graduate School, Iksan, Korea.
  • 17Department of Internal Medicine, Hepatobiliary and Pancreas Center, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
  • 18Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.


Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in "pure" BD-IPMNs without enhanced mural nodules on CT.
This retrospective study included 180 patients with surgically confirmed "pure" BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy.
BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in "pure" BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant.
In patients with "pure" BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.


Branch duct-IPMN; Neoplasms; Multicenter study; Mural nodule

MeSH Terms

Multivariate Analysis
Pancreatic Ducts
Retrospective Studies
Risk Factors
Tertiary Care Centers
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