*Department of Surgery, Seoul National University College of Medicine, Seoul, Korea†Department of Statistics, Seoul National University College of Natural Sciences, Seoul, Korea‡Department of Mathematics and Statistics, Sejong University College of Natural Sciences, Seoul, Korea§Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea¶Department of Surgery, Tokyo Women's Medical University, Institute of Gastroenterology, Tokyo, Japan||Department of Surgery, International University of Health and Welfare Mita Hospital, Surgery, Tokyo Women's Medical University, Institute of Gastroenterology, Tokyo, Japan**Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan††Department of Surgery, Kansai Medical University, Moriguchi, Osaka, Japan‡‡Department of Surgery, Nagoya University, Nagoya, Japan§§Department of Surgery, Hokkaido University, Hokkaido, Japan¶¶Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan||||Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan***Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea†††Department of Surgery, Tohoku University, Tohoku, Japan‡‡‡Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan§§§Pancreaticobiliary Cancer Clinic, Yonsei University College of Medicine, Yonsei Cancer Center, Severance Hospital, Surgery, Seoul, Korea¶¶¶Department of Surgery, Seoul National University Bundang Hospital, Surgery, Seoul National University College of Medicine, Seoul, Korea||||||Department of Surgery, Seoul National University College of Medicine, Surgery, Seoul National University Bundang Hospital, Seoul, Korea****Department of Surgery, Nara Medical University, Nara, Japan††††Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan‡‡‡‡Department of Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan§§§§Department of Surgery, Kyungpook National University, Daegu, Korea¶¶¶¶Department of Surgery, Chonbuk National University, Jeonju, Korea||||||||Department of Surgery, Soonchunhyang University, Asan, Korea*****Department of Surgery, Tokyo Medical University, Tokyo, Japan†††††Department of Surgery, Pusan National University, Pusan, Korea.
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Objectives:This study evaluated individual risks of malignancy and proposed a nomogram for predicting malignancy of branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) using the large database for IPMN.Background:Although consensus guidelines list several malignancy predicting factors in patients with BD-IPMN, those variables have different predictability and individual quantitative prediction of malignancy risk is limited.Methods:Clinicopathological factors predictive of malignancy were retrospectively analyzed in 2525 patients with biopsy proven BD-IPMN at 22 tertiary hospitals in Korea and Japan. The patients with main duct dilatation >10 mm and inaccurate information were excluded.Results:The study cohort consisted of 2258 patients. Malignant IPMNs were defined as those with high grade dysplasia and associated invasive carcinoma. Of 2258 patients, 986 (43.7%) had low, 443 (19.6%) had intermediate, 398 (17.6%) had high grade dysplasia, and 431 (19.1%) had invasive carcinoma. To construct and validate the nomogram, patients were randomly allocated into training and validation sets, with fixed ratios of benign and malignant lesions. Multiple logistic regression analysis resulted in five variables (cyst size, duct dilatation, mural nodule, serum CA19-9, and CEA) being selected to construct the nomogram. In the validation set, this nomogram showed excellent discrimination power through a 1000 times bootstrapped calibration test.Conclusion:A nomogram predicting malignancy in patients with BD-IPMN was constructed using a logistic regression model. This nomogram may be useful in identifying patients at risk of malignancy and for selecting optimal treatment methods. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.