An Evaluating Model For Pancreatic Cystic Neoplasm Based On Imaging And Its Clinical Applications

Purpose:To explore a simple and reliable non-invasive distinguishing system for the pre-operative evaluation of malignancy in pancreatic cystic neoplasm (PCN)-Discovering factors predicting malignancy through medical imaging and clinical informatics study, building a distinguishing model for malignancy to assist diagnosis and therapy for the clinical practice.Methods:This study first enrolled an observation cohort of102consecutive PCN patients. Demographic information, results of laboratory examinations, and computed tomography (CT) presentations were recorded and analyzed to achieve a distinguishing model/system for malignancy. A group of21patients was then included to validate the model/system prospectively.Results:Based on the11malignancy-related features identified by univariate analysis, a distinguishing model for malignancy in PCN was established by multivariate analysis: PCN malignant score=2.967x elevated fasting blood glucose (FBG)(≥6.16mmol/L)±4.496x asymmetrically thickened wall (or mural nodules>4mm)±1.679×septum thickening (>2mm)-5.134. With the optimal cut-off value selected as-2.8in reference to the Youden index, the proposed system for malignant PCN was established: septum thickening (>2mm), asymmetrically thickened wall (or mural nodules>4mm), or elevated FBG (>6.16mmol/L, accompanying commonly known malignant signs), the presence of at least one of these3features indicated malignancy in PCN. The accuracy, sensitivity and specificity of this system were81.4%,95.8%and76.9%, respectively. MRI was performed on32patients, making correct prediction of malignancy explicitly in only68.8%(22/32). The subsequent prospective validation study showed that the proposed distinguishing system had a predictive accuracy of85.7%(18/21). Moreover, a higher model score, or aggregation of the features in the proposed system, indicated a higher grade of malignancy (carcinoma) in PCN.Conclusion:Elevated FBG (>6.16mmol/L), asymmetrically thickened wall (or mural nodules>4mm) and septum thickening (>2mm) are of great value in differentiating the malignancy in PCN. The developed distinguishing system is reliable in the diagnosis of malignant PCN.