Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis.

The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01-1.79), size ≥ 3 cm (OR 1.90, CI 1.51-2.40), cystic wall thickening (OR 2.53, CI 1.50-4.27), mural nodule (OR 4.10, CI 3.38-4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11-4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49-22.06), lymphadenopathy (OR 8.55, CI 3.25-22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55-6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60-2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid.