Validation and head-to-head comparison of four models for predicting malignancy of intraductal papillary mucinous neoplasm of the pancreas: A study based on endoscopic ultrasound findings

Table 1 Patient characteristics

Variable	Total (n = 181)	Benign (n = 94)	Malignant (n = 87)	P valuea
Age, yr	61 (29-79)	61 (41-79)	60 (29-77)	0.672
Sex (%)				0.136
Male	108 (59.7)	61 (64.9)	47 (54.0)
Female	73 (40.3)	33 (35.1)	40 (46.0)
Symptoms (%)				0.008
Yes	111 (61.3)	49 (52.1)	62 (71.3)
No	70 (38.7)	45 (47.9)	25 (28.7)
Weight loss (%)				0.322
Yes	42 (23.2)	19 (20.2)	23 (26.4)
No	139 (76.8)	75 (79.8)	64 (73.6)
Jaundice (%)				< 0.001
Yes	17 (9.4)	2 (2.1)	15 (17.2)
No	164 (90.6)	92 (97.9)	72 (82.8)
Location (%)				0.185
Head	105 (58.0)	58 (61.7)	47 (54.0)
Body and tail	71 (39.2)	32 (34.0)	39 (44.8)
Diffuse/multifocal	5 (2.8)	4 (4.3)	1 (1.2)
Type of lesion (%)				< 0.001
MD	96 (53.0)	24 (25.6)	72 (82.8)
BD	68 (37.6)	60 (63.8)	8 (9.2)
Mixed	17 (9.4)	10 (10.6)	7 (8.0)
Type of surgery (%)				0.316
PD/PPPD	102 (56.4)	58 (61.7)	44 (50.6)
DP	66 (36.4)	30 (31.9)	36 (41.4)
TP	12 (6.6)	5 (5.3)	7 (8.0)
Enucleation	1 (0.6)	1 (1.1)	0 (0.0)
Mural nodule/solid component (%)				< 0.001
Yes	98 (54.1)	36 (38.3)	62 (71.3)
No	83 (45.9)	58 (61.7)	25 (28.7)
Size, mm	10 (2-60)	9 (3-21)	13 (3-60)	< 0.001
MPD diameter, mm	5 (1-29)	3 (1-20)	7 (2-29)	< 0.001
Cyst size of BD-IPMN, mm	25 (8-90)	24 (10-90)	25 (8-46)	0.702
Serum CA19-9, U/mL	25.3 (0.6-2125.0)	13.6 (0.6-313.0)	77.9 (0.6-2125.0)	< 0.001
Serum CEA, ng/mL	2.8 (0.5-79.2)	2.6 (0.5-15.0)	3.4 (0.8-79.2)	0.015
Serum amylase, U/L	65 (7.3-804.0)	72 (7.3-804.0)	60.0 (21.0-367.0)	0.278

Categorical variables are presented as n (%), and continuous variables as median (range).

^aP value from the χ² test for categorical variables and Mann-Whitney U test for continuous variables. BD: Branch duct; CA: Carbohydrate antigen; CEA: Carcinoembryonic antigen; DP: Distal pancreatectomy; IPMN: Intraductal papillary mucinous neoplasms; MD: Main duct; MPD: Main pancreatic duct; PD: Pancreaticoduodenectomy; PPPD: Pylorus-preserving pancreatoduodenectomy; TP: Total pancreatectomy.

Table 2 Comparison of the four models and the International Consensus Guidelines 2017

	Sensitivity	Specificity	PPV	NPV	Accuracy
PSC model	0.839	0.766	0.768	0.837	0.801
JPS model	0.655	0.702	0.671	0.688	0.680
JHH model	0.828	0.617	0.667	0.795	0.718
JPN-KOR model	0.375	0.817	0.214	0.907	0.765
ICG 2017	0.908	0.447	0.603	0.840	0.669
Our nomogram	0.839	0.840	0.830	0.849	0.840

ICG: International Consensus Guidelines; JHH: Johns Hopkins Hospital; JPN-KOR: Japan-Korea; JPS: Japan Pancreas Society; NPV: Negative predictive value; PPV: Positive predictive value; PSC: Pancreatic Surgery Consortium.