A Scoring System for Predicting Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Multicenter European Validation

Abstract

Purpose: A preoperative diagnosis of the risk of malignancy for Intraductal Papillary Mucinous Neoplasms (IPMN) is important to choose the treatment. One of the tools currently in use is the Shin score that comprises five variables: age ≥60 years, history of pancreatitis, serum CA 19-9>37 IU/mL, Main Pancreatic Duct diameter ≥6mm and presence of mural nodules. The present study carries out an external validation of Shin score in a European multicenter cohort. Method: European multicenter retrospective study. All patients undergoing surgery for IPMN at 35 hospitals in Europe between 2010-2015 with histological confirmation were included. Results: Data from 567 patients were registered. Serum Ca 19.9, the presence of mural nodules and the MPD diameter were associated with the presence of malignancy (p <0.00001, p = 0.00012, and p = 0.00596 respectively). The score was significantly associated with the presence of malignancy (p <0.00001). In all patients, 64.41% of benign IPMN had a Shin score <3 and 57.34% of those with a diagnosis of malignancy had a score ≥3. The RR with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.09% and specificity of 64.44%. Conclusion: In our series, only the serum Ca 19.9, the mural nodules and the MPD diameter were associated with malignancy. Our data suggest that patients with a Shin score≤1 should be undergo surveillance, while patients with a score≥4 should undergo surgery. Treatment of patients with Shin scores of 2/3 should be individualized.