{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T02:21:20Z","timestamp":1783045280299,"version":"3.54.6"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T00:00:00Z","timestamp":1429228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T00:00:00Z","timestamp":1429228800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The 2012 consensus guideline on intraductal papillary mucinous neoplasm of the pancreas (IPMN) described a three\u2010stage criteria involving main pancreatic duct (MPD) size with definitions of malignancy relevant for treatment decisions. Re\u2010evaluation and simplification of this classification for clinicians are warranted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the Seoul National University Hospital of 375 consecutive patients with pathology\u2010confirmed IPMN after surgery were analyzed. The association between clinicopathologic characteristics of IPMN and MPD size was assessed. The cut\u2010off value of MPD size for a current definition of malignancy prediction was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Diagnostic accuracy for malignancy was highest when the cut\u2010off value of MPD size was 7\u00a0mm (area under the curve = 0.7126). Dichotomizing IPMN into MPD \u22647\u00a0mm versus MPD &gt;7\u00a0mm, patient age (<jats:italic>p<\/jats:italic> = 0.039), sex (<jats:italic>p<\/jats:italic> = 0.001), presence of mural nodule (<jats:italic>p<\/jats:italic> &lt; 0.001), and invasiveness risk (13.2 vs. 39.8 %, <jats:italic>p<\/jats:italic> &lt; 0.001) resulted in significantly different results. Mural nodule\u2010negative patients with MPD &gt;7\u00a0mm had a significantly lower 5\u2010year survival rate than those with MPD \u22647\u00a0mm (78.4 vs. 91.4 %, <jats:italic>p<\/jats:italic> = 0.006). Among patients with MPD size \u22647\u00a0mm, elevated serum CA 19\u20109 and mural nodule were independent risk factors of malignancy. Patients with MPD size \u22647\u00a0mm without these risk factors had malignancy risk of 2.6 %.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using the definition of malignancy provided in the 2012 guideline, the MPD size &gt;7\u00a0mm criterion was statistically driven. The current morphologic classification of IPMN can be simplified as branch\u2010duct\u2010predominant IPMN (MPD \u22647\u00a0mm)\u2019 and main\u2010duct\u2010predominant IPMN (MPD &gt;7\u00a0mm). Patients who are determined to have main\u2010duct\u2010predominant IPMN and branch\u2010duct\u2010predominant IPMN with elevated serum CA 19\u20109 or mural nodule are recommended to undergo surgical treatment.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-015-3062-0","type":"journal-article","created":{"date-parts":[[2015,4,16]],"date-time":"2015-04-16T17:02:11Z","timestamp":1429203731000},"page":"2006-2013","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Clinicopathological Meaning of Size of Main\u2010Duct Dilatation in Intraductal Papillary Mucinous Neoplasm of Pancreas: Proposal of a Simplified Morphological Classification Based on the Investigation on the Size of Main Pancreatic Duct"],"prefix":"10.1002","volume":"39","author":[{"given":"Mee Joo","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer Research Institute Seoul National University College of Medicine 101 Daehak\u2010ro, Chongno\u2010gu 110\u2010744 Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin\u2010Young","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute Seoul National University College of Medicine 101 Daehak\u2010ro, Chongno\u2010gu 110\u2010744 Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selyeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Statistics Seoul National University College of Natural Sciences Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taesung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Statistics Seoul National University College of Natural Sciences Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Yeoun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics Sejong University College of Natural Sciences Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun\u2010Whe","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer Research Institute Seoul National University College of Medicine 101 Daehak\u2010ro, Chongno\u2010gu 110\u2010744 Seoul South 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