Risk prediction model for high-grade dysplasia in resected pancreatic mucinous cystic neoplasms: a nomogram-based approach.

BACKGROUND

Mucinous cystic neoplasms (MCN) are precancerous pancreatic lesions. Their management is challenged by the lack of robust predictors of malignancy. This study aimed to identify preoperative predictors of high-grade dysplasia (HGD) or invasive carcinoma and to develop a predictive nomogram.

METHODS

This multicenter retrospective study included patients who underwent resection for MCN between 2008 and 2021 across 13 centers. Surgical decisions were based on European guideline criteria. Diagnosis required ovarian-type stroma. Preoperative CT/MRI were centrally reviewed by an expert radiologist blinded to pathology. Independent predictors of ≥HGD were identified using multivariable logistic regression.

RESULTS

Among 198 patients, 32 (16 %) had ≥ HGD, including 14 (7 %) with invasive carcinoma. Independent predictors were older age (median 52.5 vs 45 years, p = 0.01), symptomatic presentation (72% vs 47%, OR 2.88, p = 0.01), larger cyst size (85 vs 46.5 mm, p < 0.001), and mural nodules (56% vs 15 %, OR 7.25, p < 0.001). The nomogram achieved an accuracy of 0.89 and an AUC of 0.86; a 10% risk threshold provided 85 % sensitivity. An interactive web-based calculator is publicly available.

CONCLUSION

Age, symptoms, cyst size, and mural nodules independently predict malignancy in resected MCNs. A validated nomogram and online calculator may support individualized surgical versus surveillance strategies.