Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Radiologic and Endoscopic Imaging Analysis
2.3. Laboratory Values Analysis
2.4. Pathological Classification
2.5. Surgical Complication Analysis
2.6. Predicted Malignancy Probability from the Nomogram
2.7. Predicted Serious Complications from the ACS NSQIP Surgical Risk Calculator
2.8. Risk–Benefit Analysis for Surgical Decisions
2.8.1. Using the Complication Rate of the Study Cohort as a Statistical Risk
2.8.2. Using PSC-ACS NSQIP as Predicted Risk
2.9. Statistical Analysis
3. Results
3.1. Study Population
3.2. Validation of the Nomogram and ACS NSQIP Surgical Risk Calculator
3.3. Risk–Benefit Analysis for Surgical Decision Making
3.3.1. Using the Complication Rate of the Study Cohort as the Statistical Risk
3.3.2. Using SC-ACS NSQIP as the Predicted Risk
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Cutoff (%) | FP | FN | FP × Complication Rate (%) | |||
---|---|---|---|---|---|---|
≥Grade II (43.3) | ≥Grade IIIa (18.1) | ≥Grade IIIb (6.7) | ≥Grade IV (2.4) | |||
10 | 319 | 2 | 138.127 | 57.739 | 21.373 | 7.656 |
13 | 288 | 6 | 124.704 | 52.128 | 19.296 | 6.912 |
14 | 274 | 8 | 118.642 | 49.594 | 18.358 | 6.576 |
15 | 266 | 8 | 115.178 | 48.146 | 17.822 | 6.384 |
20 | 208 | 13 | 90.064 | 37.648 | 13.936 | 4.992 |
21 | 203 | 14 | 87.899 | 36.743 | 13.601 | 4.872 |
22 | 196 | 15 | 84.868 | 35.476 | 13.132 | 4.704 |
30 | 148 | 22 | 64.084 | 26.788 | 9.916 | 3.552 |
32 | 131 | 23 | 56.723 | 23.711 | 8.777 | 3.144 |
33 | 125 | 26 | 54.125 | 22.625 | 8.375 | 3 |
34 | 117 | 29 | 50.661 | 21.177 | 7.839 | 2.736 |
40 | 89 | 35 | 38.537 | 16.109 | 5.963 | 2.136 |
41 | 86 | 37 | 37.238 | 15.566 | 5.762 | 2.064 |
42 | 82 | 38 | 35.506 | 14.842 | 5.494 | 1.968 |
Cutoff (%) | FP | FN | FP × Complication Rate (%) | |||
---|---|---|---|---|---|---|
≥Grade II (30.4) | ≥Grade IIIa (8.5) | ≥Grade IIIb (3.4) | ≥Grade IV (2.0) | |||
10 | 188 | 0 | 57.152 | 15.98 | 6.392 | 3.76 |
13 | 149 | 2 | 45.296 | 12.665 | 5.066 | 2.98 |
14 | 138 | 3 | 41.952 | 11.73 | 4.692 | 2.76 |
15 | 127 | 4 | 38.608 | 10.795 | 4.318 | 2.54 |
16 | 118 | 4 | 35.872 | 10.03 | 4.012 | 2.36 |
17 | 107 | 4 | 32.528 | 9.095 | 3.638 | 2.14 |
18 | 103 | 5 | 31.312 | 8.755 | 3.502 | 2.06 |
20 | 86 | 6 | 26.144 | 7.31 | 2.924 | 1.72 |
21 | 82 | 7 | 24.928 | 6.97 | 2.788 | 1.64 |
22 | 78 | 8 | 23.712 | 6.63 | 2.652 | 1.56 |
25 | 59 | 11 | 17.936 | 5.015 | 2.006 | 1.18 |
26 | 56 | 13 | 17.024 | 4.76 | 1.904 | 1.12 |
27 | 54 | 16 | 16.416 | 4.59 | 1.836 | 1.08 |
30 | 46 | 20 | 13.984 | 3.91 | 1.564 | 0.92 |
Complication Rate | Cutoff Value | Number under Cutoff (%) | Sensitivity | Specificity | PPV | NPV | AUC |
---|---|---|---|---|---|---|---|
≥grade IV | 13% | 66 (14.2) | 0.9483 | 0.1724 | 0.2764 | 0.9091 | 0.5158 |
≥grade IIIb | 21% | 159 (34.3) | 0.8793 | 0.4167 | 0.3344 | 0.9119 | 0.6480 |
≥grade IIIa | 32% | 240 (51.7) | 0.8017 | 0.6236 | 0.4152 | 0.9042 | 0.7126 |
≥grade II | 41% | 299 (64.4) | 0.6810 | 0.7529 | 0.4788 | 0.8762 | 0.4986 |
Complication Rate | Cutoff Value | Number under Cutoff (%) | Sensitivity | Specificity | PPV | NPV | AUC |
---|---|---|---|---|---|---|---|
≥grade IV | 14% | 104 (35.5) | 0.9444 | 0.4226 | 0.2698 | 0.9712 | 0.6835 |
≥grade IIIb | 16% | 125 (42.7) | 0.9259 | 0.5523 | 0.2976 | 0.9680 | 0.7161 |
≥grade IIIa | 21% | 164 (56.0) | 0.8704 | 0.6527 | 0.3615 | 0.9571 | 0.7615 |
≥grade II | 27% | 201 (68.6) | 0.7037 | 0.7741 | 0.4130 | 0.9204 | 0.5346 |
Cutoff | Number above the Cutoff (%) | Sensitivity | Specificity | PPV | NPV | AUC |
---|---|---|---|---|---|---|
SC-ACS NSQIP | 546 (68.3) | 0.9255 | 0.3922 | 0.3187 | 0.9449 | 0.6588 |
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Lee, S.J.; Park, S.Y.; Hwang, D.W.; Lee, J.H.; Song, K.B.; Lee, W.; Kwon, J.; Park, Y.; Kim, S.C. Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm. J. Clin. Med. 2020, 9, 2758. https://doi.org/10.3390/jcm9092758
Lee SJ, Park SY, Hwang DW, Lee JH, Song KB, Lee W, Kwon J, Park Y, Kim SC. Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm. Journal of Clinical Medicine. 2020; 9(9):2758. https://doi.org/10.3390/jcm9092758
Chicago/Turabian StyleLee, Seung Jae, Seo Young Park, Dae Wook Hwang, Jae Hoon Lee, Ki Byung Song, Woohyung Lee, Jaewoo Kwon, Yejong Park, and Song Cheol Kim. 2020. "Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm" Journal of Clinical Medicine 9, no. 9: 2758. https://doi.org/10.3390/jcm9092758