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Interobserver Variability and Diagnostic Performance in Predicting Malignancy of Pancreatic Intraductal Papillary
Seo-Youn Choi1, Ji Hye Min1, Jung Hoon Kim1
1From the Departments of Radiology (S.Y.C.) and Biostatistics, Clinical Trial Center (J.E.M.), Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea (J.H.M., J.H.L.); Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (J.H.K.); Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea (H.J.P.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (Y.Y.K.); Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea (Y.E.H.); Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea (S.H.B.); and School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Republic of Korea (Y.H.C.).
Abstract:
Background The 2017 international consensus guidelines for intraductal papillary mucinous neoplasm (IPMN) of the pancreas are widely used. Purpose To evaluate the interobserver agreement and diagnostic performance of MRI assessment in predicting the malignant potential of IPMN according to radiologists' experience. Materials and Methods This multicenter retrospective study included 100 patients with pathologically proven pancreatic IPMN (77 patients with surgery, 23 patients with biopsy) who underwent contrast-enhanced MRI between 2016 and 2021. Eight post-fellowship radiologists (four more-experienced [8-20 years] and four less-experienced [1-4 years] reviewers) evaluated MRI for high-risk stigmata and worrisome features identified by the most recent 2017 guidelines. Interobserver agreement was determined using Fleiss κ statistics according to radiologist experience. The diagnostic performance for malignant IPMN was assessed using receiver operating characteristic curve analysis. Results Among 100 patients (mean age, 66 years ± 10 [SD]; 57 men), 52 (52%) had malignant IPMN. For high-risk stigmata, interobserver agreement was substantial for main pancreatic duct size of at least 10 mm (κ = 0.78; 95% CI: 0.75, 0.82), enhancing mural nodule of at least 5 mm (κ = 0.70: 95% CI: 0.66, 0.74), and at least one high-risk stigmata (κ = 0.73: 95% CI: 0.69, 0.76). The worrisome features showed fair to substantial interobserver agreement (κ range, 0.22-0.80). More-experienced reviewers demonstrated better agreement in the assessment of at least one high-risk stigmata than less-experienced reviewers (κ = 0.77 vs κ = 0.69, P < .001). The overall diagnostic performance of each reviewer was good for the prediction of malignant pancreatic IPMN (area under the receiver operating characteristic curve [AUC] range, 0.77-0.84; median AUC, 0.82), with substantial agreement (κ = 0.76). Conclusion The 2017 international consensus guidelines enabled good diagnostic performance and substantial interobserver agreement for high-risk stigmata but not worrisome features on the evaluation of the malignant pancreatic IPMN using MRI. Agreement tended to be better among more-experienced reviewers than among less-experienced reviewers. © RSNA, 2023 Supplemental material is available for this article.
Insights
The 2017 guidelines for pancreatic intraductal papillary mucinous neoplasm (IPMN) show good MRI diagnostic performance for high-risk stigmata. Experienced radiologists achieved better agreement, but worrisome features showed less consistent interpretation.
Area of Science:
- Gastroenterology and Hepatology
- Radiology and Imaging
- Oncology
Background:
- The 2017 international consensus guidelines are widely adopted for managing pancreatic intraductal papillary mucinous neoplasm (IPMN).
- Accurate assessment of IPMN malignancy potential is crucial for patient management and treatment decisions.
Purpose of the Study:
- To evaluate the interobserver agreement among radiologists with varying experience levels in assessing IPMN using MRI.
- To determine the diagnostic performance of MRI in predicting malignant IPMN based on the 2017 guidelines.
Main Methods:
- Retrospective multicenter study of 100 patients with pathologically proven pancreatic IPMN who underwent contrast-enhanced MRI.
- Eight post-fellowship radiologists (4 experienced, 4 less-experienced) assessed MRI for high-risk stigmata and worrisome features per 2017 guidelines.
- Interobserver agreement analyzed using Fleiss κ statistics; diagnostic performance assessed via ROC curve analysis.
Main Results:
- Substantial interobserver agreement was observed for high-risk stigmata (e.g., main pancreatic duct size ≥10 mm, enhancing mural nodule ≥5 mm).
- Fair to substantial agreement was noted for worrisome features, with more experienced radiologists showing better agreement for high-risk stigmata.
- Overall diagnostic performance for predicting malignant IPMN was good (AUC range, 0.77-0.84), with substantial agreement (κ=0.76).
Conclusions:
- The 2017 guidelines facilitate good diagnostic performance and substantial interobserver agreement for high-risk stigmata in malignant IPMN detection via MRI.
- Interobserver agreement for worrisome features was less consistent, highlighting a potential area for guideline refinement.
- Radiologist experience positively influences agreement in assessing high-risk stigmata for pancreatic IPMN.
