Determining malignant potential of pancreatic intraductal papillary mucinous neoplasm with CT: interobserver variability and diagnostic performance

초록

Objectives To evaluate interobserver agreement and diagnostic performance of computed tomography (CT) in assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs) based on the 2024 International evidence-based Kyoto guidelines, focusing on the impact of reviewer experience. Methods In this multicenter retrospective study, CT images of 120 patients with pathologically confirmed IPMNs (53 malignant, 44.2%) were independently reviewed by eight observers (four experienced abdominal radiologists and four radiology residents). Malignant potential was graded using a five-point scale based on high-risk stigmata (HRS) and worrisome features (WF) defined by the 2024 Kyoto guidelines. Diagnostic performance (AUC) and interobserver agreement were compared between experience-based and guideline-based interpretations according to reviewer experience. Results Among 120 patients (mean age, 65.9 +/- 10.5 years; range, 41-87), 53 (44.2%) had malignant IPMNs. Interobserver agreement was substantial (alpha = 0.66) using the Kyoto guidelines and was higher among more experienced reviewers (alpha = 0.73 vs. 0.66; p < 0.001). Diagnostic performance was good (AUC, 0.75-0.89), with no statistically significant difference between more and less experienced reviewer groups (p = 0.26). For less experienced reviewers, guideline-based interpretation improved diagnostic performance (AUC 0.71-0.80 to 0.75-0.85; p < 0.001) and interobserver agreement (alpha = 0.43 to 0.66; p < 0.001) compared with experience-based assessment. In contrast, for more experienced reviewers, guideline-based interpretation did not result in a statistically significant change in diagnostic performance (AUC 0.88-0.92 to 0.82-0.89; p = 0.08), while interobserver agreement showed a modest decrease (alpha = 0.81 to 0.73; p < 0.001). Conclusion The 2024 Kyoto guidelines demonstrated an experience-dependent effect, improving diagnostic performance and interobserver agreement among less experienced readers, with limited additional benefit for experienced radiologists.

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