When multivariate analysis among seven clinical parameters, including age, sex, branch duct size, nodule size, diameter of main pancreatic duct, serum CEA and CA19-9 levels, in addition to MSX2 expression, was done, MSX2 expression was identified as the only independent factor that predicted malignant BD-IPMN (Table 4). This evidence concerns the gene MSX2 and pancreatic intraductal papillary-mucinous neoplasm.