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Gardner TB, Park WG, Allen PJ. Diagnosis and Management of Pancreatic Cysts. Gastroenterology 2024; 167:454-468. [PMID: 38442782 DOI: 10.1053/j.gastro.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/01/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024]
Abstract
As pancreatic cyst incidence rises, likely due to the ubiquitous increase in cross-sectional imaging, their management presents multiple challenges for both the practitioner and patient. It is critical that all pancreatic cysts are appropriately characterized, as treatment decisions depend on an accurate diagnosis. Diagnostic modalities such as cytology, biopsy, and cyst fluid biomarkers allow for definitive diagnosis of virtually all lesions. Some cysts, such as intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, and cystic pancreatic endocrine neoplasms, have malignant potential and must be surveyed. Other cysts, such as serous cystadenomas and pancreatic fluid collections, do not have malignant potential. Surveillance strategies vary widely depending on cyst type and size and while multiple medical societies advocate surveillance, their published surveillance guidelines are heterogenous. Cysts with high-risk stigmata or worrisome features are usually resected, depending on the patient's surgical fitness. In patients unfit for resection, newer endoscopic ablative techniques are advocated. Controversial aspects regarding cyst management include whether surveillance can be stopped, how surveillance should be performed, and the extensive financial burden cyst management places on the health care system. Further study into the natural history of cystic lesions, including definitive determination of the rate of malignant transformation for each cyst type, is essential.
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Affiliation(s)
- Timothy B Gardner
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Walter G Park
- Section of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Peter J Allen
- Division of Surgical Oncology, Duke University Medical Center, Durham, North Carolina
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Vilas-Boas F, Ribeiro T, Macedo G, Dhar J, Samanta J, Sina S, Manfrin E, Facciorusso A, Conti Bellocchi MC, De Pretis N, Frulloni L, Crinò SF. Endoscopic Ultrasound-Guided Through-the-Needle Biopsy: A Narrative Review of the Technique and Its Emerging Role in Pancreatic Cyst Diagnosis. Diagnostics (Basel) 2024; 14:1587. [PMID: 39125463 PMCID: PMC11311500 DOI: 10.3390/diagnostics14151587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Pancreatic cystic lesions (PCLs) pose a diagnostic challenge due to their increasing incidence and the limitations of cross-sectional imaging and endoscopic-ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-guided through the needle biopsy (EUS-TTNB) has emerged as a promising tool for improving the accuracy of cyst type determination and neoplastic risk stratification. EUS-TTNB demonstrates superior diagnostic performance over EUS-FNA, providing critical preoperative information that can significantly influence patient management and reduce unnecessary surgeries. However, the procedure has risks, with an overall adverse event rate of approximately 9%. Preventive measures and further prospective studies are essential to optimize its safety and efficacy. This review highlights the potential of EUS-TTNB to enhance the diagnostic and management approaches for patients with PCLs. It examines the current state of EUS-TTNB, including available devices, indications, procedural techniques, specimen handling, diagnostic yield, clinical impact, and associated adverse events.
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Affiliation(s)
- Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina da Universidade do Porto, 4200-349 Porto, Portugal; (F.V.-B.); (T.R.); (G.M.)
| | - Tiago Ribeiro
- Gastroenterology Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina da Universidade do Porto, 4200-349 Porto, Portugal; (F.V.-B.); (T.R.); (G.M.)
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar e Universitário de São João, Faculdade de Medicina da Universidade do Porto, 4200-349 Porto, Portugal; (F.V.-B.); (T.R.); (G.M.)
| | - Jahnvi Dhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; (J.D.); (J.S.)
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; (J.D.); (J.S.)
| | - Sokol Sina
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy; (S.S.); (E.M.)
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy; (S.S.); (E.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
| | - Nicolò De Pretis
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, University Hospital of Verona, 37134 Verona, Italy; (M.C.C.B.); (N.D.P.); (L.F.)
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Lopes Vendrami C, Hammond NA, Escobar DJ, Zilber Z, Dwyer M, Moreno CC, Mittal PK, Miller FH. Imaging of pancreatic serous cystadenoma and common imitators. Abdom Radiol (NY) 2024:10.1007/s00261-024-04337-1. [PMID: 38825609 DOI: 10.1007/s00261-024-04337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 06/04/2024]
Abstract
Pancreatic cystic neoplasms are lesions comprised of cystic components that show different biological behaviors, epidemiology, clinical manifestations, imaging features, and malignant potential and management. Benign cystic neoplasms include serous cystic neoplasms (SCAs). Other pancreatic cystic lesions have malignant potential, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. SCAs can be divided into microcystic (classic appearance), honeycomb, oligocystic/macrocystic, and solid patterns based on imaging appearance. They are usually solitary but may be multiple in von Hippel-Lindau disease, which may depict disseminated involvement. The variable appearances of SCAs can mimic other types of pancreatic cystic lesions, and cross-sectional imaging plays an important role in their differential diagnosis. Endoscopic ultrasonography has helped in improving diagnostic accuracy of pancreatic cystic lesions by guiding tissue sampling (biopsy) or cyst fluid analysis. Immunohistochemistry and newer techniques such as radiomics have shown improved performance for preoperatively discriminating SCAs and their mimickers.
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Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Nancy A Hammond
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - David J Escobar
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Zachary Zilber
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Meaghan Dwyer
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, 30322, USA
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA, 30912, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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Tian XF, Yu LY, Yang DH, Zuo D, Cao JY, Wang Y, Yang ZY, Lou WH, Wang WP, Gong W, Dong Y. Contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) features for characterizing serous microcystic adenomas (SMAs): In comparison to pancreatic neuroendocrine tumors (pNETs). Heliyon 2024; 10:e25185. [PMID: 38327470 PMCID: PMC10847598 DOI: 10.1016/j.heliyon.2024.e25185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives Serous microcystic adenoma (SMA), a primary benign pancreatic tumor which can be clinically followed-up instead of undergoing surgery, are sometimes mis-distinguished as pancreatic neuroendocrine tumor (pNET) in regular preoperative imaging examinations. This study aimed to analyze preoperative contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) features of SMAs in comparison to pNETs. Material and methods In this retrospective study, patients with imaging-diagnosed pancreatic lesions were screened between October 2020 to October 2022 (ethical approval No. B2020-309R). Performing by a Siemens Sequoia (Siemens Medical Solutions, Mountain View, CA, USA) equipped with a 5C-1 curved array transducer (3.0-4.5 MHz), CEUS examination was conducted to observe the microvascular perfusion patterns of pancreatic lesions in arterial phase, venous/late phases (VLP) using SonoVue® (Bracco Imaging Spa, Milan, Italy) as the contrast agent. Virtual touch tissue imaging and quantification (VTIQ) - SWE was used to measure the shear wave velocity (SWV, m/s) value to represent the quantitative stiffness of pancreatic lesions. Multivariate logistic regression was performed to analyze potential ultrasound and clinical features in discriminating SMAs and pNETs. Results Finally, 30 SMA and 40 pNET patients were included. All pancreatic lesions were pathologically proven via biopsy or surgery. During the arterial phase of CEUS, most SMAs and pNETs showed iso- or hyperenhancement (29/30, 97 % and 31/40, 78 %), with a specific early honeycomb enhancement pattern appeared in 14/30 (47 %) SMA lesions. During the VLP, while most of the SMA lesions remained iso- or hyperenhancement (25/30, 83 %), nearly half of the pNET lesions revealed an attenuated hypoenhancement (17/40, 43 %). The proportion of hypoenhancement pattern during the VLP of CEUS differed significantly between SMAs and pNETs (P = 0.021). The measured SWV value of SMAs was significantly higher than pNETs (2.04 ± 0.70 m/s versus 1.42 ± 0.44 m/s, P = 0.002). Taking a SWV value > 1.83 m/s as a cutoff in differentiating SMAs and pNETs, the area under the receiver operating characteristic curve (AUROC) was 0.825, with sensitivity, specificity and likelihood ratio (+) of 85.71 %, 72.73 % and 3.143, respectively. Multivariate logistic regression revealed that SWV value (m/s) of the pancreatic lesion was an independent variable in discriminating SMA and pNET. Conclusion By comprehensively evaluating CEUS patterns and SWE features, SMA and pNET may be well differentiated before the operation. While SMA typically presents as harder lesion in VTIQ-SWE, exhibiting a specific honeycomb hyperenhancement pattern during the arterial phase of CEUS, pNET is characterized by relative softness, occasionally displaying a wash-out pattern during the VLP of CEUS.
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Affiliation(s)
- Xiao-Fan Tian
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China
| | - Ling-Yun Yu
- Department of Ultrasound, Xiamen Branch, Zhongshan Hospital, Fudan University, 361006, Xiamen, China
| | - Dao-Hui Yang
- Department of Ultrasound, Xiamen Branch, Zhongshan Hospital, Fudan University, 361006, Xiamen, China
| | - Dan Zuo
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Jia-Ying Cao
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China
| | - Ying Wang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China
| | - Zi-Yi Yang
- Department of Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wen-Hui Lou
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Wei Gong
- Department of Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China
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Yip-Schneider MT, Muraru R, Kim RC, Wu HH, Sherman S, Gutta A, Al-Haddad MA, Dewitt JM, Schmidt CM. EUS-guided fine needle aspiration-based clues to mistaken or uncertain identity: serous pancreatic cysts. HPB (Oxford) 2023; 25:1587-1594. [PMID: 37749004 PMCID: PMC10843000 DOI: 10.1016/j.hpb.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND/OBJECTIVES Pancreatic serous cystic neoplasms (SCN) present a diagnostic challenge given their increasing frequency of detection and benign nature yet relatively high rate of misdiagnosis. Here, imaging and analyses associated with EUS-guided fine-needle aspiration (EUS-FNA) are evaluated for their ability to provide a correct preoperative diagnosis of SCN. METHODS A surgical cohort with confirmed pathological diagnosis of SCN (n = 62) and a surveillance cohort with likely SCN (n = 31) were assessed for imaging (CT/MRI/EUS) and EUS-FNA-based analyses (cytology/DNA analysis for Von Hippel-Lindau [VHL] gene alterations/biomarkers). RESULTS In the surgical cohort, CT/MRI and EUS respectively predicted SCN in 4 of 58(7%) and 19 of 62(31%). Cyst fluid cytology and VHL alterations predicted SCN in 1 of 51(2%) and 5 of 21(24%), respectively. High specificity cyst fluid biomarkers (vascular endothelial growth factor [VEGF]/glucose/carcinoembryonic antigen [CEA]/amylase) correctly identified SCN in 25 of 27(93%). In the surveillance cohort, cyst fluid biomarkers predicted SCN in 12 of 12(100%) while VHL alterations identified SCN 3 of 10(30%). CONCLUSION High specificity cyst fluid biomarkers provided the most sensitive means of diagnosing SCN preoperatively. To obtain a preoperative diagnosis of SCN at the highest level of certainty, a multidisciplinary approach should be taken to inform appropriate SCN management.
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Affiliation(s)
- Michele T Yip-Schneider
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Walther Oncology Center, Indianapolis, IN, USA; Indiana University Simon Cancer Center, Indianapolis, IN, USA; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA.
| | - Rodica Muraru
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel C Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stuart Sherman
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aditya Gutta
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad A Al-Haddad
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John M Dewitt
- Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Walther Oncology Center, Indianapolis, IN, USA; Indiana University Simon Cancer Center, Indianapolis, IN, USA; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA.
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Gao J, Liu C, Zhou J, Lin X, Zhang Y. Increased Uptake in Microcystic Serous Cystadenoma Mimicking Pancreatic Neuroendocrine Tumor on 68 Ga-DOTATATE PET/MRI. Clin Nucl Med 2023; 48:987-988. [PMID: 37756486 DOI: 10.1097/rlu.0000000000004857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT A 2.6-cm solid cystic lesion in the pancreatic head was found in a 51-year-old woman on CT. A pancreatic neuroendocrine tumor was suspected, and a 68 Ga-DOTATATE PET/MRI was performed, which showed increased tracer uptake in the lesion. However, postsurgical pathologic examination indicated a pancreatic serous cystadenoma. Here, we reported a case of microcystic pancreatic serous cystadenoma that could be misdiagnosed as a pancreatic neuroendocrine tumor on a 68 Ga-DOTATATE PET/MRI.
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Affiliation(s)
- Jing Gao
- From the Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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Mørch-Jessen T, Chatterjee SA. A case report: Serous cystadenoma in the pancreas turned malignant. Radiol Case Rep 2023; 18:2850-2853. [PMID: 37388257 PMCID: PMC10300473 DOI: 10.1016/j.radcr.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Serous cystadenomas represent 16% of pancreatic serous neoplasms. It can be subdivided into 4 variants: polycystic, oligocystic, honeycomb and solid. Such tumors rarely turn malignant. Most are asymptomatic at the time of diagnosis, but symptomatic patients mainly suffer from abdominal pain and pancreaticobiliary symptoms. Due to the usually benign status, no follow-up or surgery is usually required. This case report concerns a histologically proven serous cystadenoma in an 84-year elderly woman. Due to benign status, no follow-up was required. Thirteen years later she was diagnosed with malignant transformation on computed tomography.
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9
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Yang KS, O'Shea A, Zelga P, Liss AS, Del Castillo CF, Weissleder R. Extracellular vesicle analysis of plasma allows differential diagnosis of atypical pancreatic serous cystadenoma. Sci Rep 2023; 13:10969. [PMID: 37414831 PMCID: PMC10325992 DOI: 10.1038/s41598-023-37966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023] Open
Abstract
Increased use of cross-sectional imaging has resulted in frequent detection of incidental cystic pancreatic lesions. Serous cystadenomas (SCAs) are benign cysts that do not require surgical intervention unless symptomatic. Unfortunately, up to half of SCAs do not have typical imaging findings ("atypical SCAs"), overlap with potentially malignant precursor lesions, and thus pose a diagnostic challenge. We tested whether the analysis of circulating extracellular vesicle (EV) biomarkers using a digital EV screening technology (DEST) could enhance the discrimination of cystic pancreatic lesions and avoid unnecessary surgical intervention in these atypical SCAs. Analysis of 25 different protein biomarkers in plasma EV from 68 patients identified a putative biomarker signature of Das-1, Vimentin, Chromogranin A, and CAIX with high discriminatory power (AUC of 0.99). Analysis of plasma EV for multiplexed markers may thus be helpful in clinical decision-making.
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Affiliation(s)
- Katherine S Yang
- Center for Systems Biology, Massachusetts General Hospital, 185 Cambridge St, CPZN 5206, Boston, MA, 02114, USA
- Department of Radiology, Massachusetts General Hospital, 32 Fruit St, Boston, MA, 02114, USA
| | - Aileen O'Shea
- Center for Systems Biology, Massachusetts General Hospital, 185 Cambridge St, CPZN 5206, Boston, MA, 02114, USA
- Department of Radiology, Massachusetts General Hospital, 32 Fruit St, Boston, MA, 02114, USA
| | - Piotr Zelga
- Department of Surgery, Massachusetts General Hospital, 32 Fruit St, Boston, MA, 02114, USA
| | - Andrew S Liss
- Department of Surgery, Massachusetts General Hospital, 32 Fruit St, Boston, MA, 02114, USA
| | | | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, 185 Cambridge St, CPZN 5206, Boston, MA, 02114, USA.
- Department of Radiology, Massachusetts General Hospital, 32 Fruit St, Boston, MA, 02114, USA.
- Department of Systems Biology, Harvard Medical School, 200 Longwood Ave, Boston, MA, 02115, USA.
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The Role of MRI in the Diagnosis of Solid Pseudopapillary Neoplasm of the Pancreas and Its Mimickers: A Case-Based Review with Emphasis on Differential Diagnosis. Diagnostics (Basel) 2023; 13:diagnostics13061074. [PMID: 36980388 PMCID: PMC10046973 DOI: 10.3390/diagnostics13061074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is rare pancreatic tumor occurring most commonly in young females. The typical imaging appearance of SPN is of well-defined, encapsulated, and large heterogeneous tumors, consisting of solid and cystic components due to various degrees of intralesional hemorrhage and necrosis. However, atypical imaging presentation in the form of small solid tumors or uniformly cystic lesions might also be seen, which can be explained by specific pathological characteristics. Other imaging features such as a round shape, the absence of main pancreatic duct dilatation, and slow growth, in combination with vague symptoms, favor the diagnosis of SPNs. Nevertheless, the radiological findings of SPN might overlap with other solid and cystic pancreatic neoplasms, such as neuroendocrine tumors, serous and mucinous neoplasms, and even small pancreatic adenocarcinomas. In addition, a few benign non-tumorous conditions including walled-of-necrosis, and intrapancreatic accessory spleen may also pose diagnostic dilemmas simulating SPNs on imaging studies. The aim of this manuscript is to provide a comprehensive overview of the typical and atypical imaging features of SPNs and to describe useful tips for differential diagnosis with its potential mimickers.
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11
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Chen L, Nie L, Tian B, Xiong J. Pancreatic solid serous cystadenoma in the pancreatic head with increasing tracer uptake at 68-GaDOTA-peptide positron emission tomography: A case report. Asian J Surg 2022; 46:2121-2122. [PMID: 36411164 DOI: 10.1016/j.asjsur.2022.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
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12
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Fang X, Jiang H, Cao K, Li J, Liu F, Wang L, Lu J, Shao C, Bian Y. Distinguishing pancreatic solid serous cystadenomas from nonfunctional pancreatic neuroendocrine tumors by computed tomography: A propensity score analysis. Medicine (Baltimore) 2022; 101:e30523. [PMID: 36123910 PMCID: PMC9478255 DOI: 10.1097/md.0000000000030523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the utility of calculated computed tomography (CT) attenuation value ratio (AVR) and enhancement pattern in distinguishing pancreatic solid serous cystadenomas (SCAs) from nonfunctional pancreatic neuroendocrine tumors (NF-pNETs). A total of 142 consecutive patients with 22 solid SCAs and 120 NF-pNETs confirmed by pathology were included in this retrospective study. All patients underwent preoperative contrast-enhanced CT and were categorized into 2 groups, solid SCA and NF-pNET groups. Patients with NF-pNETs were matched to patients with solid SCAs via propensity scores. AVR was measured and defined as: attenuation value of tumor/attenuation value of normal pancreas. AVR and enhancement pattern performance were assessed according to the discriminative abilities of patients. After matching, 29 patients were allocated to the NF-pNET group. Before matching, sex, age, and the peak enhanced value phase were significantly different between solid SCA and NF-pNET patients (P < .05). After matching, no significant difference was observed between both groups (P > .05). Solid SCAs AVRs were significantly smaller than NF-pNETs AVRs in all unenhanced, arterial, portal venous, and delayed phases (P < .05). Solid SCAs showed significantly more wash-in and wash-out enhancement patterns than NF-pNETs (P < .05). For unenhanced, arterial, portal venous, and delayed phases, and enhancement pattern, the area under the curve (AUC) values were 0.96, 0.72, 0.80, 0.85, and 0.86, respectively. Low AVR on unenhanced CT and wash-in and wash-out enhancement patterns were useful for differentiating solid SCAs from NF-pNETs and may be useful for clinical decisions, a clearer opinion will be formed with further studies to be conducted with larger patient numbers.
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Affiliation(s)
- Xu Fang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Hui Jiang
- Department of Pathology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Kai Cao
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Fang Liu
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Yun Bian
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
- *Correspondence: Yun Bian, Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Changhai Road 168, Shanghai 200434, China (e-mail: )
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13
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Hu F, Hu Y, Wang D, Ma X, Yue Y, Tang W, Liu W, Wu P, Peng W, Tong T. Cystic Neoplasms of the Pancreas: Differential Diagnosis and Radiology Correlation. Front Oncol 2022; 12:860740. [PMID: 35299739 PMCID: PMC8921498 DOI: 10.3389/fonc.2022.860740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/04/2022] [Indexed: 12/18/2022] Open
Abstract
Although the probability of pancreatic cystic neoplasms (PCNs) being detected is raising year by year, their differential diagnosis and individualized treatment are still a challenge in clinical work. PCNs are tumors containing cystic components with different biological behaviors, and their clinical manifestations, epidemiology, imaging features, and malignant risks are different. Some are benign [e.g., serous cystic neoplasms (SCNs)], with a barely possible that turning into malignant, while others display a low or higher malignant risk [e.g., solid pseudopapillary neoplasms (SPNs), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms (MCNs)]. PCN management should concentrate on preventing the progression of malignant tumors while preventing complications caused by unnecessary surgical intervention. Clinically, various advanced imaging equipment are usually combined to obtain a more reliable preoperative diagnosis. The challenge for clinicians and radiologists is how to accurately diagnose PCNs before surgery so that corresponding surgical methods and follow-up strategies can be developed or not, as appropriate. The objective of this review is to sum up the clinical features, imaging findings and management of the most common PCNs according to the classic literature and latest guidelines.
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Affiliation(s)
- Feixiang Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yue Hu
- Hefei Cancer Hospital, Chinese Academy of Sciences (CAS), Hefei, China
| | - Dan Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yali Yue
- Children's Hospital, Fudan University, Shanghai, China
| | - Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Liu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Puye Wu
- General Electric (GE) Healthcare, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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14
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Chen HY, Deng XY, Pan Y, Chen JY, Liu YY, Chen WJ, Yang H, Zheng Y, Yang YB, Liu C, Shao GL, Yu RS. Pancreatic Serous Cystic Neoplasms and Mucinous Cystic Neoplasms: Differential Diagnosis by Combining Imaging Features and Enhanced CT Texture Analysis. Front Oncol 2022; 11:745001. [PMID: 35004272 PMCID: PMC8733460 DOI: 10.3389/fonc.2021.745001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
Objective To establish a diagnostic model by combining imaging features with enhanced CT texture analysis to differentiate pancreatic serous cystadenomas (SCNs) from pancreatic mucinous cystadenomas (MCNs). Materials and Methods Fifty-seven and 43 patients with pathology-confirmed SCNs and MCNs, respectively, from one center were analyzed and divided into a training cohort (n = 72) and an internal validation cohort (n = 28). An external validation cohort (n = 28) from another center was allocated. Demographic and radiological information were collected. The least absolute shrinkage and selection operator (LASSO) and recursive feature elimination linear support vector machine (RFE_LinearSVC) were implemented to select significant features. Multivariable logistic regression algorithms were conducted for model construction. Receiver operating characteristic (ROC) curves for the models were evaluated, and their prediction efficiency was quantified by the area under the curve (AUC), 95% confidence interval (95% CI), sensitivity and specificity. Results Following multivariable logistic regression analysis, the AUC was 0.932 and 0.887, the sensitivity was 87.5% and 90%, and the specificity was 82.4% and 84.6% with the training and validation cohorts, respectively, for the model combining radiological features and CT texture features. For the model based on radiological features alone, the AUC was 0.84 and 0.91, the sensitivity was 75% and 66.7%, and the specificity was 82.4% and 77% with the training and validation cohorts, respectively. Conclusion This study showed that a logistic model combining radiological features and CT texture features is more effective in distinguishing SCNs from MCNs of the pancreas than a model based on radiological features alone.
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Affiliation(s)
- Hai-Yan Chen
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Xue-Ying Deng
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Yao Pan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie-Yu Chen
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Yun-Ying Liu
- Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Wu-Jie Chen
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Hong Yang
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Yao Zheng
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Yong-Bo Yang
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Cheng Liu
- Research Institute of Artificial Intelligence in Healthcare, Hangzhou YITU Healthcare Technology Co. Ltd., Hangzhou, China
| | - Guo-Liang Shao
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institue of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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A Bringeland E, Rønne E, Kjellmo Å, M Keil T. Pancreatic serous cystadenoma with a high 68Ga DOTATOC-uptake mimicking a pancreatic NET. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2022. [DOI: 10.5348/100097z04eb2022eb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Lee LS. Updates in diagnosis and management of pancreatic cysts. World J Gastroenterol 2021; 27:5700-5714. [PMID: 34629795 PMCID: PMC8473602 DOI: 10.3748/wjg.v27.i34.5700] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
Incidental pancreatic cysts are commonly encountered with some cysts having malignant potential. The most common pancreatic cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. Risk stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound (EUS) or surgical resection. Surgery should be reserved for patients with malignant cysts or cysts at high risk for developing malignancy as suggested by various risk features including solid mass, nodule and dilated main pancreatic duct. EUS may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on imaging. Various cyst fluid markers including carcinoembryonic antigen, glucose, amylase, cytology, and DNA markers help distinguish mucinous from nonmucinous cysts. This review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or surgery. For presumed low risk cysts, surveillance strategies will be discussed. Managing pancreatic cysts requires an individualized approach that is directed by the various guidelines.
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Affiliation(s)
- Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, United States
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17
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Abstract
Pancreatoblastoma (PB) is a rare epithelial malignancy usually occurring in the
paediatric population. Adult PB is rare, and its imaging findings are similar to those of
other tumours, making preoperative diagnosis a considerable challenge. We report
correlative ultrasound, contrast-enhanced ultrasonography, contrast-enhanced magnetic
resonance imaging, and positron emission tomography-computed tomography findings in a
60-year-old woman with PB. PB often presents with uncommon imaging features and should be
considered in the differential diagnosis of pancreatic masses. It is important for
clinicians to be aware of these differences to provide effective treatment.
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Affiliation(s)
- Jianchun Li
- Department of Medical Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
| | - Chengzhong Peng
- Department of Medical Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
| | - Xiaoming Fan
- Department of Medical Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
| | - Ligang Wang
- Department of Medical Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
| | - Jing Wang
- Department of Medical Ultrasound, Zhejiang Provincial People's Hospital, People's Hospital of HangZhou Medical College, Hangzhou, China
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18
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Cystic pancreatic lesions: MR imaging findings and management. Insights Imaging 2021; 12:115. [PMID: 34374885 PMCID: PMC8355307 DOI: 10.1186/s13244-021-01060-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/17/2021] [Indexed: 12/14/2022] Open
Abstract
Cystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.
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19
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Wong NACS, Beavers S, Gill P, Heryet A, Linares J. Calponin and MUC6 complement inhibin as diagnostic immunomarkers of serous cystadenoma in endoscopic ultrasound-guided aspiration/biopsy specimens. Histopathology 2021; 79:252-259. [PMID: 33657658 DOI: 10.1111/his.14362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
AIMS Because serous cystadenoma (SCA) does not usually require excision, it is critical to distinguish it from differential diagnoses which do, especially neuroendocrine tumour (NET). The gold standard for diagnosing SCA is assessment of endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNAB) material. Inhibin immunohistochemistry aids this assessment, but such positivity is not absolutely sensitive or specific to SCA. The following is the largest known study of SCA EUS-FNAB specimens and the first to compare four potential SCA immunomarkers between themselves and inhibin, compared against NET. METHODS AND RESULTS Immunohistochemistry for calponin, mucin 6 (MUC6), glucose transporter 1 (GLUT1) and vascular endothelial growth factor A (VEGFA) was performed on 30 EUS-FNAB and three resection specimens of SCA and 32 EUS-FNAB specimens of NET. GLUT1 and VEGFA were suboptimal as diagnostic immunomarkers of SCA, being expressed by 10 and 44% of NETs, respectively. Further, their expression by cellular constituents of blood which often contaminate EUS-FNAB specimens hampered identification of neoplastic cells, especially in hypocellular samples. While 19% of NETs showed nuclear MUC6 positivity, cytoplasmic expression of the protein showed 100% specificity and sensitivity as an SCA marker. However, assessing MUC6 in EUS-FNAB specimens must also consider the protein's focal expression in physiological pancreatic, gastric or duodenal tissues, which can contaminate these specimens. Calponin was less sensitive (71% versus 100%) but more specific (100% versus 91%) than inhibin, although easier to assess in EUS-FNAB specimens than MUC6. CONCLUSIONS Of the four potential immunomarkers of SCA suggested by the existing literature, calponin and MUC6 are useful complementary studies to inhibin for application to EUS-FNAB specimens.
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Affiliation(s)
| | - Sophie Beavers
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
| | - Pelvender Gill
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
| | - Andrew Heryet
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
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20
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Utility of CT to Differentiate Pancreatic Parenchymal Metastasis from Pancreatic Ductal Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13133103. [PMID: 34206263 PMCID: PMC8268077 DOI: 10.3390/cancers13133103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/29/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The purpose of this retrospective study was to report the computed tomography (CT) features of pancreatic parenchymal metastasis (PPM) and identify CT features that may help discriminate between PPM and PDAC. At multivariable analysis, well-defined margins (OR, 6.64; 95% CI: 1.47–29.93; p = 0.014), maximal enhancement during arterial phase (OR, 6.15; 95% CI: 1.13–33.51; p = 0.036), no vessel involvement (OR, 7.19; 95% CI: 1.51–34.14) and no Wirsung duct dilatation (OR, 10.63; 95% CI: 2.27–49.91) were independently associated with PPM. A nomogram based on CT features identified at multivariable analysis yielded an AUC of 0.92 (95% CI: 0.85–0.98) for the diagnosis of PPM vs. PDAC. Abstract Purpose: To report the computed tomography (CT) features of pancreatic parenchymal metastasis (PPM) and identify CT features that may help discriminate between PPM and pancreatic ductal adenocarcinoma (PDAC). Materials and methods: Thirty-four patients (24 men, 12 women; mean age, 63.3 ± 10.2 [SD] years) with CT and histopathologically proven PPM were analyzed by two independent readers and compared to 34 patients with PDAC. Diagnosis performances of each variable for the diagnosis of PPM against PDAC were calculated. Univariable and multivariable analyses were performed. A nomogram was developed to diagnose PPM against PDAC. Results: PPM mostly presented as single (34/34; 100%), enhancing (34/34; 100%), solid (27/34; 79%) pancreatic lesion without visible associated lymph nodes (24/34; 71%) and no Wirsung duct enlargement (29/34; 85%). At multivariable analysis, well-defined margins (OR, 6.64; 95% CI: 1.47–29.93; p = 0.014), maximal enhancement during arterial phase (OR, 6.15; 95% CI: 1.13–33.51; p = 0.036), no vessel involvement (OR, 7.19; 95% CI: 1.512–34.14) and no Wirsung duct dilatation (OR, 10.63; 95% CI: 2.27–49.91) were independently associated with PPM. The nomogram yielded an AUC of 0.92 (95% CI: 0.85–0.98) for the diagnosis of PPM vs. PDAC. Conclusion: CT findings may help discriminate between PPM and PDAC.
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21
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Xie T, Wang X, Zhang Z, Zhou Z. CT-Based Radiomics Analysis for Preoperative Diagnosis of Pancreatic Mucinous Cystic Neoplasm and Atypical Serous Cystadenomas. Front Oncol 2021; 11:621520. [PMID: 34178619 PMCID: PMC8231011 DOI: 10.3389/fonc.2021.621520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives To investigate the value of CT-based radiomics analysis in preoperatively discriminating pancreatic mucinous cystic neoplasms (MCN) and atypical serous cystadenomas (ASCN). Methods A total of 103 MCN and 113 ASCN patients who underwent surgery were retrospectively enrolled. A total of 764 radiomics features were extracted from preoperative CT images. The optimal features were selected by Mann-Whitney U test and minimum redundancy and maximum relevance method. The radiomics score (Rad-score) was then built using random forest algorithm. Radiological/clinical features were also assessed for each patient. Multivariable logistic regression was used to construct a radiological model. The performance of the Rad-score and the radiological model was evaluated using 10-fold cross-validation for area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Ten screened optimal features were identified and the Rad-score was then built based on them. The radiological model was built based on four radiological/clinical factors. In the 10-fold cross-validation, the Rad-score was proved to be robust and reliable (average AUC: 0.784, sensitivity: 0.847, specificity: 0.745, PPV: 0.767, NPV: 0.849, accuracy: 0.793). The radiological model performed slightly less well in classification (average AUC: average AUC: 0.734 sensitivity: 0.748, specificity: 0.705, PPV: 0.732, NPV: 0.798, accuracy: 0.728. Conclusions The CT-based radiomics analysis provided promising performance for preoperatively discriminating MCN from ASCN and showed good potential in improving diagnostic power, which may serve as a novel tool for guiding clinical decision-making for these patients.
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Affiliation(s)
- Tiansong Xie
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Xuanyi Wang
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Zehua Zhang
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Zhengrong Zhou
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Minhang Branch, Shanghai Cancer Center, Fudan University, Shanghai, China
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22
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Dmitriev K, Marino J, Baker K, Kaufman AE. Visual Analytics of a Computer-Aided Diagnosis System for Pancreatic Lesions. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2021; 27:2174-2185. [PMID: 31613771 DOI: 10.1109/tvcg.2019.2947037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Machine learning is a powerful and effective tool for medical image analysis to perform computer-aided diagnosis (CAD). Having great potential in improving the accuracy of a diagnosis, CAD systems are often analyzed in terms of the final accuracy, leading to a limited understanding of the internal decision process, impossibility to gain insights, and ultimately to skepticism from clinicians. We present a visual analytics approach to uncover the decision-making process of a CAD system for classifying pancreatic cystic lesions. This CAD algorithm consists of two distinct components: random forest (RF), which classifies a set of predefined features, including demographic features, and a convolutional neural network (CNN), which analyzes radiological (imaging) features of the lesions. We study the class probabilities generated by the RF and the semantical meaning of the features learned by the CNN. We also use an eye tracker to better understand which radiological features are particularly useful for a radiologist to make a diagnosis and to quantitatively compare with the features that lead the CNN to its final classification decision. Additionally, we evaluate the effects and benefits of supplying the CAD system with a case-based visual aid in a second-reader setting.
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23
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AMICO EC, SALGADO CTS, EMERENCIANO LM, FERREIRA FILHO GAS, ALVES JR, SOUZA LEOFFD, SILVA JSPD. CISTOADENOMA SEROSO DE PÂNCREAS. POR QUE A ACURÁCIA É BAIXA AOS EXAMES DE IMAGEM? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1640. [PMID: 35107502 PMCID: PMC8846411 DOI: 10.1590/0102-672020210002e1640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022]
Abstract
Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due
to diagnostic doubt.
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24
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Nappo G, Funel N, Giudici S, Spaggiari P, Capretti G, Carrara S, Pepe G, Zerbi A. Pancreatic serous cystoadenoma (CSA) showing increased tracer uptake at 68-GaDOTA-peptide Positron Emission Tomography (68Ga-DOTA-peptide PET-CT): a case report. BMC Surg 2020; 20:331. [PMID: 33317505 PMCID: PMC7737276 DOI: 10.1186/s12893-020-01004-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Serous cysto-adenoma (SCA) is a rare benign neoplasm of the pancreas. SCA can mimic other pancreatic lesions, such as neuroendocrine tumours. 68Gallium-DOTA-peptide Positron Emission Tomography (PET) is able to image in vivo the over-expression of the somatostatin receptors, playing an important role for the identification of neuroendocrine neoplasms. CASE PRESENTATION We reported a case of 63-year-old man, with a solid lesion of 7 cm of diameter of the body-tail of the pancreas. Two fine-needle-aspirations (FNA) were inconclusive. A 68Ga-DOTA-peptide PET-CT revealed a pathological uptake of the pancreatic lesion. The diagnosis of a pancreatic neuroendocrine neoplasm was established and a laparoscopic distal splenopancreatectomy and cholecystectomy was performed. Final histopathological report revealed the presence of a micro-cystic SCA. CONCLUSIONS The current case firstly reports a pancreatic SCA showing increased radiopharmaceutical uptake at 68Ga-DOTA-peptide PET-CT images. This unexpected finding should be taken into account during the diagnostic algorithm of a pancreatic lesion, in order to minimize the risk of misdiagnosis and overtreatment of SCA.
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Affiliation(s)
- Gennaro Nappo
- grid.417728.f0000 0004 1756 8807Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS Rozzano, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Niccola Funel
- grid.5395.a0000 0004 1757 3729Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Giudici
- grid.417728.f0000 0004 1756 8807Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS Rozzano, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Paola Spaggiari
- grid.417728.f0000 0004 1756 8807Pathology Department, Humanitas Clinical and Research Center-IRCCS Rozzano, Milan, Italy
| | - Giovanni Capretti
- grid.417728.f0000 0004 1756 8807Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS Rozzano, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Silvia Carrara
- grid.417728.f0000 0004 1756 8807Endoscopic Unit, Humanitas Clinical and Research Center-IRCCS Rozzano, Milan, Italy
| | - Giovanna Pepe
- grid.417728.f0000 0004 1756 8807Nuclear Medicine Department, Humanitas Clinical and Research Center-IRCCS Rozzano, Milan, Italy
| | - Alessandro Zerbi
- grid.417728.f0000 0004 1756 8807Pancreatic Surgery Unit, Humanitas Clinical and Research Center-IRCCS Rozzano, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy ,grid.452490.eHumanitas University, Rozzano, Milan Italy
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Wang GX, Wang ZP, Chen HL, Zhang D, Wen L. Discrimination of serous cystadenoma from mucinous cystic neoplasm and branch duct intraductal papillary mucinous neoplasm in the pancreas with CT. Abdom Radiol (NY) 2020; 45:2772-2778. [PMID: 32705313 DOI: 10.1007/s00261-020-02664-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The imaging features of serous cystadenomas (SCAs) overlap with those of mucinous cystic neoplasms (MCNs) and branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), and an accurate preoperative diagnosis is important for clinical treatment due to their different biological behaviors. The aim of this study was to provide a computed tomographic (CT) feature for the diagnosis of SCAs and estimate whether the "circumvascular sign" can contribute to the discrimination of SCAs from MCNs and BD-IPMNs. METHODS From August 2011 through December 2019, a total of 71 patients (30 patients with 30 SCAs, 21 patients with 21 MCNs and 20 patients with 22 BP-IPMNs) were enrolled in this study. All patients underwent CT examination and were confirmed by surgical pathology. In addition to patient clinical information, CT features (e.g., location, shape) were evaluated via CT. RESULTS Central scarring, central calcification and the circumvascular sign were found to be specific CT features for the diagnosis of SCAs and their differential diagnosis from MCNs and BD-IPMNs. All three CT features had high specificity, and both central scarring and central calcification had low sensitivity. When any one of these two features was combined with the circumvascular sign, the sensitivity increased to 83.3%. CONCLUSION Pancreatic cystic neoplasms that show central scarring, central calcification or the circumvascular sign on CT could be diagnosed as SCAs. When either of the first two features is combined with the circumvascular sign, the diagnostic sensitivity could be increased.
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Affiliation(s)
- Guang-Xian Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Zhi-Ping Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Hai-Ling Chen
- Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China
| | - Li Wen
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
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Khanna L, Prasad SR, Sunnapwar A, Kondapaneni S, Dasyam A, Tammisetti VS, Salman U, Nazarullah A, Katabathina VS. Pancreatic Neuroendocrine Neoplasms: 2020 Update on Pathologic and Imaging Findings and Classification. Radiographics 2020; 40:1240-1262. [PMID: 32795239 DOI: 10.1148/rg.2020200025] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pancreatic neuroendocrine neoplasms (panNENs) are heterogeneous neoplasms with neuroendocrine differentiation that show characteristic clinical, histomorphologic, and prognostic features; genetic alterations; and biologic behavior. Up to 10% of panNENs develop in patients with syndromes that predispose them to cancer, such as multiple endocrine neoplasia type 1, von Hippel-Lindau disease, tuberous sclerosis complex, neurofibromatosis type 1, and glucagon cell adenomatosis. PanNENs are classified as either functioning tumors, which manifest early because of clinical symptoms related to increased hormone production, or nonfunctioning tumors, which often manifest late because of mass effect. PanNENs are histopathologically classified as well-differentiated pancreatic neuroendocrine tumors (panNETs) or poorly differentiated pancreatic neuroendocrine carcinomas (panNECs) according to the 2010 World Health Organization (WHO) classification system. Recent advances in cytogenetics and molecular biology have shown substantial heterogeneity in panNECs, and a new tumor subtype, well-differentiated, high-grade panNET, has been introduced. High-grade panNETs and panNECs are two distinct entities with different pathogenesis, clinical features, imaging findings, treatment options, and prognoses. The 2017 WHO classification system and the eighth edition of the American Joint Committee on Cancer staging system include substantial changes. Multidetector CT, MRI, and endoscopic US help in anatomic localization of the primary tumor, local-regional spread, and metastases. Somatostatin receptor scintigraphy and fluorine 18-fluorodeoxyglucose PET/CT are helpful for functional and metabolic assessment. Knowledge of recent updates in the pathogenesis, classification, and staging of panNENs and familiarity with their imaging findings allow optimal patient treatment. ©RSNA, 2020.
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Affiliation(s)
- Lokesh Khanna
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Srinivasa R Prasad
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Abhijit Sunnapwar
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Sainath Kondapaneni
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Anil Dasyam
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Varaha S Tammisetti
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Umber Salman
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Alia Nazarullah
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
| | - Venkata S Katabathina
- From the Departments of Radiology (L.K., A.S., U.S., V.S.K.) and Pathology (V.S.T.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Molecular Biosciences, University of Texas at Austin, Austin, Tex (S.K.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (A.N.)
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Management of Incidental Pancreatic Cystic Lesions: Integrating Novel Diagnostic and Prognostic Factors With Current Clinical Guidelines. J Clin Gastroenterol 2020; 54:415-427. [PMID: 32011401 DOI: 10.1097/mcg.0000000000001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Owing to increased detection rates, the diagnosis and management of incidental pancreatic cysts has become a common predicament. Up to 13% of patients undergoing cross-sectional imaging studies for other indications are found to have pancreatic cystic lesions. Although most cystic lesions are benign, the malignant potential of several types of pancreatic cysts makes accurate classification vital to directing therapy. To this end, advances in the last decade led to better characterization of pancreatic cyst morphology and hence enhanced the ability to predict underlying histopathology, and biological behavior. Although accurate classification remains a challenge, the utilization of complementary diagnostic tools is the optimal approach to dictate management. The following review includes a description of pancreatic cysts, a critical review of current and emerging diagnostic techniques and a review of recent guidelines in the management of incidental pancreatic cysts.
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Kang JS, Kim HJ, Choi YJ, Byun Y, Lee JM, Han Y, Kim H, Kwon W, Jang JY. Clinicoradiological features of resected serous cystic neoplasms according to morphological subtype and preoperative tentative diagnosis: can radiological characteristics distinguish serous cystic neoplasms from other lesions? Ann Surg Treat Res 2020; 98:247-253. [PMID: 32411629 PMCID: PMC7200608 DOI: 10.4174/astr.2020.98.5.247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/12/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Serous cystic neoplasm (SCN) of the pancreas is considered benign in most cases. However, some SCN patients undergo surgical resection because lesions could not be differentiated preoperatively. This study evaluated causes of resection for SCN, investigated clinical and radiological features of surgically resected SCNs, and compared characteristics of SCNs diagnosed accurately and those misdiagnosed. Methods One hundred patients, who underwent surgery for pancreatic cystic tumors with pathological confirmation of SCN between 2000 and 2014 were retrospectively analyzed. Results The mean patient age was 52.9 years, 67 (67%) were female, and most lesions (72%) were located in the pancreatic body or tail. Fifty-one (51%) pathologically confirmed SCNs were preoperatively diagnosed as non-SCNs. Patients underwent surgery due to uncertain diagnosis (58%) or symptomatology (18%). According to radiological examination, most lesions were macrocystic (85%), exhibited septation (58%), or were enhancing lesions (48%). Compared with preoperatively diagnosed non-SCNs, accurately diagnosed SCNs exhibited septation (75.5% vs. 41.2%, P = 0.001) and central scar (36.7% vs. 11.8%, P = 0.003) more frequently in radiological examinations. In terms of macrocystic tumors (n = 85), most parameters did not differentiate preoperative diagnoses, although lesions accurately diagnosed as SCN exhibited septation more frequently than those preoperatively misdiagnosed as mucinous cystic neoplasm or intraductal papillary mucinous neoplasm (70.7% vs. 38.9% vs. 33.3%, respectively, P = 0.009). Conclusion It is difficult to accurately distinguish macrocystic SCNs from other cystic tumors using conventional radiological methods. For more accurate diagnosis, new biomarkers and/or other diagnostic modalities are needed and warrant further investigation.
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Affiliation(s)
- Jae Seung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jun Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Jin Choi
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonhyeong Byun
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Sun Y, Yang S, Qi E, Liu F, Zhou F, Lu Y, Liang P, Ye H, Yu X. Comparative Diagnostic Evaluation with Contrast-Enhanced Ultrasound, Computed Tomography and Magnetic Resonance Imaging in Patients with Pancreatic Cystic Neoplasms. Cancer Manag Res 2020; 12:2889-2898. [PMID: 32425602 PMCID: PMC7196192 DOI: 10.2147/cmar.s246564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of our study was to evaluate the role of contrast-enhanced ultrasound (CEUS) with magnetic resonance imaging (MRI) and computed tomography (CT) in the pathological diagnosis of pancreatic cystic neoplasms (PCNs). Methods A total of 90 patients (66 women, 24 men) aged 18–71 years were studied prospectively. CEUS was performed in all patients, whereas MRI was performed in 85 patients and CT in 69 patients. We analyzed the sensitivity and accuracy of these three imaging modalities to diagnose the PCNs. Neoplasm size, location, shape, intralesional mural nodules, septa and duct dilatation were also assessed by different radiologists. Results There were no significant differences in sensitivity for discriminating PCNs from pancreatic cystic lesions between CEUS and MRI (p=0.614) or between CEUS and CT (p=0.479). The diagnostic accuracy of CEUS for classifying PCNs was 64.4% (58/90), which was higher than that of CT (53.6%, 37/69, P=0.017), and lower than that of MRI (70.6%, 60/85, p=0.791). Regarding tumor size for lesions larger than 3 cm, CEUS was superior to CT in differentiating the specific type of PCN (p=0.041), and CEUS had the same value as MRI (p=0.774). Furthermore, CEUS is valuable for precisely characterizing internal structures, for instance, septa (p=0.003, compared with CT; p=0.443, compared with MRI) and nodules (p= 0.018, compared with CT; p=0.033, compared with MRI). The number of septa (p=0.033) and cyst morphology (p=0.016) were meaningful indicators in differentiating serous and mucinous adenoma. There was no significant difference in evaluating size and detecting duct dilatation among the three imaging methods. Conclusion CEUS compares favorably with MRI in displaying the inner structure of PCNs and offers advantages over CT. CEUS can contribute in an important way to the diagnosis of pancreatic cystic neoplasms.
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Affiliation(s)
- Ya Sun
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.,Department of Ultrasound, Aerospace Central Hospital, Beijing 100049, People's Republic of China
| | - Shuo Yang
- Chinese PLA Medical School, Beijing, 100853, People's Republic of China
| | - Erpeng Qi
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Fubo Zhou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Yuhan Lu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Huiyi Ye
- Radiology Department, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
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30
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Massaras D, Pantiora EV, Koutalas J, Primetis EC, Fragulidis GP. Serous Microcystic Cystadenocarcinoma of the Pancreas with Synchronous Liver Metastases: Clinical Characteristics and Management. Cureus 2020; 12:e7707. [PMID: 32431986 PMCID: PMC7233488 DOI: 10.7759/cureus.7707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Serous cystadenocarcinoma of the pancreas is a rare but well-established entity. The origin and evolution of this disorder remain unclear, but even metastatic cases have an excellent prognosis. These tumors are very similar to benign serous cystic neoplasms (SCNs) of the pancreas, except that they tend to be larger, are locally invasive, and present distant metastasis. The most frequent local invasion is adjacent vessels, spleen, stomach, and duodenum. The most common site of distant metastasis is the liver. Diagnosis via imaging as well as pathology examination may be misguided due to atypical characteristics of the tumor. In fact, in some, the diagnosis of malignancy was established only after metastases were detected. We present a 60-year-old female patient with malignant serous microcystic cystadenocarcinoma of the pancreas and liver metastasis that was initially misdiagnosed as a metastatic renal cell carcinoma. The patient underwent tumor resection and liver metastasectomy and she is currently doing well after three years of follow-up, with no tumor recurrence or new metastatic liver nodules based on imaging findings.
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Affiliation(s)
- Dimitrios Massaras
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Eirini V Pantiora
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - John Koutalas
- Anesthesiology, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Georgios P Fragulidis
- 2nd Department of Surgery, "Aretaeio" Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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31
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Barat M, Dohan A, Gaujoux S, Hoeffel C, Jornet D, Oudjit A, Coriat R, Barret M, Terris B, Soyer P. Computed tomography features of acinar cell carcinoma of the pancreas. Diagn Interv Imaging 2020; 101:565-575. [PMID: 32146131 DOI: 10.1016/j.diii.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS The CT examinations of 20 patients (13 men, 7 women; mean age, 66.5±10.7 [SD] years; range: 51-88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model. RESULTS Pancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6±28.0 (SD) mm (range: 24-120mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P=0.005), nondilated bile ducts (OR, 9.00; P=0.007), visible lymph nodes (OR, 4.33; P=0.028) and adjacent organ involvement (OR, 5.67; P=0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14±4.8 [SD]; range: 7-25mm) than in those with PDA (8.8±4.1 [SD]; range: 5-15mm) (P=0.039). CONCLUSION On CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.
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Affiliation(s)
- M Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France.
| | - A Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
| | - S Gaujoux
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Abdominal Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - C Hoeffel
- Department of Radiology, Hôpital Robert Debré, 51092 Reims, France
| | - D Jornet
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - A Oudjit
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - R Coriat
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - M Barret
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - B Terris
- Université de Paris, Descartes-Paris 5, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - P Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France
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Abstract
Robotic surgery is flourishing worldwide. Pancreatic cancer is the fourth leading cause of cancer death in the United States. Most pancreatic operations are undertaken for the management of pancreatic adenocarcinoma. Therefore, it is essential for all physicians caring for patients with cancer to understand the role and importance of molecular tumor markers. This article details our technique and application of the robotic platform to robotic pancreatectomy. The use of the robot does not change the nature of pancreatic operations, but it is our belief that it will improve patient outcomes and, possibly, survival by reducing perioperative complications.
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33
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Sydney GI, Ioakim KJ, Michaelides C, Sepsa A, Sopaki-Valalaki A, Tsiotos GG, Theocharis S, Salla C, Nikas I. EUS-FNA diagnosis of pancreatic serous cystadenoma with the aid of cell blocks and α-inhibin immunochemistry: A case series. Diagn Cytopathol 2019; 48:239-243. [PMID: 31785091 DOI: 10.1002/dc.24348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022]
Abstract
Serous cystadenoma (SCA) is an uncommon benign pancreatic neoplasm that is most often managed conservatively with follow-up rather than surgical excision. Therefore, to avoid the serious complications of pancreatic surgery, SCA should be diagnosed accurately at the preoperative level. Preoperative SCA diagnosis requires a multimodal diagnostic approach that includes imaging, cystic fluid biochemical analysis and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA). In this brief report, we describe six EUS-FNA cases from five patients that were reported as "benign, consistent with serous cystadenoma". Samples were hypocellular, composed of loose clusters and single cuboidal, bland-looking cells among epithelial sheets representing gastrointestinal contamination. Cell blocks were prepared and all six FNA cases revealed cuboidal cells with a positive α-inhibin immunophenotype, consistent with a diagnosis of SCA. As EUS-FNAs of SCA commonly result in non-diagnostic interpretations, cell block preparations with subsequent immunochemistry can increase their diagnostic accuracy and guide patient management.
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Affiliation(s)
- Guy I Sydney
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | | | - Constantinos Michaelides
- School of Medicine, European University Cyprus, Nicosia, Cyprus.,First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Sepsa
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Stamatios Theocharis
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charitini Salla
- Department of Cytopathology, Hygeia & Mitera Hospital, Athens, Greece
| | - Ilias Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus.,First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Rowan D, Pant M, Hagen C, Giorgadze T. Coexisting pancreatic serous cystadenoma and pancreatic ductal adenocarcinoma: A cytological-pathologic correlation with literature review. Ann Diagn Pathol 2019; 42:87-91. [PMID: 31382079 DOI: 10.1016/j.anndiagpath.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022]
Abstract
Pancreatic serous cystadenoma (SCA) is a benign neoplastic lesion with a distinctive gross and microscopic appearance consisting of numerous thin-walled cysts lined by uniform epithelial cells with clear cytoplasm and small nuclei. The vast majority of serous cystadenomas are benign. Pancreatic SCA has rarely been reported in association with other pancreatic lesions. We present a challenging case in which a cystic and solid pancreatic mass was identified on imaging studies. FNA was performed and showed clusters of atypical cells with significant nuclear pleomorphism (>4:1), disorganized, overlapping nuclei, and prominent nucleoli. The FNA diagnosis was positive for malignancy, consistent with adenocarcinoma. The patient underwent neoadjuvant therapy and pancreaticoduodenectomy. Final pathology showed a serous cystadenoma associated with small foci of high-grade PanIN. The lack of invasive adenocarcinoma in the resection specimen was most likely due to complete response of the tumor to neoadjuvant chemoradiation therapy, but it is also possible that only high-grade PanIN was present initially. To our knowledge, this is the first reported case of SCA and high grade PanIN/PDAC that was assessed by FNA. We discuss the cytologic differential diagnosis and how to avoid potential pitfalls highlighted by this case.
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Affiliation(s)
- Daniel Rowan
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mamta Pant
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Catherine Hagen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tamara Giorgadze
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Jornet D, Soyer P, Terris B, Hoeffel C, Oudjit A, Legmann P, Gaujoux S, Barret M, Dohan A. MR imaging features of pancreatic acinar cell carcinoma. Diagn Interv Imaging 2019; 100:427-435. [PMID: 30846400 DOI: 10.1016/j.diii.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to report the magnetic resonance imaging (MRI) features of acinar cell carcinoma (ACC) of the pancreas including diffusion-weighted MRI findings. MATERIALS AND METHODS The MRI examinations of five patients (3 men, 2 women; median age, 61years) with histopathologically proven ACC of the pancreas were retrospectively reviewed. MR images were analyzed qualitatively (location, shape, homogeneity, signal intensity, vascular involvement and extrapancreatic extent of ACC) and quantitatively (tumor size, apparent diffusion coefficient [ADC] and normalized ADC of ACC). RESULTS All ACC were visible on MRI, presenting as an oval pancreatic mass (5/5; 100%), with moderate and heterogeneous enhancement (5/5; 100%), with a median transverse diameter of 43mm (Q1, 35; Q3, 82mm; range: 30-91mm). Tumor capsule was visible in 4/5 ACC (80%) and Wirsung duct enlargement in 2/5 ACC (40%). On diffusion-weighted MRI, all ACC (5/5; 100%) were hyperintense on the 3 b value images. Median ADC value of ACC was 1.061×10-3mm2/s (Q1, 0.870×10-3mm2/s; Q3, 1.138×10-3mm2/s; range: 0.834-1.195×10-3mm2/s). Median normalized ADC ratio of ACC was 1.127 (Q1, 1.071; Q3, 1.237; range: 1.054-1.244). CONCLUSIONS On MRI, ACC of the pancreas presents as a large, oval pancreatic mass with moderate and heterogeneous enhancement after intravenous administration of a gadolinium chelate, with restricted diffusion and a median ADC value of 1.061×10-3mm2/s on diffusion-weighted MRI. Further studies however are needed to confirm our findings obtained in a limited number of patients.
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Affiliation(s)
- D Jornet
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Soyer
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; UMR Inserm 965, 2, rue Amboise-Paré, 75010 Paris, France
| | - B Terris
- Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France
| | - A Oudjit
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Legmann
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France
| | - S Gaujoux
- Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Abdominal surgery, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Barret
- Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Dohan
- Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Descartes Paris 5, Sorbonne Paris Cité, rue de l'École-de-Médecine, 75006 Paris, France; UMR Inserm 965, 2, rue Amboise-Paré, 75010 Paris, France.
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Giambelluca D, Bruno A, Picone D, Midiri M. The honeycomb pattern of pancreatic serous cystadenoma. Abdom Radiol (NY) 2019; 44:1191-1192. [PMID: 30288583 DOI: 10.1007/s00261-018-1796-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dario Giambelluca
- Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Alberto Bruno
- Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Dario Picone
- Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Hwang H, Yu JS, Cho ES, Kim JH, Chung JJ. Serous Cystic Neoplasms of the Pancreas: Endoscopic Ultrasonographic Versus Computed Tomography and Magnetic Resonance Imaging Features of Surgically Removed Masses. Ultrasound Q 2019; 34:122-127. [PMID: 29509575 DOI: 10.1097/ruq.0000000000000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Our purpose was to assess the endoscopic ultrasonography (EUS) features of serous cystic neoplasms (SCNs) of the pancreas in determining the surgical removal compared with computed tomography (CT) and magnetic resonance imaging (MRI) features. For 33 consecutive patients with 34 surgically confirmed SCNs over the past 11 years, preoperative EUS features were compared with those of CT and MRI (CT&MRI). Besides the lesion size and location, a retrospective analysis of the various imaging features was performed by 2 observers to understand the characteristics that determine the need for surgical intervention in terms of multiplicity of locules, calcification, mural thickening, mural nodules, ductal communication, and main pancreatic duct dilatation in addition to the gross morphologic type: microcystic, macrocystic (>1 cm), mixed, or solid. The most common gross morphologic type was mixed lesions, which consisted of microcystic and macrocystic components (15/34; 44%), followed by microcystic (38%), macrocystic (15%), and solid (3%) lesions. A minority (5/34; 18%) of the lesions showed main pancreatic duct dilatation (upstream, n = 3; downstream, n = 0; diffuse, n = 2). Mural nodules or solid components were more frequently noted in EUS (67%) than in CT&MRI (25%; P = 0.001), whereas other findings showed no remarkable difference between EUS and CT&MRI (P > 0.05). In determining the surgical treatment of multiloculated cystic lesions, interpretation of EUS features for the presence of solid component or mural nodules should be more carefully determined, especially in the patients with suggestive features of SCN on CT or MRI to avoid unnecessary surgery.
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Affiliation(s)
- Hyeonseung Hwang
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Factors influencing surgical indication in patients with asymptomatic pancreatic cystic lesion - is EUS always indicated before surgery? Pancreatology 2019; 19:206-207. [PMID: 30583979 DOI: 10.1016/j.pan.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022]
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Harrell K, Dowden J. Atypical Solid Serous Cystadenoma of the Pancreas. Am Surg 2018. [DOI: 10.1177/000313481808400924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kevin Harrell
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - Jacob Dowden
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
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Chen HY, Zhao J, Lu YF, Lv SY, Chen JY, Pan Y, Shi D, Xu XF, Yu RS. The "extracapsular cystic" sign in pancreatic serous cystic neoplasms: A clinicopathologic study of 177 patients with cystic pancreatic lesions. Eur J Radiol 2018; 106:167-172. [PMID: 30150040 DOI: 10.1016/j.ejrad.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess a new imaging feature that we have named the extracapsular cystic sign which can make a constructive contribution towards differentiating serous cystic neoplasms (SCNs) from other pancreatic cystic lesions. MATERIAL AND METHODS We retrospectively reviewed 177 CTs/MRIs of patients who underwent pancreatic resection of cystic lesions at two institutions from January 2011/2013, to September 2017. For each patient, demographic information, clinical presentation, especially imaging features were carefully investigated by two experienced abdominal radiologists, retrospectively. All statistical analyses were performed using SPSS V.23.0. RESULTS Twenty-one lesions had extracapsular cystic signs which were newly discovered, 17 (28.3%) of 60 SCNs and 4 (3.4%) (mucinous cystic neoplasm = 1, walled-off necrosis = 2, retention cyst = 1) of 117 Non-SCNs were included, from which indicating that the extracapsular cystic sign was more often detected on SCNs. As for 21 lesions, 86% (n = 18) were females, and mean age at diagnosis was 51.2 years. 71% (n = 15) located in the pancreatic body and tail. Average size was 27.2 mm (23.7-53.4), mean (SD) ratio of biggest daughter cyst to mother cyst was 0.51[0.14] (p = 0.99), average (SD) angle between two of them was 105.5° [14.9] (p = 0.84). The average time interval between last imaging examination and surgery was 8.4 days. CONCLUSIONS The new sign named the extracapsular cystic sign in SCNs may help differentiate SCNs from other pancreatic cystic lesions. Furthermore, this study supports an original diagnosis for SCNs when the sign of extracapsular cyst appears.
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Affiliation(s)
- Hai-Yan Chen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jin Zhao
- Department of Radiology, Zhejiang Hospital, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sang-Ying Lv
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie-Yu Chen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Pan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Shi
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiu-Fang Xu
- Department of Radiology, Hangzhou Medical College, Hangzhou, China.
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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41
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Rare pancreatic masses: a pictorial review of radiological concepts. Clin Imaging 2018; 50:314-323. [DOI: 10.1016/j.clinimag.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/08/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023]
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42
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Incidence and reasons of pancreatic resection in patients with asymptomatic serous cystadenoma. Pancreatology 2018; 18:577-584. [PMID: 29903633 DOI: 10.1016/j.pan.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Despite diagnostic refinements, pancreatic resection (PR) is eventually performed in some patients with asymptomatic serous cystadenoma (A-SCA). The aim of this study was to define incidence and reasons of PR in A-SCA. METHODS A retrospective analysis of a prospectively maintained database was performed for all the patients referred for pancreatic cystic lesions (PCL) between January 2005 and March 2016. RESULTS Overall, there were 1488 patients with PCL, including 1271 (85.4%) with incidental PCL (I-PCL). During the study period referral of I-PCL increased 8.5-fold. Surgery was immediately advised in 94 I-PCL (7.3%) and became necessary later on in 11 additional patients (0.9%), because of the development of symptoms. Overall, PR was performed in 105/1271 patients presenting with I-PCL (8.2%), including 27 with A-SCA (2.1%). All patients with A-SCA underwent ultrasonography and contrast-enhanced computed tomography. Magnetic resonance imaging was performed in 21 patients (77.8%), 18 F-FDG positron emission tomography in 8 (29.6%), endoscopic ultrasonography (EUS) in 2 (7.4%), and EUS-guided fine needle aspiration (EUS-FNA) in 1 (3.7%). These studies demonstrated a combination of atypical features such as solid tumor (3; 11.1%), oligo-/macrocystic tumor (24; 88.8%), mural nodules (14; 51.8%), enhancing cyst walls (17; 62.9%), dilation of the main pancreatic duct (3; 11.1%), and upstream pancreatic atrophy (1; 3.7%). Additionally, 14/27 patients (51.8%) were females with oligo-/macrocystic tumors located in the body-tail of the pancreas. CONCLUSIONS Management of patients with A-SCA entails a small risk of PR especially when these tumors demonstrate atypical radiologic features associated with confounding anatomic and demographic characteristics.
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Abstract
Pancreatic cystic lesions are being detected with increasing frequency because of increased use and improved quality of cross-sectional imaging techniques. Pancreatic cystic lesions encompass non-neoplastic lesions (such as pancreatitis-related collections) and neoplastic tumors. Common cystic pancreatic neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary tumors. These cystic pancreatic neoplasms may have typical morphology, but at times show overlapping imaging features on cross-sectional examinations. This article reviews the classical and atypical imaging features of commonly encountered cystic pancreatic neoplasms and presents the limitations of current cross-sectional imaging techniques in accurately classifying pancreatic cystic lesions.
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Affiliation(s)
- Thomas L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Frank J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
PURPOSE OF REVIEW The goal of this review is to critically analyze the current literature regarding the management of incidental pancreatic cysts. Given their increased rates of detection due to the frequent use of cross-sectional imaging, correctly identifying the subset of high risk lesions that are appropriate for surgical resection is critical. However, the existing consensus and societal guidelines discussed in this review lack high quality data to create evidence-based recommendations, making achieving this important aim challenging. RECENT FINDINGS Several recent studies have focused on the natural history of pancreatic cysts and defining the role of endoscopic ultrasound, which remains unclear. EUS-guided diagnostic tools include molecular analysis of obtained fluid; EUS-guided FNA, FNB, and intracystic forceps biopsy of the cyst wall; and confocal endomicroscopy. While their precise role in diagnosing pancreatic cystic neoplasms remains to be defined, they represent promising innovations that may play a future role in cyst assessment and management. Large, long-term, prospective studies of incidentally identified pancreatic cysts are essential to fully understand their natural history and potential for neoplastic progression. Given the absence of such data at present, an individualized patient approach is recommended.
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Affiliation(s)
- Jennifer Phan
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 330-37, Los Angeles, CA, 90095, USA
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 330-37, Los Angeles, CA, 90095, USA.
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45
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Chen M, Zhang H, Hu Y, Liu K, Deng Y, Yu Y, Wu Y, Qi A, Li Y, Wen G. Adult pancreatoblastoma: A case report and clinicopathological review of the literature. Clin Imaging 2018; 50:324-329. [PMID: 29753278 DOI: 10.1016/j.clinimag.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Our purpose was to report a case of adult pancreatoblastoma, and review the literature in order to assist clinicians in the management of the disease. MATERIALS AND METHODS The demographic, clinical, and imaging findings of 41 patients with pathologically proven pancreatoblastoma from 1986 to 2017 identified in PubMed were reviewed. The key words used for searching PubMed were: "pancreatoblastoma", "pancreatic tumor", and "adult pancreatoblastoma." We also reported the details of a case of adult pancreatoblastoma treated at our institution. RESULTS We identified 41 cases of adult pancreatoblastomas, and the mean age at diagnosis was 41.4 ± 17.4 years. Pancreatoblastomas occurred in the pancreatic head in 48.4% of patients, and in 39.0% of cases the tumor was >8 cm in diameter at diagnosis. Patient age and tumor size were similar between males and females (P = 0.59; P = 0.32, respectively). Metastases was present in 17 of the 41 adult patients (41.5%). No significant difference in age, sex, tumor size, and tumor location was found between patients with and without metastases (P = 0.57, 0.58, 0.64, 0.39, respectively). CONCLUSION Preoperative diagnosis of adult pancreatoblastoma is difficult because of the heterogeneous, variable cellular differentiation and atypical clinical and imaging features. A pancreatoblastoma should be considered when tumors in the pancreas are solid and cystic.
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Affiliation(s)
- Menglin Chen
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Haijie Zhang
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yixin Hu
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Kai Liu
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yanjia Deng
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yuanmeng Yu
- Department of Medical Imaging, Jinling Hospital, Nanjing University Medical School, Nanjing 210002, Jiangsu, China
| | - Yulan Wu
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Anqi Qi
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yingjia Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
| | - Ge Wen
- Medical Imaging Teaching and Research Office, Southern Medical University, Guangzhou 510515, Guangdong, China.
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Abstract
CT and MRI are the imaging modalities of choice to guide the clinical management of incidentally discovered pancreatic cysts. Most of these lesions are mucinous cysts with varying degrees of malignant potential. This article reviews the CT and MRI findings that help differentiate a potentially aggressive lesion that requires EUS or surgery from a lesion of low malignant potential that is appropriate for imaging surveillance. The imaging-based societal guidelines for these cysts are reviewed.
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Affiliation(s)
- R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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