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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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Mao KZ, Ma C, Song B. Radiomics advances in the evaluation of pancreatic cystic neoplasms. Heliyon 2024; 10:e25535. [PMID: 38333791 PMCID: PMC10850586 DOI: 10.1016/j.heliyon.2024.e25535] [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: 09/06/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
With the development of medical imaging, the detection rate of pancreatic cystic neoplasms (PCNs) has increased greatly. Serous cystic neoplasm, solid pseudopapillary neoplasm, intraductal papillary mucinous neoplasm and mucinous cystic neoplasm are the main subtypes of PCN, and their treatment options vary greatly due to the different biological behaviours of the tumours. Different from conventional qualitative imaging evaluation, radiomics is a promising noninvasive approach for the diagnosis, classification, and risk stratification of diseases involving high-throughput extraction of medical image features. We present a review of radiomics in the diagnosis of serous cystic neoplasm and mucinous cystic neoplasm, risk classification of intraductal papillary mucinous neoplasm and prediction of solid pseudopapillary neoplasm invasiveness compared to conventional imaging diagnosis. Radiomics is a promising tool in the field of medical imaging, providing a noninvasive, high-performance model for preoperative diagnosis and risk stratification of PCNs and improving prospects regarding management of these diseases. Further studies are warranted to investigate MRI image radiomics in connection with PCNs to improve the diagnosis and treatment strategies in the management of PCN patients.
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Affiliation(s)
- Kuan-Zheng Mao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
- Department of Pancreatic Surgery, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
- College of Electronic and Information Engineering, Tongji University, Shanghai, 201804, China
| | - Bin Song
- Department of Pancreatic Surgery, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, 200433, China
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Minelli C, Balducci F, Cavalleri C, Milanetto AC, Ferrara F, Crimì F, Quaia E, Vernuccio F. Intraductal papillary mucinous neoplasms of the pancreas: Uncommon imaging presentation, evolution and comparison of guidelines. Eur J Radiol Open 2023; 11:100531. [PMID: 37920680 PMCID: PMC10618428 DOI: 10.1016/j.ejro.2023.100531] [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: 08/04/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
Pancreatic cystic lesions are often asymptomatic, incidentally detected and include a range of entities with varying degrees of concern for malignancy. Among these, intraductal papillary mucinous neoplasms (IPMN) are considered premalignant pancreatic lesions, with a broad pathological spectrum ranging from lesions without dysplasia, which can be managed conservatively, to malignant lesions that require surgical resection. The increasing use of CT and MRI has led to increased recognition of this entity incidentally, with branch-duct IPMN representing the most common subtype and the most challenging lesions in terms of patient management. The main imaging modality involved in diagnosis and surveillance of IPMN is MRI. Radiologists play an important role in the management of patients with IPMN, including lesion detection, characterization, follow-up and prognostication, allowing early MRI identification of features that are concerning for malignancy. The main aim of this pictorial review is to illustrate MRI features of IPMN and to discuss risk stratification scores based on different guidelines, with a main focus on branch-duct IPMN. The secondary aims include the presentation of common and uncommon imaging evolution of BD-IPMN as well as the discussion on current controversies on the appropriate management of IPMN.
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Affiliation(s)
- Chiara Minelli
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Federico Balducci
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Cristina Cavalleri
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Anna Caterina Milanetto
- Chirurgia Generale 3, Department of Surgery, Oncology and Gastroenterology - University of Padova, 35128, Padova, Italy
| | - Francesco Ferrara
- Gastroenterology Unit - University Hospital of Padova, 35128 Padova, Italy
| | - Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, 35128 Padova, Italy
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Taya M, Hecht EM, Huang C, Lo GC. Pancreatic Cystic Lesions: Imaging Techniques and Diagnostic Features. Gastrointest Endosc Clin N Am 2023; 33:497-518. [PMID: 37245932 DOI: 10.1016/j.giec.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The detection of incidental pancreatic cystic lesions has increased over time. It is crucial to separate benign from potentially malignant or malignant lesions to guide management and reduce morbidity and mortality. The key imaging features used to fully characterize cystic lesions are optimally assessed by contrast-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography, with pancreas protocol computed tomography offering a complementary role. While some imaging features have high specificity for a particular diagnosis, overlapping imaging features between diagnoses may require further investigation with follow-up diagnostic imaging or tissue sampling.
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Affiliation(s)
- Michio Taya
- Department of Radiology, New York Presbyterian - Weill Cornell Medicine, 520 East 70th Street, Starr 8a, New York, NY 10021, USA
| | - Elizabeth M Hecht
- Department of Radiology, New York Presbyterian - Weill Cornell Medicine, 520 East 70th Street, Starr 8a, New York, NY 10021, USA
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, 560 1st Avenue, 2F, New York, NY 10016, USA
| | - Grace C Lo
- Department of Radiology, New York Presbyterian - Weill Cornell Medicine, 520 East 70th Street, Starr 8a, New York, NY 10021, USA.
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Wang Q, Šabanović B, Awada A, Reina C, Aicher A, Tang J, Heeschen C. Single-cell omics: a new perspective for early detection of pancreatic cancer? Eur J Cancer 2023; 190:112940. [PMID: 37413845 DOI: 10.1016/j.ejca.2023.112940] [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: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 07/08/2023]
Abstract
Pancreatic cancer is one of the most lethal cancers, mostly due to late diagnosis and limited treatment options. Early detection of pancreatic cancer in high-risk populations bears the potential to greatly improve outcomes, but current screening approaches remain of limited value despite recent technological advances. This review explores the possible advantages of liquid biopsies for this application, particularly focusing on circulating tumour cells (CTCs) and their subsequent single-cell omics analysis. Originating from both primary and metastatic tumour sites, CTCs provide important information for diagnosis, prognosis and tailoring of treatment strategies. Notably, CTCs have even been detected in the blood of subjects with pancreatic precursor lesions, suggesting their suitability as a non-invasive tool for the early detection of malignant transformation in the pancreas. As intact cells, CTCs offer comprehensive genomic, transcriptomic, epigenetic and proteomic information that can be explored using rapidly developing techniques for analysing individual cells at the molecular level. Studying CTCs during serial sampling and at single-cell resolution will help to dissect tumour heterogeneity for individual patients and among different patients, providing new insights into cancer evolution during disease progression and in response to treatment. Using CTCs for non-invasive tracking of cancer features, including stemness, metastatic potential and expression of immune targets, provides important and readily accessible molecular insights. Finally, the emerging technology of ex vivo culturing of CTCs could create new opportunities to study the functionality of individual cancers at any stage and develop personalised and more effective treatment approaches for this lethal disease.
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Affiliation(s)
- Qi Wang
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Berina Šabanović
- Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Azhar Awada
- Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy; Molecular Biotechnology Center, University of Turin (UniTO), Turin, Italy
| | - Chiara Reina
- Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Alexandra Aicher
- Precision Immunotherapy, Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Jiajia Tang
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University School of Medicine, Shanghai, China; South Chongqing Road 227, Shanghai, China.
| | - Christopher Heeschen
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Pancreatic Cancer Heterogeneity, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy; South Chongqing Road 227, Shanghai, China.
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Quingalahua E, Al-Hawary MM, Machicado JD. The Role of Magnetic Resonance Imaging (MRI) in the Diagnosis of Pancreatic Cystic Lesions (PCLs). Diagnostics (Basel) 2023; 13:diagnostics13040585. [PMID: 36832073 PMCID: PMC9955706 DOI: 10.3390/diagnostics13040585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/22/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Pancreatic cystic lesions (PCLs) are a common incidental finding on cross-sectional imaging. Given the high signal to noise and contrast resolution, multi-parametric capability and lack of ionizing radiation, magnetic resonance imaging (MRI) has become the non-invasive method of choice to predict cyst type, risk stratify the presence of neoplasia, and monitor changes during surveillance. In many patients with PCLs, the combination of MRI and the patient's history and demographics will suffice to stratify lesions and guide treatment decisions. In other patients, especially those with worrisome or high-risk features, a multimodal diagnostic approach that includes endoscopic ultrasound (EUS) with fluid analysis, digital pathomics, and/or molecular analysis is often necessary to decide on management options. The application of radiomics and artificial intelligence in MRI may improve the ability to non-invasively stratify PCLs and better guide treatment decisions. This review will summarize the evidence on the evolution of MRI for PCLs, the prevalence of PCLs using MRI, and the MRI features to diagnose specific PCL types and early malignancy. We will also describe topics such as the utility of gadolinium and secretin in MRIs of PCLs, the limitations of MRI for PCLs, and future directions.
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Affiliation(s)
- Elit Quingalahua
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mahmoud M. Al-Hawary
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jorge D. Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence:
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Pancreatic Cystic Tumors: A Single-Center Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020241. [PMID: 36837443 PMCID: PMC9964881 DOI: 10.3390/medicina59020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: The aim of the study was to analyze the prevalence and characteristics of pancreatic cystic tumors (PCTs). Material and Methods: A retrospective analysis of the medical records of 124 patients, 102 (69%) women and 46 (31%) men, who had undergone surgery for pancreatic cystic tumors in 2014-2018. Among 148 pancreatic cysts, 24 (16%) were non-neoplasmatic and 124 (84%) were neoplasmatic. The neoplasmatic cysts (n = 124) were included in our analysis. There were five main types of PCTs: IPMN (intraductal papillary mucinous neoplasm) (n = 45), MCN (mucinous cystic neoplasm) (n = 30), SCN (serous cystic neoplasm) (n = 28), SPN (solid pseudopapillary neoplasm) (n = 8), and CPEN (cystic pancreatic endocrine neoplasm) (n = 8), as well as mixed-type tumors (n = 5). Results: A statistically significant dependency between PCT type and age was proven (p= 0.0001): IPMNs were observed in the older group of patients with an average age of 66.12 (40-79) years while SPNs were noted in the youngest group of patients with an average age of 36.22 (22-55) years. A statistically significant association between PCT type and gender (p = 0.0001) was found: IPMNs occurred among 24 (53.33%) men and 21 (46.6%) women. In the MCN and SPN groups, all patients were female (100%). Among the SCN group, the majority were women (27 (96.43%)), and there was only 1 (3.57%) man. A statistically significant dependency between PCT type and size was proven (p = 0.0007). The mean size of IPMNs was the smallest 2.95 (0.6-10 cm) and the mean size of MCNs was the largest 6.78 (1.5-19 cm). A statistically significant dependency between PCT type and tumor location was proven (p = 0.000238). The most frequent location of IPMN was the pancreatic head: 27 (60%). MCN was most frequently located in the pancreatic tail (18 (60%)). Most (10/28) SCNs were found in the pancreatic tail (10 (35.71%)). CPENs were most frequently located in the pancreatic tail (three (37.5%)) and pancreatic body and tail (three (37.5%)). SPNs were located commonly in the pancreatic head (five (62.5%)). The type of surgery depended on the tumor location. The most frequent surgery for IPMNs was pancreatoduodenectomy (44.4%), while for MCNs and SCNs, it was distal pancreatectomy (81%). The postoperative morbidity and mortality were 34.68% and 1.61%, respectively. Postoperative pancreatic fistula (POPF) was the most frequent (29%) complication. Conclusions: IPMN was the most frequent resected PCT in our material. A statistically significant association between the type of cyst and location within the pancreas, size, local lymph node involvement, and patient's age and sex was proved. POPF was the most frequent postoperative complication. In patients with PCTs, due to substantial postoperative morbidity, adequate patient selection, considering both the surgical risk as well as the long-term risk of malignant transformation, is very important during qualification for surgery.
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Kloth C, Haggenmüller B, Beck A, Wagner M, Kornmann M, Steinacker JP, Steinacker-Stanescu N, Vogele D, Beer M, Juchems MS, Schmidt SA. Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines. Diagnostics (Basel) 2023; 13:diagnostics13030454. [PMID: 36766560 PMCID: PMC9914853 DOI: 10.3390/diagnostics13030454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Benedikt Haggenmüller
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Annika Beck
- Institute of Pathology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Martin Wagner
- Department of Internal Medicine 1, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Marko Kornmann
- Department of General and Visceral Surgery, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jochen P. Steinacker
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nora Steinacker-Stanescu
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Markus S. Juchems
- Department of Diagnostic and Interventional Radiology, Konstanz Hospital, Mainaustraße 35, 78464 Konstanz, Germany
| | - Stefan A. Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-500-61004; Fax: +49-731-500-61005
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Chen C, Lin X, Lin R, Huang H, Lu F. A high serum creatine kinase (CK)-MB-to-total-CK ratio in patients with pancreatic cancer: a novel application of a traditional marker in predicting malignancy of pancreatic masses? World J Surg Oncol 2023; 21:13. [PMID: 36653771 PMCID: PMC9847085 DOI: 10.1186/s12957-023-02903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The finding that some benign pancreatic masses mimic the imaging appearance of carcinomas poses a challenge for pancreatic surgeons. Preoperative markers that assist in the diagnosis are critical under this circumstance. Abnormal serum creatine kinase (CK) isozyme levels were reported in cancer patients, and this study aimed to explore the potential value of the CK-MB-to-total-CK ratio (CK ratio) in differentiating pancreatic cancer (PC) from benign masses when combined with carbohydrate antigen 19-9 (CA19-9). METHODS A total of 190 patients primarily diagnosed with pancreatic masses were retrospectively reviewed and assigned to the PC group and the benign pancreatic mass (BPM) group. Sixty-eight controls were enrolled for comparison. Levels of preoperative parameters, including total serum CK, CK-MB, absolute neutrophil count, absolute lymphocyte count, albumin, and CA19-9, were recorded as well as pathological information. A logistic regression model was established to assess the application value of the combination of CA19-9 and the CK ratio in diagnosis. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the markers. RESULTS The CK ratio was significantly elevated in the PC group compared with the BPM group (P < 0.001). In the multivariate analysis, a CK ratio greater than 0.220 was a statistically significant variable for predicting malignancy of pancreatic masses (P=0.001). Patients with stage III/IV PC had a higher CK ratio than those with stage I/II PC (P<0.01). Combined detection of CA19-9 and the CK ratio produced an increased Youden index (0.739 vs. 0.815) with improved sensitivity (82.2% vs. 89.8%). CONCLUSIONS The CK ratio is elevated in patients with pancreatic adenocarcinoma and is an independent factor predicting pancreatic adenocarcinoma. The CK ratio augments the diagnostic capacity of CA19-9 in detecting malignancy.
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Affiliation(s)
- Cong Chen
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Xianchao Lin
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Ronggui Lin
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Heguang Huang
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Fengchun Lu
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
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10
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Impact of the transection plan on postoperative pancreatic fistulas occurring after robot-assisted distal pancreatectomy for nonmalignant pancreatic neoplasms. Surg Endosc 2023; 37:309-318. [PMID: 35941312 DOI: 10.1007/s00464-022-09489-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Postoperative pancreatic fistula (POPF) is the main complication of distal pancreatectomy (DP) and affects the prognosis of patients. The impact of several clinical factors mentioned in recent studies on POPF remains controversial. This study aimed to investigate the impact of a remnant pancreas and other perioperative factors on POPFs occurring after robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms. METHODS A total of 197 patients who received robot-assisted distal pancreatectomy (RDP) for nonmalignant pancreatic neoplasms at the Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2018 to December 2020 were included in this retrospective study. According to the intraoperative transection plan, patients were divided into an RDP body group and an RDP tail group. Clinical and pathological features and perioperative factors affecting POPF were analyzed and compared between the two groups. RESULTS The results showed that a transection plan involving the tail of the pancreas (OR = 2.133, 95% CI 1.109-4.103, p = 0.023) and spleen preservation (OR = 2.588, 95% CI 1.435-4.665, p = 0.001) independently increased the incidence of POPF in patients with nonmalignant pancreatic neoplasms treated by RDP. A transection plan involving the tail of the pancreas was also an independent risk factor (OR = 3.464, 95% CI 1.270-9.450, p = 0.015) for grade B/C POPF. Length of remnant pancreas > 6.23 cm was an independent risk factor for POPF (OR = 3.116, 95% CI 1.364-7.121, p = 0.007). Length of remnant pancreas > 9.82 cm was an independent risk factor for grade B/C POPF (OR = 3.340, 95% CI 1.386-8.051, p = 0.007). CONCLUSION This retrospective study suggests that a transection plan involving the tail of the pancreas is an independent risk factor for POPF in patients with nonmalignant neoplasms treated by RDP. We also propose that the postoperative length of the remnant pancreas evaluated by computed tomography scans can be used to identify patients with a high risk of POPF in order to optimize the individualized strategy.
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Scherer JA, Gebhard R, Firkins SA, Shah ZK, Urbina Andersson IK, Barker SJ, Fiorillo LE, Hollander E, Shaheen N, Koay EJ, Conwell DL, Krishna SG. Lower Interobserver Reliability for Nondimensional Intracystic Features Among Abdominal Radiologists for Characterizing Intraductal Papillary Mucinous Neoplasms Using Magnetic Resonance Imaging. Pancreas 2022; 51:1225-1230. [PMID: 37078949 DOI: 10.1097/mpa.0000000000002174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Current guidelines recommend magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) for risk stratification of intraductal papillary mucinous neoplasms (IPMNs). We assessed the interobserver agreement among radiologists in evaluating and risk stratifying IPMNs. METHODS This single-center study evaluated 30 patients with IPMNs who had undergone MRI/MRCP, endoscopic ultrasound, and/or surgical resection. Six abdominal radiologists evaluated the MRI/MRCPs to document multiple parameters. The analysis applied Landis and Koch κ interpretation for categorical variables and intraclass correlation coefficient (r) for continuous variables. RESULTS Radiologists demonstrated almost perfect agreement for location (κ = 0.81, 95% confidence interval [CI], 0.74-0.87), size (r = 0.95; 95% CI, 0.89-0.98), and main pancreatic duct diameter (r = 0.98; 95% CI, 0.96-0.99). Substantial agreement was observed for communication with the main pancreatic duct (κ = 0.66; 95% CI, 0.57-0.75) and classification of IPMN subtype (κ = 0.77; 95% CI, 0.67-0.86). Presence of intracystic nodules (κ = 0.31; 95% CI, 0.21-0.42) and wall thickening (κ = 0.09; 95% CI, -0.01 to 0.18) reached only fair and slight agreement, respectively. CONCLUSIONS Although MRI/MRCP is excellent in the evaluation of spatial aspects, there is lower reliability for nondimensional characteristics of IPMNs. These data support guideline-recommended complementary evaluation of IPMNs with MRI/MRCP and endoscopic ultrasound.
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Affiliation(s)
| | | | - Stephen A Firkins
- Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | | | | | - Samantha J Barker
- Department of Radiology, University of Minnesota Medical Center, Minneapolis
| | | | | | | | - Eugene J Koay
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Darwin L Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus
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12
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Yang Z, Shi G. Comparison of clinicopathologic characteristics and survival outcomes between invasive IPMN and invasive MCN: A population-based analysis. Front Oncol 2022; 12:899761. [PMID: 35965523 PMCID: PMC9372276 DOI: 10.3389/fonc.2022.899761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) are two main histological subtypes of pancreatic cystic neoplasms with rapidly increasing incidence recently. The natural histories, treatment patterns, and survival outcomes of invasive IPMN and invasive MCN have not been well explored.MethodsPatients with a diagnosis of invasive IPMN and invasive MCN in the SEER database from 2000 through 2018 were retrospectively identified. Multivariable Cox regression analysis was conducted to determine the independent risk factors associated with overall survival (OS). Subgroup analyses of survival outcomes for invasive IPMN and invasive MCN were conducted. The OS for invasive IPMN was compared between patients who underwent surgery alone and those who received surgery plus chemotherapy by propensity score matching (PSM).ResultsA total of 2,505 patients were included, of whom 2,300 were diagnosed with invasive IPMN and 205 were diagnosed with invasive MCN. Half of the invasive IPMN (48.4%) and three-quarters of the invasive MCN (76.1%) patients were female. Of all patients, both the OS and cancer-specific survival were significantly better in the invasive MCN cohort compared to the invasive IPMN cohort. In subgroup analyses, while invasive MCN experienced better OS compared to invasive IPMN in the subgroups of patients with local–regional disease, the survival advantages disappeared in patients at a distant stage. In addition, surgery plus chemotherapy in invasive IPMN patients was associated with significantly better survival compared to surgery alone after PSM.ConclusionWe examined the demographic and clinical characteristics between invasive IPMN and invasive MCN patients using a large-population-based analysis. Although the OS is significantly better for invasive MCN versus invasive IPMN, the difference disappeared in patients with distant disease. A combination of surgery and chemotherapy in selected invasive IPMN patients could confer survival benefits compared to surgery alone.
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13
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Pancreatic cystic lesions. Differential diagnosis and treatment strategy. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2022; 87:188-197. [DOI: 10.1016/j.rgmxen.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
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14
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Song L, Jiang Z, Cui J, Gao B, Luo Y. Benign Pancreatic Neurofibroma with Malignant Imaging Features: A Case Report and Literature Review. Front Surg 2022; 9:874006. [PMID: 35465421 PMCID: PMC9022114 DOI: 10.3389/fsurg.2022.874006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Pancreatic neurofibroma is a very rare benign neurogenic tumor unrelated to neurofibromatosis type 1 (NF-1). As the volume increases, it has the risk of malignant transformation. The surgical prognosis of pancreatic neurofibroma is good, but its preoperative imaging features are very similar to those of malignant tumors, which may affect the formulation of treatment plans. This article reports a case of giant neurofibroma of the pancreas with contrast-enhanced ultrasound (CEUS) as one of the diagnostic methods and discusses the tumor’s preoperative clinical features, laboratory examinations, and imaging features.
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15
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Abstract
The basic pancreatic lesions include location, size, shape, number, capsule, calcification/calculi, hemorrhage, cystic degeneration, fibrosis, pancreatic duct alterations, and microvessel. One or more basic lesions form a kind of pancreatic disease. As recognizing the characteristic imaging features of pancreatic basic lesions and their relationships with pathology aids in differentiating the variety of pancreatic diseases. The purpose of this study is to review the pathological and imaging features of the basic pancreatic lesions.
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16
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Abubakar I, Bashir B, Agbo S, Umar M, Sani H, Abdullahi M, Emetuma F. Pancreatic cystic lesions: An 11 years (2010–2020) of experience at Usmanu Danfodiyo University teaching hospital, Sokoto. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_73_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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A nomogram for predicting pancreatic mucinous cystic neoplasm and serous cystic neoplasm. Abdom Radiol (NY) 2021; 46:3963-3973. [PMID: 33748881 DOI: 10.1007/s00261-021-03038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To develop and validate a nomogram for the preoperative prediction of pancreatic serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN) based on multidetector computed tomography (MDCT). MATERIALS AND METHODS In this retrospective study, the data of 227 patients with SCN and MCN were analyzed. Each patient underwent MDCT and surgical resection. A multivariable logistic regression model was developed using a training set consisting of 129 patients with SCN and 38 patients with MCN who were admitted between October 2012 and April 2019. The model was validated in 60 consecutive patients, 44 of whom had SCN and 16 of whom had MCN, admitted between May 2019 and April 2020. The regression model was adopted to establish a nomogram. Nomogram performance was determined by its discriminative ability and clinical utility. RESULT The multivariable logistic regression model included sex, size, location, shape, cyst characteristic, and cystic wall thickening. The individualized prediction nomogram showed good discrimination in the training sample (AUC 0.89; 95% CI 0.83-0.95) and in the validation sample (AUC 0.81; 95% CI 0.70-0.94). If the threshold probability is between 0.03 and 0.9, and > 0.93 in the prediction model, using the nomogram to predict SCN and MCN is more beneficial than the treat-all-patients as SCN scheme or the treat-all-patients as MCN scheme. The prediction model showed better discrimination than the radiologists' diagnosis (AUC = 0.68). CONCLUSION The nomogram could predict SCN and MCN preoperatively and may aid clinical decision-making.
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Multiparameter Analysis Using 18F-FDG PET/CT in the Differential Diagnosis of Pancreatic Cystic Neoplasms. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6658644. [PMID: 33880111 PMCID: PMC8046553 DOI: 10.1155/2021/6658644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022]
Abstract
Purpose To evaluate multiparametric analysis in differential diagnosis between pancreatic serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) as well as the differentiation of the benign and malignant MCNs with 18F-FDG (18-fluorodeoxyglucose) PET/CT (positron emission tomography). Methods Forty patients with total of 41 lesions (SCNs: 27/41; MCNs: 14/41), who were preoperatively examined with 18F-FDG PET/CT, were retrospectively analyzed. Multiple quantitative parameters using conventional and texture features were included. The combined model was established with complementary PET/MR parameters. The differential diagnostic efficacy of each independent parameter and the combined model were evaluated with receiver operating characteristic (ROC) analysis. Integrated discriminatory improvement (IDI) and net reclassification improvement (NRI) were used to evaluate improvement of diagnostic efficacy by using combination of multiple parameters. Results Among all independent parameters, the percentile 5th (0.88 ± 0.38 vs 0.47 ± 0.23, P < 0.001) showed the highest discriminative diagnostic value. The combination of multiple parameters can improve the differential diagnostic efficacy of SCNs and MCNs (sensitivity = 71.4%, specificity = 77.8%, and AUC = 0.788), and the addition of texture parameters to the conventional parameters allowed a significant reclassification with IDI = 0.236 (95% CI: 0.095-0.377) and categorical NRI = 0.434 (95% CI: 0.030-0.838). SURmax (tumor to normal pancreas ratio, T/P) and SURmax (tumor to aorta ratio, T/A) both showed the highest discriminative diagnostic value (sensitivity = 100.0%, specificity = 70.0%, AUC = 0.900, and Youden index = 0.700) in the differential diagnosis of benign and malignant MCNs, with the cutoff values of 0.84 and 0.90, respectively. Conclusion Combination of multiple parameters using 18F-FDG PET/CT could further improve differentiation between pancreatic SCNs and MCNs. SURmax (T/P) and SURmax (T/A) could improve differential diagnosis of benign and malignant MCNs.
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Laukamp KR, Tirumani SH, Lennartz S, Hokamp NG, Gupta A, Pennig L, Persigehl T, Gilkeson R, Ramaiya N. Evaluation of equivocal small cystic pancreatic lesions with spectral-detector computed tomography. Acta Radiol 2021; 62:172-181. [PMID: 32306744 DOI: 10.1177/0284185120917119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Evaluation of small cystic lesions of the pancreas remains a challenging task, as due to their size appearance can be rather hypodense than clearly fluid-filled. PURPOSE To evaluate whether additional information provided by novel dual-layer spectral-detector computed tomography (SDCT) imaging can improve assessment of these lesions. MATERIAL AND METHODS For this retrospective study, we reviewed reports of 1192 contrast-enhanced portal-venous phase SDCT scans of the abdomen conducted between May 2017 and January 2019. On basis of the radiological report 25 small (≤1.5 cm) cystic pancreatic lesions in 22 patients were identified, in which additional short-term follow-up imaging was recommended to confirm/clarify cystic nature. Conventional images (CI) and spectral images (SI) including virtual-monoenergetic images at 40 keV (VMI), iodine-density and iodine-overlay images were reconstructed. Two readers indicated lesion conspicuity and confidence for presence of cystic nature on three-point scales. First, solely CI were evaluated, while in a second reading after a four-week interval, the combination of CI and corresponding SI were reviewed. Quantitatively, ROI-based mean attenuation was measured in CI and VMI. RESULTS In the subjective reading, SI significantly improved lesion conspicuity (CI 2 [1-2], SI 3 [2-3], P < 0.001) and confidence regarding presence of cystic nature (CI 2 [1-2], SI 3 [3-3], P < 0.001). Inter-observer agreement depicted by intraclass correlation coefficient improved considerably from 0.51 with only CI to 0.85 when the combination with SI was used. Further, VMI displayed significantly higher signal-to-noise (CI 1.2 ± 0.8, VMI 3.2 ± 1.8, P < 0.001) and contrast-to-noise ratios (CI 2.6 ± 0.8, VMI 4.7 ± 1.9). CONCLUSION Compared to CI alone, combination with SI significantly improves visualization and confidence in evaluation of small equivocal cystic pancreatic lesions.
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Affiliation(s)
- Kai Roman Laukamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
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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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21
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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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22
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Molecular markers contribute to the clinical diagnosis for pancreatic cystic neoplasms. Chin Med J (Engl) 2020; 133:847-852. [PMID: 32106125 PMCID: PMC7147649 DOI: 10.1097/cm9.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A pancreatic cystic neoplasm (PCN) is a rare pancreatic disease. Malignant PCNs are usually identified incidentally while evaluating other lesions. However, PCNs are being identified more frequently owing to the increased use of abdominal imaging. Malignant PCNs have complicated and diverse biological behaviors, including various malignant risk factors, diverse molecular features, natural history, and complex pathological classifications. Although many diagnostic methods, such as cross-sectional imaging and endoscopic evaluation, have been developed, malignant PCNs are still difficult to differentiate from benign tumors. On searching for related articles in the recent decade, we found that some molecular biomarkers such as carcinoembryonic antigen could be useful for discriminating between malignant tumors and benign tumors. However, cytopathologic evaluation is the most useful method for differentiating between benign and malignant lesions. Although cytopathologic evaluation has a specificity of 100% for identifying malignancies, its accuracy is often hampered by the low cellularity of PCN cells in the cystic fluid. Herein, we review the progress in the use of cellular and molecular markers for the accurate identification of PCNs.
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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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Xu X, Chen D, Cao L, Feng X, Tong R, Zheng S, Wu J. Spontaneous rupture of solid pseudopapillary tumor of pancreas: A case report and review of literature. Medicine (Baltimore) 2019; 98:e17554. [PMID: 31689759 PMCID: PMC6946308 DOI: 10.1097/md.0000000000017554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Solid pseudopapillary tumors (SPT) account for 1% to 3% of all pancreatic tumors. They have low malignant potential with a favorable prognosis, and predominantly occur in young women. The pathogenesis and clinical behavior of SPT are still uncertain. In addition, most ruptures of SPT were associated with blunt abdominal trauma, while spontaneous ruptures seemed to be quite rare. Up to now, there have been only 3 spontaneous ruptured SPT cases reported worldwide. PATIENT CONCERNS Here, we reported a 22-year-old female patient with left lower abdominal pain. Computed tomography (CT) showed that a hemorrhagic complex solid cystic mass located in the lesser omentum sac. DIAGNOSIS According to pathological findings of tumor specimen, the diagnosis of solid pseudopapillary tumor (SPT) of the pancreas was made. INTERVENTIONS Distal pancreatectomy and splenectomy was carried out. OUTCOMES The patient recovered to normal status within 10 days after surgery. CONCLUSION Besides, we reviewed about 50 cases in literatures to find out the clinical characteristics and differential diagnostic strategies of SPT.
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Affiliation(s)
- Xiaofeng Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
| | - Diyu Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health,
| | - Linping Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
| | - Xiaode Feng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health,
| | - Rongliang Tong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health,
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health,
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, Zhejiang, China
| | - Jian Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University,
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health,
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, Zhejiang, China
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