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Ferronato M, Lizzio CE, Berardinelli D, Marini D, Elia E, Andreetto L, Trentini A, Potenza MC, Serra C, Mazzotta E, Ricci C, Casadei R, Migliori M. Abdominal ultrasound in the characterization of branch-duct intraductal papillary mucinous neoplasms: A new tool for surveillance of low-risk patients? Dig Liver Dis 2024; 56:1071-1077. [PMID: 38042636 DOI: 10.1016/j.dld.2023.11.010] [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: 07/05/2023] [Revised: 10/06/2023] [Accepted: 11/07/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is regarded as gold-standard for intraductal papillary mucinous neoplasms (IPMNs) follow-up. Given the low risk of transformation and the increasing population under surveillance, there is growing interest in identifying optimal follow-up strategies. AIM To evaluate reliability of abdominal ultrasound (US) for characterization of low-risk IPMN, compared to MRI. METHODS Prospective monocentric study among 79 consecutive patients with a suspected BD-IPMN on US. Each patient underwent confirmatory MRI. We evaluated Cohen's kappa statistic and concordance rate (CR) between MRI and US. RESULTS Of 79 suspected IPMNs on US, MRI confirmed 71 BD-IPMNs. There was high agreement for cyst location and number (CR and kappa of 77.5 % and 81.7 % and 0.66±0.08 and 0.62±0.11 respectively). We found high agreement for cyst size (CR=96.5 %, kappa=0.93±0.05) and main pancreatic duct (MPD) dilatation (CR=100 %, kappa=1). There was a good agreement for thickened septa (CR=80.3 %, kappa=0.38±0.12). US seems inferior to MRI for the identification of mural nodules < 5 mm (CR=97.2 %, kappa=0). CONCLUSIONS In a cohort of low-risk BD-IPMN, US presented high agreement rate with MRI regarding location, number, and size. There was a good agreement for MPD dilatation and thickened septa, while US underperform for detection of mural nodules < 5 mm.
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Affiliation(s)
- Marco Ferronato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy.
| | - Chiara Elide Lizzio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Dante Berardinelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Desy Marini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Eleonora Elia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Lorenzo Andreetto
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Alice Trentini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Maria Chiara Potenza
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Carla Serra
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Interventional Utrasound Unit, Italy
| | - Elena Mazzotta
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
| | - Claudio Ricci
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Pancreas and Endocrine Surgery Unit, Italy
| | - Riccardo Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Pancreas and Endocrine Surgery Unit, Italy
| | - Marina Migliori
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit, Italy
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2
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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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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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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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5
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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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6
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Zhong L, Chai N, Linghu E, Li H, Yang J, Tang P. A prospective study on endoscopic ultrasound for the differential diagnosis of serous cystic neoplasms and mucinous cystic neoplasms. BMC Gastroenterol 2019; 19:127. [PMID: 31311499 PMCID: PMC6636106 DOI: 10.1186/s12876-019-1035-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background To provide criteria for the differential diagnosis of serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) by analyzing the imaging features of these two neoplasms by endoscopic ultrasound (EUS). Methods From April 2015 to December 2017, a total of 69 patients were enrolled in this study. All patients were confirmed to have MCNs (31 patients) or SCNs (38 patients) by surgical pathology. All patients underwent EUS examination. The observation and recorded items were size, location, shape, cystic wall thickness, number of septa, and solid components. Results Head/neck location, lobulated shape, thin wall and > 2 septa were the specific imaging features for the diagnosis of SCNs. When any two imaging features were combined, we achieved the highest area under the curve (Az) (0.824), as well as the appropriate sensitivity (84.2%), specificity (80.6%), positive predictive value (PPV) (84.2%), and negative predictive value (NPV) (80.6%). Body/tail location, round shape, thick wall and 0–2 septa were the specific imaging features for the diagnosis of MCNs. When any three imaging features were combined, we obtained the highest Az value (0.808), as well as the appropriate sensitivity (77.4%), specificity (84.2%), PPV (80.0%) and NPV (82.1%). Conclusions Pancreatic cystadenomas that meet any two of the four imaging features of head/neck location, lobulated shape, thin wall and > 2 septa could be diagnosed as SCNs, and those that meet any three of the four imaging features of body/tail location, round shape, thick wall and 0–2 septa could be considered as MCNs. Trial registration The study was registered at the Chinese Clinical Trial Registry. The registration identification number is ChiCTR-OOC-15006118. The date of registration is 2015-03-20.
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Affiliation(s)
- Lisen Zhong
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Huikai Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jing Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
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7
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Yang J, Guo X, Ou X, Zhang W, Ma X. Discrimination of Pancreatic Serous Cystadenomas From Mucinous Cystadenomas With CT Textural Features: Based on Machine Learning. Front Oncol 2019; 9:494. [PMID: 31245294 PMCID: PMC6581751 DOI: 10.3389/fonc.2019.00494] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/24/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives: This study was designed to estimate the performance of textural features derived from contrast-enhanced CT in the differential diagnosis of pancreatic serous cystadenomas and pancreatic mucinous cystadenomas. Methods: Fifty-three patients with pancreatic serous cystadenoma and 25 patients with pancreatic mucinous cystadenoma were included. Textural parameters of the pancreatic neoplasms were extracted using the LIFEx software, and were analyzed using random forest and Least Absolute Shrinkage and Selection Operator (LASSO) methods. Patients were randomly divided into training and validation sets with a ratio of 4:1; random forest method was adopted to constructed a diagnostic prediction model. Scoring metrics included sensitivity, specificity, accuracy, and AUC. Results: Radiomics features extracted from contrast-enhanced CT were able to discriminate pancreatic mucinous cystadenomas from serous cystadenomas in both the training group (slice thickness of 2 mm, AUC 0.77, sensitivity 0.95, specificity 0.83, accuracy 0.85; slice thickness of 5 mm, AUC 0.72, sensitivity 0.90, specificity 0.84, accuracy 0.86) and the validation group (slice thickness of 2 mm, AUC 0.66, sensitivity 0.86, specificity 0.71, accuracy 0.74; slice thickness of 5 mm, AUC 0.75, sensitivity 0.85, specificity 0.83, accuracy 0.83). Conclusions: In conclusion, our study provided preliminary evidence that textural features derived from CT images were useful in differential diagnosis of pancreatic mucinous cystadenomas and serous cystadenomas, which may provide a non-invasive approach to determine whether surgery is needed in clinical practice. However, multicentre studies with larger sample size are needed to confirm these results.
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Affiliation(s)
- Jing Yang
- State Key Laboratory of Biotherapy, Department of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China
| | - Xinli Guo
- West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Xuejin Ou
- State Key Laboratory of Biotherapy, Department of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China
| | - Weiwei Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- State Key Laboratory of Biotherapy, Department of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China
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Morelli L, Guadagni S, Borrelli V, Pisano R, Di Franco G, Palmeri M, Furbetta N, Gambaccini D, Marchi S, Boraschi P, Bastiani L, Campatelli A, Mosca F, Di Candio G. Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging. World J Gastroenterol 2019; 25:2217-2228. [PMID: 31143072 PMCID: PMC6526159 DOI: 10.3748/wjg.v25.i18.2217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with pancreatic cystic neoplasms (PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime image-based surveillance follow-up. In these patients, the current European evidenced-based guidelines advise magnetic resonance imaging (MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound (US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by US.
AIM To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of MRI.
METHODS We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US findings. In this communication, we reported the clinical results of this alternative follow-up, and the results of a comparative cost-analysis between our surveillance protocol (abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance protocol.
RESULTS In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients (1%) because of the appearance of suspicious features at imaging (with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN appearance in 28 patients (14%). These comprised main pancreatic duct dilatation (n = 1), increased size of the main cyst (n = 14) and increased number of PNC (n = 13). In all of these patients, MRI confirmed US findings, without adding more information. The bi-annual MRI identified evolution of the lesions not identified by US in only 11 patients with intraductal papillary mucinous neoplasms (5.5%), largely consisting of an increased number of very small PCN (P = 0.14). The overall mean cost of surveillance, based on a theoretical use of the European evidenced-based exclusive MRI surveillance in the same group of patients, would have been 1158.9 ± 798.6 € per patient, in contrast with a significantly lower cost of 366.4 ± 348.7 € (P < 0.0001) incurred by the US-restricted MRI surveillance used at our institution.
CONCLUSION In patients with non-surgical PCN at the time of diagnosis, US surveillance could be a safe complementary approach to MRI, delaying and reducing the numbers of second level examinations and therefore reducing the costs.
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Affiliation(s)
- Luca Morelli
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa 56124, Italy
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa 56124, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa 56124, Italy
| | - Valerio Borrelli
- Diagnostic and Interventional Ultrasound in Transplants Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa 56124, Italy
| | - Roberta Pisano
- Diagnostic and Interventional Ultrasound in Transplants Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa 56124, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa 56124, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa 56124, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa 56124, Italy
| | | | - Santino Marchi
- Gastroenterology Unit, University of Pisa, Pisa 56124, Italy
| | - Piero Boraschi
- 2nd Radiology Unit, Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Pisana, Pisa 56124, Italy
| | - Luca Bastiani
- Institute of Clinical Physiology, National Council of Research, Pisa 56124, Italy
| | - Alessandro Campatelli
- Diagnostic and Interventional Ultrasound in Transplants Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa 56124, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa 56124, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Surgery, Translational and New Technologies in Medicine, University of Pisa, Pisa 56124, Italy
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Chingkoe CM, Brook A, Moser AJ, Mortele KJ. Subspecialized radiology review at multidisciplinary pancreas conference: impact on patient management. Abdom Radiol (NY) 2018; 43:2783-2789. [PMID: 29550957 DOI: 10.1007/s00261-018-1549-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE At our tertiary medical center, multidisciplinary subspecialists meet twice a week during a CME-accredited conference to discuss oncologic and non-oncologic patients with pancreatic diseases at which time a subspecialized abdominal staff radiologist reinterprets the patient's relevant imaging studies. This study assesses the changes in patient management due to imaging reinterpretation during multidisciplinary pancreas conference (MPC). MATERIALS AND METHODS In this retrospective, IRB-approved, HIPAA-compliant study, imaging studies of all patients discussed at MPC between July 1 and December 31, 2015 were assessed for technical adequacy, and original reports analyzed for congruency with reinterpretation. Management measures included change in diagnosis, clinical stage, treatment, or workup. Additional data were obtained on referring services affected and their resultant change in practice. Changes in surgical resectability, surgical approach, or delayed operative dates were noted for surgeons. Changes in chemotherapeutic or radiation oncology regimens as well as decisions for additional imaging, laboratory workup, or histologic evaluation were also recorded. RESULTS A total of 252 patients were included (54.4% males, 45.6% females, mean age 63.71 years). Relevant imaging consisted of 142 abdominal CT scans, 112 abdominal MRI scans, 1 abdominal ultrasound, and 1 nuclear medicine octreotide study of which 69.4% were performed in-house. Image quality was deemed appropriate in 95.2%. Cases presented included solid pancreatic malignancies (n = 140; 55.6%), cystic pancreatic lesions (n = 41; 16.3%), acute and chronic inflammatory conditions (n = 52; 20.6%), and miscellaneous entities (n = 10; 4.0%); 9 (3.6%) cases were normal. Image reinterpretation was congruent with original reports in 56.7%, with minor, moderate, and major discrepancies occurring in 9.5, 26.2%, and 7.5% of cases, respectively. Incongruent reinterpretation was predominantly due to perceptional errors (false-negative reports due to missed findings) and interpretative errors (false-positive results due to over-reporting or misclassification of diagnoses). Services most commonly affected included surgical oncology, radiology, and gastroenterology at 16.7%, 13.1%, and 12.7% of cases, respectively. Management changes included a change in diagnosis in 8.7%, change in clinical stage in 8.7%, change in treatment in 17.9%, and further workup needed in 19.0% of patients, respectively. No change in management occurred in the remaining 61.5% of cases. CONCLUSIONS Subspecialized abdominal radiologist reinterpretation in the context of more comprehensive patient information heavily impacts the multidisciplinary management of patients with pancreatic disorders. Further efforts are needed to solidify the abdominal radiologist's role in the multidisciplinary clinical setting.
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Affiliation(s)
- C M Chingkoe
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. Shapiro Clinical Center, 4th Floor, Boston, MA, 02215, USA
| | - A Brook
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. Shapiro Clinical Center, 4th Floor, Boston, MA, 02215, USA
| | - A J Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K J Mortele
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. Shapiro Clinical Center, 4th Floor, Boston, MA, 02215, USA.
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10
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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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11
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12
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Abstract
Imaging of the endocrine pancreas is dominated by neuroendocrine tumors, a diverse category of neoplasms that may or may not cause symptoms from hormone hypersecretion. These tumors may also be evidence of several different genetic syndromes. Understanding the usefulness of different imaging modalities and entities that simulate neuroendocrine tumors is key for both radiologists and referring physicians.
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Affiliation(s)
- Mark Masciocchi
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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13
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Current status of multi-detector row helical CT in imaging of adult acquired pancreatic diseases and assessing surgical neoplastic resectability. ALEXANDRIA JOURNAL OF MEDICINE 2017. [DOI: 10.1016/j.ajme.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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14
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Vidhyarkorn S, Siripongsakun S, Yu J, Sayre J, Agopian VG, Durazo F, Lu DS. Longterm follow-up of small pancreatic cystic lesions in liver transplant recipients. Liver Transpl 2017; 23:324-329. [PMID: 27875639 DOI: 10.1002/lt.24680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/08/2016] [Indexed: 12/21/2022]
Abstract
Incidental small pancreatic cystic lesions (PCLs) are often found on preoperative imaging in patients undergoing orthotopic liver transplantation (OLT). Although these are considered benign or of low malignant potential, the influence of immunosuppression after OLT may be of concern. The aim of this study was to observe the longterm outcome of these small PCLs in post-OLT patients. An institutional OLT database of 1778 consecutive OLT patients from January 2000 to December 2010 was analyzed. Computed tomography, magnetic resonance imaging, or endoscopic ultrasound at the time of OLT and all subsequent imaging, cytology, fluid analysis of PCLs, and patient status were evaluated. A total of 70 patients with 182 PCLs, of benign or low malignant potential, were identified with a mean follow-up time of 64 months. At initial diagnosis of PCLs in 48 patients, 7 branch duct-type intraductal papillary mucinous neoplasms (B-IPMNs), 1 serous cystadenoma (SCA), and 40 nonspecific benign cysts were identified. Final diagnosis at the end of the follow-up revealed 16 B-IPMNs, 3 SCAs, and a mixed acinar-neuroendocrine carcinoma, in which the latter developed 9 years after initial diagnosis of B-IPMN. During the follow-up time, average increase in size and number of PCLs were 4.5 mm and 1.4, respectively (P < 0.001 for both). The majority of incidental PCLs in OLT patients showed an indolent behavior despite immunosuppression. Risk of malignancy development was very low and comparable with normal population. Liver Transplantation 23 324-329 2017 AASLD.
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Affiliation(s)
- Sirachat Vidhyarkorn
- Department of Radiology, University of California, Los Angeles, CA.,Department of Radiology, Chulabhorn Hospital, Bangkok, Thailand
| | | | - Jennifer Yu
- Department of Radiology, University of California, Los Angeles, CA
| | - James Sayre
- School of Public Health, University of California, Los Angeles, CA
| | - Vatche G Agopian
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Francisco Durazo
- Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - David S Lu
- Department of Radiology, University of California, Los Angeles, CA
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15
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Sun Y, Zhou F, Liu F, Hu Y, Tan S, Liang P, Linghu E, Yu X. Discrimination of serous cystadenoma from mucinous cystadenoma in the pancreas with contrast-enhanced ultrasonography: a prospective study in 61 patients. Onco Targets Ther 2017; 10:1285-1294. [PMID: 28280363 PMCID: PMC5338980 DOI: 10.2147/ott.s125497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives The preoperative diagnosis between serous cystadenomas (SCAs) and mucinous cystadenomas (MCAs) in pancreas is significant due to their completely different biological behaviors. The purpose of our study was to examine and compare detailed contrast-enhanced ultrasonography (CEUS) images of SCAs and MCAs and to determine whether there are significant findings that can contribute to the discrimination between these two diseases. Methods From April 2015 to June 2016, 61 patients (35 patients with SCAs and 26 patients with MCAs) were enrolled in this study. Forty-three cases were confirmed by surgical pathology and 18 by comprehensive clinical diagnoses. All of the CEUS characteristics of these lesions were recorded: size, location, echogenicity, shape, wall characteristics, septa characteristics, and the presence of a honeycomb pattern or nodules. CEUS examinations were performed by two ultrasound physicians. Results Location (P=0.003), shape (P=0.000), thickness of the wall (P=0.005), the number of septa (P=0.001), and the honeycomb pattern (P=0.001) were statistically significantly different. A head–neck location, a lobulated shape, an inner regular honeycomb pattern, and a thin wall (<3 mm thick) were significant in diagnosing patients with SCAs. When two of these four findings were combined, we could achieve a sensitivity of 71.4% and a specificity of 80.8% to diagnose SCA; when three of these four findings were combined, the specificity was 100%. A body–tail location, a round/oval shape, 0–2 septa, and a thick wall (≥3 mm thick) were most often detected in patients with MCAs. When two of these four findings were combined, we could achieve a sensitivity of 88.5% and a specificity of 65.7% to diagnose MCA; when three of these four findings were combined, the area under the curve (Az) was highest at 0.832, with a sensitivity of 80.8% and a specificity of 85.7%. Conclusions The characteristics of tumor location, shape, thickness of the wall, the number of septa, and the honeycomb pattern by CEUS play an important role in the diagnosis of SCAs and MCAs. A combination of these findings can provide better diagnostic performance in the discrimination of SCAs from MCAs.
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Affiliation(s)
- Ya Sun
- Department of Interventional Ultrasound
| | - Fubo Zhou
- Department of Interventional Ultrasound
| | | | - Yanyan Hu
- Department of Interventional Ultrasound
| | | | | | - Enqiang Linghu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing, People's Republic of China
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16
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Boos J, Brook A, Chingkoe CM, Morrison T, Mortele K, Raptopoulos V, Pedrosa I, Brook OR. MDCT vs. MRI for incidental pancreatic cysts: measurement variability and impact on clinical management. Abdom Radiol (NY) 2017; 42:521-530. [PMID: 27581431 DOI: 10.1007/s00261-016-0883-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate incidental pancreatic cysts (IPCs) size discrepancy in a cohort of patients receiving both computed tomography (CT) and magnetic resonance imaging (MRI) and its impact on clinical management based on the 2010 American College of Radiology (ACR) guidelines. METHODS This was a HIPAA-compliant, retrospective, IRB-approved study. Informed consent was waived. Patients with known IPCs and at least one case-pair, consisting of an abdominal CT and MRI examination within 180 days between 05/1999 and 12/2011, were included. Maximum diameter of cysts was measured in both the CT and MR examinations. A subset of 30 patients was measured by three radiologists independently to assess inter-observer variability. Absolute difference in diameter measurements between CT and MRI was calculated. Influence of cyst size, cyst location, and patient characteristics such as weight, height, and body mass index (BMI) on variability of size measurements were evaluated. Clinical impact in terms of current ACR guidelines was assessed. RESULTS Overall, 267 case-pairs of cysts in 113 patients were included in this study. 59/267 cysts were visualized on MRI but not on CT (22.1%, 95% CI 17.1%-27.1%; 32 patients, 64.6 ± 11.7 years, BMI 28.5 ± 4.8 kg/m2), with a median MRI cyst size of 7.8 mm, IQR 6.0-9.0 mm, range 2-17.8 mm. 208 case-pairs in 113 patients with a mean BMI of 26.9 ± 5.1 kg/m2 (range 16.9-39.5 kg/m2) and mean cysts size of 13.4 ± 8.1 mm (range 3-49 mm) were seen in both CT and MRI. The mean absolute size difference for IPCs measured on MRI and CT was 2.1 ± 1.8 mm (median 1.5 mm, IQR 0.9-2.9 mm, range 0-9 mm). Absolute size difference between CT and MRI measurements increased with size of the cyst (r = 0.31, p < 0.001), whereas location of the cyst did not influence the absolute difference between CT and MRI measurements (p = 0.44). Patient weight and BMI had a negative correlation with the difference in cyst size between CT and MRI (weight r = -0.17, p = 0.023; BMI r = -0.17, p = 0.027), with cyst measurements being larger on MRI in thin patients and on CT in obese patients. Inter-reader variability was excellent (ICC = 0.99). In 12/208 (5.7%, 95% CI 2.7%-9.1%), variability between CT and MRI would have changed ACR-based follow-up recommendation. CONCLUSION There was a median difference of 1.5 mm between measurements of IPCs on CT vs. MRI. If imaging modality was switched during follow-up, variability of measurements may lead to inappropriate change of follow-up regimen in 6% of all cases. A single follow-up CT for incidental IPCs does not seem sufficient due to a high number (22%) of missed IPCs on CT.
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Affiliation(s)
- Johannes Boos
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexander Brook
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Christina M Chingkoe
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Trevor Morrison
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Koenraad Mortele
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Vassilios Raptopoulos
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Ivan Pedrosa
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Olga R Brook
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
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17
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Nougaret S, Mannelli L, Pierredon MA, Schembri V, Guiu B. Cystic pancreatic lesions: From increased diagnosis rate to new dilemmas. Diagn Interv Imaging 2016; 97:1275-1285. [PMID: 27840080 DOI: 10.1016/j.diii.2016.08.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/24/2016] [Indexed: 12/18/2022]
Abstract
Cystic pancreatic lesions vary from benign to malignant entities and are increasingly detected on cross-sectional imaging. Knowledge of the imaging appearances of cystic pancreatic lesions may help radiologists in their diagnostic reporting and management. In this review, we discuss the morphologic classification of these lesions based on a diagnostic algorithm as well as the management of these lesions.
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Affiliation(s)
- S Nougaret
- Department of Radiology, institut régional du cancer de Montpellier (IRCM), institut de recherche en cancérologie de Montpellier, Inserm, U1194, 371, avenue du Doyen-G.-Giraud, 34295 Montpellier, France.
| | - L Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 10075 New York, NY, USA
| | - M-A Pierredon
- Department of Radiology, hôpital Saint-Éloi, CHU de Monptellier, 34000 Montpellier, France
| | - V Schembri
- Department of Radiology, hôpital Saint-Éloi, CHU de Monptellier, 34000 Montpellier, France
| | - B Guiu
- Department of Radiology, hôpital Saint-Éloi, CHU de Monptellier, 34000 Montpellier, France
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18
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Qi XY, Ma L, Lu Q, Yang LL, Li JW, Ling WW, Luo Y. Ultrasonographic features and differential diagnosis of solid pseudopapillary tumors of the pancreas. Shijie Huaren Xiaohua Zazhi 2016; 24:1269-1276. [DOI: 10.11569/wcjd.v24.i8.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the ultrasonographic features of solid pseudopapillary tumors of the pancreas (SPTP) and their differential diagnosis from pancreatic neuroendocrine tumors (PNET) and pancreatic cancer (PC).
METHODS: Clinical data including conventional ultrasonographic characteristics for 52 patients with pathologically confirmed SPTP, 63 patients with PNET, and 68 patients with PC and the patterns of contrast enhanced ultrasonography (CEUS) in 6 cases of SPTP, 10 cases of PNET and 21 cases of PC were retrospectively analyzed.
RESULTS: There were significant differences between the SPTP group and the PNET group in age, sex, jaundice, tumor size, shape, calcification, liquefaction, separation, blood flow, arterial phase and late phase enhancement mode and non-enhancement area in the lesions (P < 0.05), while presence of abdominal pain, elevated CA-199, number of tumors, location, expansion of the main pancreatic duct and recurrence or metastasis had no statistical significance (P > 0.05). There were significant differences between the SPTP group and the PC group in age, sex, abdominal pain, jaundice, elevated CA-199, tumor size, location, shape, calcification, liquefaction, expansion of the main pancreatic duct, recurrence or metastasis, arterial phase enhancement mode and non-enhancement area in the lesions (P < 0.05), while number of tumors, separation, blood flow and late phase enhancement mode had no statistical significance (P > 0.05).
CONCLUSION: A solid or cystic-solid pancreatic tumor which shows peripheral ring enhancement in the arterial phase, hypo-enhancement in the late phase and central non-enhancement area could be considered as an SPTP in young female patients without jaundice, elevated CA-199 or main pancreatic duct dilation. It should be differentiated from PNET and PC.
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19
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Ciliated pancreatic foregut cyst: MRI, EUS, and cytologic features. Clin Imaging 2016; 40:140-3. [DOI: 10.1016/j.clinimag.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/21/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022]
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20
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Al-Hawary MM, Francis IR, Anderson MA. Pancreatic Solid and Cystic Neoplasms: Diagnostic Evaluation and Intervention. Radiol Clin North Am 2015; 53:1037-48. [PMID: 26321452 DOI: 10.1016/j.rcl.2015.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
High-resolution imaging modalities, such as multi-detector computed tomography, MR imaging, and endoscopic ultrasound, are frequently used alone or in combination to characterize focal solid and cystic pancreatic neoplasms. Imaging in solid pancreatic neoplasms, typically adenocarcinoma and neuroendocrine tumors, is primarily used to detect and stage the extent of the tumor and to determine if complete surgical resection for cure is feasible. In cystic pancreatic masses, imaging aims to differentiate benign nonmucinous cystic lesions from potentially or frankly malignant mucin-producing cysts. Several noninvasive and invasive treatment options can be performed if surgical resection is not possible or contraindicated.
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Affiliation(s)
- Mahmoud M Al-Hawary
- Division of Abdominal Imaging, Department of Radiology, University of Michigan Hospitals, 1500 East Medical Center Drive, Room B1 D502, Ann Arbor, MI 48109, USA.
| | - Isaac R Francis
- Division of Abdominal Imaging, Department of Radiology, University of Michigan Hospitals, 1500 East Medical Center Drive, Room B1 D540, Ann Arbor, MI 48109, USA
| | - Michelle A Anderson
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Hospitals, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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21
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Balachandran A, Bhosale PR, Charnsangavej C, Tamm EP. Imaging of pancreatic neoplasms. Surg Oncol Clin N Am 2015; 23:751-88. [PMID: 25246049 DOI: 10.1016/j.soc.2014.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ductal adenocarcinoma accounts for 85% to 90% of all solid pancreatic neoplasms, is increasing in incidence, and is the fourth leading cause of cancer-related deaths. There are currently no screening tests available for the detection of ductal adenocarcinoma. The only chance for cure in pancreatic adenocarcinoma is surgery. Imaging has a crucial role in the identification of the primary tumor, vascular variants, identification of metastases, disease response assessment to treatment, and prediction of respectability. Pancreatic neuroendocrine neoplasms can have a distinctive appearance and pattern of spread, which should be recognized on imaging for appropriate management of these patients.
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Affiliation(s)
- Aparna Balachandran
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA.
| | - Priya R Bhosale
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA
| | - Chuslip Charnsangavej
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Eric P Tamm
- Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA
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22
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Jana T, Shroff J, Bhutani MS. Pancreatic cystic neoplasms: Review of current knowledge, diagnostic challenges, and management options. J Carcinog 2015; 14:3. [PMID: 25821410 PMCID: PMC4374202 DOI: 10.4103/1477-3163.153285] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/01/2015] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cystic lesions are being detected with increasing frequency, largely due to advances in cross-sectional imaging. The most common neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, solid pseudopapillary neoplasms, and cystic pancreatic endocrine neoplasms. Computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) are currently used as imaging modalities. EUS-guided fine needle aspiration has proved to be a useful diagnostic tool, and enables an assessment of tumor markers, cytology, chemistries, and DNA analysis. Here, we review the current literature on pancreatic cystic neoplasms, including classification, diagnosis, treatment, and recommendations for surveillance. Data for this manuscript was acquired via searching the literature from inception to December 2014 on PubMed and Ovid MEDLINE.
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Affiliation(s)
- Tanima Jana
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Jennifer Shroff
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Medical School at Houston, Houston, TX, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Buscarini E, Pezzilli R, Cannizzaro R, De Angelis C, Gion M, Morana G, Zamboni G, Arcidiacono P, Balzano G, Barresi L, Basso D, Bocus P, Calculli L, Capurso G, Canzonieri V, Casadei R, Crippa S, D'Onofrio M, Frulloni L, Fusaroli P, Manfredi G, Pacchioni D, Pasquali C, Rocca R, Ventrucci M, Venturini S, Villanacci V, Zerbi A, Falconi M. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014; 46:479-93. [PMID: 24809235 DOI: 10.1016/j.dld.2013.12.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/07/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.
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Affiliation(s)
| | | | | | - Raffaele Pezzilli
- Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Claudio De Angelis
- Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy
| | - Massimo Gion
- Department of Clinical Pathology, AULSS 12, Venice, Italy
| | - Giovanni Morana
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Paolo Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy
| | - Gianpaolo Balzano
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Barresi
- Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - Paolo Bocus
- Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy
| | - Lucia Calculli
- Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy
| | | | - Riccardo Casadei
- Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Crippa
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy
| | - Pietro Fusaroli
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | | | - Claudio Pasquali
- Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Rodolfo Rocca
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Maurizio Ventrucci
- Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy
| | - Silvia Venturini
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Alessandro Zerbi
- Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Falconi
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
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Nougaret S, Reinhold C, Chong J, Escal L, Mercier G, Fabre JM, Guiu B, Molinari N. Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol 2014; 24:1020-9. [PMID: 24569848 DOI: 10.1007/s00330-014-3112-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/16/2014] [Accepted: 01/29/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine the natural history of incidentally detected pancreatic cysts and whether a simplified MRI protocol without gadolinium is adequate for lesion follow-up. METHODS Over a 10-year period, 301-patients with asymptomatic pancreatic cysts underwent follow-up (45 months ± 30). The magnetic resonance imaging (MRI) protocol included axial, coronal T2-weighted images, MR cholangiopancreatographic and fat suppressed T1-weighted sequences before and after gadolinium. Three radiologists independently reviewed the initial MRI, the follow-up studies using first only unenhanced images, then secondly gadolinium-enhanced-sequences. Lesion changes during follow-up were recorded and the added value of gadolinium-enhanced sequences was determined by classifying the lesions into risk categories. RESULTS Three hundred and one patients (1,174 cysts) constituted the study population. Only 35/301 patients (12 %) showed significant lesion change on follow-up. Using multivariate analysis the only independent factor of lesion growth (OR = 2.4; 95 % CI, 1.7-3.3; P < 0.001) and mural nodule development (OR = 1.9; 95 % CI, 1.1-3.4, P = 0.03) during follow-up was initial lesion size. No patient with a lesion initial size less than 2 cm developed cancer during follow-up. Intra-observer agreement with and without gadolinium enhancement ranged from 0.86 to 0.97. After consensus review of discordant cases, gadolinium-enhanced sequences demonstrated no added value. CONCLUSION Most incidental pancreatic cystic lesions did not demonstrate change during follow-up. The addition of gadolinium-enhanced-sequences had no added-value for risk assignment on serial follow-up. KEY POINTS Significant growth of pancreatic cysts occurred in a minority of patients only. No lesion <2 cm demonstrated any change during the first year of follow-up. Intra-observer agreement between MR pancreatic protocols with and without gadolinium was excellent. Gadolinium application had limited value for follow-up of asymptomatic pancreatic cystic lesions.
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Affiliation(s)
- Stephanie Nougaret
- Department of Abdominal Imaging, Saint Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France,
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Institutional experience with solid pseudopapillary neoplasms: focus on computed tomography, magnetic resonance imaging, conventional ultrasound, endoscopic ultrasound, and predictors of aggressive histology. J Comput Assist Tomogr 2013; 37:824-33. [PMID: 24045264 DOI: 10.1097/rct.0b013e31829d44fa] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Solid pseudopapillary neoplasms (SPNs) are low-grade malignancies with an excellent prognosis, albeit with the potential for metastatic disease. This study details our institution's experience with the diagnosis and treatment of SPN, including clinical presentation, multimodality imaging findings, and potential predictors of aggressive tumor behavior. MATERIALS AND METHODS The institutional pathology database was searched through for all cases of SPN since 1988, yielding 51 patients. The electronic medical record was searched for clinical and demographic information regarding these patients, including age, sex, presenting symptoms, type of surgery, postoperative length of stay, tumor markers, and postsurgical follow-up. All available imaging data were reviewed, including those of 30 patients who underwent multidetector computed tomography, those of 9 patients who underwent magnetic resonance imaging (MRI), those of 3 patients who underwent conventional ultrasound, and those of 11 patients who underwent endoscopic ultrasound. RESULTS A total of 84% of patients were females, with a mean age of only 33 years. Prognosis was excellent, with a mean follow-up of 3 years without recurrence. Only 1 of the 51 patients developed metastatic disease to the liver 8 years after the surgery. On computed tomography, lesions tended to be large (5.3 cm), well circumscribed (29/30), round/oval (20/30), and encapsulated (23/30). The lesions often demonstrated calcification (14/30) and typically resulted in no biliary or pancreatic ductal dilatation. The lesions ranged from completely cystic to completely solid. On MRI, the lesions often demonstrated a T2 hypointense or enhancing capsule (6/9) and demonstrated internal blood products (5/9). The lesions tended to be devoid of vascularity on conventional ultrasound. Ten patients were found to have "aggressive" histology at presentation (T3 tumor, nodal involvement, perineural invasion, or vascular invasion). No demographic, clinical, or multidetector computed tomographic imaging features were found to correlate with aggressive histology. CONCLUSIONS Certain imaging features (eg, well-circumscribed mass with calcification, peripheral capsule, internal blood products, and lack of biliary/pancreatic ductal obstruction) on computed tomography and MRI are highly suggestive of the diagnosis of SPN, particularly when visualized in young female patients. However, it is not possible to predict aggressive histology on the basis of imaging findings, clinical presentation, or patient demographic features.
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Current world literature. Curr Opin Organ Transplant 2013; 18:111-30. [PMID: 23299306 DOI: 10.1097/mot.0b013e32835daf68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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