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Miller FH, Lopes Vendrami C, Recht HS, Wood CG, Mittal P, Keswani RN, Gabriel H, Borhani AA, Nikolaidis P, Hammond NA. Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect. Radiographics 2021; 42:87-105. [PMID: 34855543 DOI: 10.1148/rg.210056] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The widespread use of high-spatial-resolution cross-sectional imaging has led to an increase in detection of incidental pancreatic cystic lesions. These lesions are a diverse group, ranging from indolent and premalignant lesions to invasive cancers. The diagnosis of several of these lesions can be suggested on the basis of their imaging appearance, while many other lesions require follow-up imaging and/or aspiration. The smaller cystic lesions, often branch-duct intraductal papillary mucinous neoplasms, have overlapping imaging characteristics that make diagnostic assessment of the natural history and malignancy risk confusing. Expert panels have developed societal guidelines, based on a consensus, for surveillance of these lesions. However, these guidelines are often inconsistent and are constantly evolving as additional scientific data are accumulated. Identification of features associated with increased risk of malignancy is important for proper management. The concept of field defect, whereby pancreatic adenocarcinoma develops at a site different from the site of the pancreatic cyst, adds to the complexity of screening guidelines. As a result of the differences in guidelines, key stakeholders (eg, radiologists, gastroenterologists, and surgeons) must review and come to a consensus regarding which guideline, or combination of guidelines, to follow at their individual institutions. Standardized reporting and macros are helpful for ensuring the uniformity of interpretations. Radiologists play a critical role in the detection and characterization of pancreatic cystic lesions, in the follow-up recommendations for these lesions, and in the detection of associated cancer. An invited commentary by Zaheer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Camila Lopes Vendrami
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Hannah S Recht
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Cecil G Wood
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Pardeep Mittal
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Rajesh N Keswani
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Helena Gabriel
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Amir A Borhani
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Paul Nikolaidis
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Nancy A Hammond
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
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Gao CT, Ren J, Yu J, Li SN, Guo XF, Zhou YZ. KIF23 enhances cell proliferation in pancreatic ductal adenocarcinoma and is a potent therapeutic target. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1394. [PMID: 33313139 PMCID: PMC7723550 DOI: 10.21037/atm-20-1970] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background In recent research, high expression of kinesin family member 23 (KIF23), one of the kinesin motor proteins involved in the regulation of cytokinesis, has been shown to be related to poor prognosis in glioma and paclitaxel-resistant gastric cancer, as a results of the enhancement of proliferation, migration, and invasion. In this study, we analyzed the role of KIF23 in the progression of pancreatic ductal adenocarcinoma. Methods A bioinformatic method was used to analyze the KIF23 mRNA level in pancreatic tumor tissues compared with normal pancreatic tissues and to analyze the connection between high KIF23 expression and prognosis. We examined the expression of KIF23 using immunohistochemistry and analyzed the connection between the expression of KIF23 and clinicopathological features in pancreatic ductal adenocarcinoma patients. In addition, a colony formation assay, MTT assay, and western blot assay were performed in vitro, along with a mouse xenograft model in vivo, to analyze the effect of KIF23 on proliferation. Further, the correlation between KIF23 and CDCA8 was analyzed by TCGA and immunohistochemical data. Results Bioinformatic results showed that KIF23 mRNA expression was higher in pancreatic tumor tissues than in normal pancreatic tissues and a poor prognosis has been linked to the high expression of KIF23. Immunohistochemistry revealed that KIF23 was highly expressed at the protein level and high expression of KIF23 correlated with adverse clinicopathological features. Our experimental results demonstrated that knockdown of KIF23 could inhibit the proliferation of pancreatic cells. Further, a positive correlation between KIF23 and CDCA8 expression existed, and KIF23 might promote pancreatic cancer proliferation by affecting CDCA8 expression. Conclusions Our data showed that high expression of KIF23 is associated with a poor prognosis, and KIF23 might be a potential therapeutic target for pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Chun-Tao Gao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jin Ren
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Jie Yu
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sheng-Nan Li
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiao-Fan Guo
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yi-Zhang Zhou
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Kanani T, Isherwood J, Chung WY, Dennison A. Diagnostic approaches for pancreatic cystic lesions. ANZ J Surg 2020; 90:2211-2218. [PMID: 32815222 DOI: 10.1111/ans.16251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cystic lesions of the pancreas (PCLs) may be inflammatory or proliferative and making an accurate and timely pre-operative diagnosis remains a significant clinical challenge. This is principally due to the heterogeneity of the pathological processes involved. PCLs constitute an entity with diverse histology and although infrequent, the possible potential for malignant transformation of these lesions and the opportunity for curative surgery mandates that our diagnostic approaches are up to date and evidence based. In addition, improved diagnostic accuracy is crucial to prevent unnecessary surgical procedures with the inevitable associated morbidity. METHODS This narrative review examines the current diagnostic benchmarks and identifies novel diagnostic techniques that warrant further consideration, a number of which are beginning to be included in routine clinical practice when these PCLs are being investigated. A computerized search was made of MEDLINE, EMBASE and PubMed using the search words 'diagnostic approaches to pancreatic cystic lesions'. All relevant articles in English language or with an English abstract were retrieved and additionally cross referenced. CONCLUSION The increasing accuracy of available imaging techniques together with the wider availability of endoluminal ultrasound and the development of additional novel methods to assess PCLs presents an opportunity to significantly improve the pre-operative diagnosis rate. This is essential to classify the type of PCL and hence guide the management particularly with lesions where there is a likelihood of progression to more serious pathology. We have highlighted the need for a comprehensive and standardized algorithm for the diagnosis and management of PCLs.
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Affiliation(s)
- Trisha Kanani
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK
| | - John Isherwood
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Wen Yuan Chung
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Ashley Dennison
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK
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