Abdominal ultrasound in the characterization of branch-duct intraductal papillary mucinous neoplasms: A new tool for surveillance of low-risk patients?

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.

The importance of updatable analytical screening methods for new psychoactive substances in clinical and forensic toxicology

Abstract

The continuous emergence of New Psychoactive Substances enter-ing the illegal markets poses always new challenges to forensic and clinical toxicology laboratories facing the lack of analytical methods capable of determining the newer parent compounds and eventual metabolites. More than 50 new molecules have been reported by the European Monitoring Centre for Drugs and Drug Addiction only in 2021, further expanding the panel of target analytes. However, the implementation of new detection methodologies may not be viable due to time constraints and inadequate resources. To this concern, the updatable analytical screening methods constitute a powerful tool for pharmacotoxicological laboratories investigating both non biological seizure materials and conventional and non conventional matrices coming from intoxications and fatalities of drugs consumers.

The targeted analysis of New Psychoactive Substances in oral fluid through chromatographic-spectrometric methods: review of recent findings

OBJECTIVE

The oral fluid was demonstrated as an effective matrix to assess drug consumption in forensic settings. Recently, the increasing number of intoxications related to New Psychoactive Substances raised the attention of the scientific community. To this concern, different analytical methods to detect and quantify NPS in oral fluids were developed and validated, most of them based on hyphenated techniques.

MATERIALS AND METHODS

A broad-ranging search was conducted on multidisciplinary research databases using "New Psychoactive Substances", "oral fluid", "toxicological analysis", "analytical method", "targeted method", "HPLC-MS/MS", "GC-MS", "GC-MS/MS" alone or in combination as search strings. All research articles published between 2017 and 2021 were considered.

RESULTS

Different chromatographic-spectrometric methods to detect and quantify the NPS in oral fluid were reported in the literature. The classes of NPS explored were synthetic cannabinoids, synthetic cathinones, new designer benzodiazepines, synthetic opioids, fentanyl analogues, tryptamines, and phenethylamines. The most used technique was HPLC-MS/MS due to the sensitivity and high throughput. The GC-MS technique was preferred for synthetic cannabinoids, anyway different HPLC-MS/MS methods were developed. Moreover, the LC-HRMS technique was applied for the development of an analytical assay to detect new synthetic opioids and fentanyl analogues.

CONCLUSIONS

The analytical interest on oral fluid as an effective matrix to assess drug exposure is increasing. The hyphenated techniques were demonstrated effective in the detection of NPS in oral fluids. The most suitable techniques are HPLC-MS/MS due to the sensitivity and the possibility to include different classes of substances in a single analytical run.