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Nagayama R, Ueki T, Shimizu Y, Hijioka S, Nakamura M, Kitano M, Hara K, Masamune A, Kin T, Hanada K, Koshita S, Yamada R, Takenaka M, Itoi T, Yanagisawa A, Otuka T, Hirono S, Kanno A, Ideno N, Kuwahara T, Shimizu A, Kamata K, Asai Y, Takeyama Y. Is preoperative pancreatic juice cytology useful for determining therapeutic strategies for patients with intraductal papillary mucinous neoplasm of the pancreas? J Hepatobiliary Pancreat Sci 2024; 31:183-192. [PMID: 38084510 DOI: 10.1002/jhbp.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND We compared the results of preoperative pancreatic juice cytology (PJC) and final pathological diagnosis after resection in patients who underwent resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas to determine whether preoperative PJC can help determine therapeutic strategies. METHODS Of 1130 patients who underwent surgical resection IPMN at 11 Japanese tertiary institutions, the study included 852 patients who underwent preoperative PJC guided by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS The accuracy of preoperative PJC for differentiation between cancerous and noncancerous lesions were 55% for IPMN overall; 59% for the branch duct type; 49% for the main pancreatic duct type; 53% for the mixed type, respectively. On classifying IPMN according to the diameters of the mural nodule (MN) and main pancreatic duct (MPD), the corresponding values for diagnostic performance were 40% for type 1 (MN ≥5 mm and MPD ≥ 10 mm); 46% for type 2 (MN ≥5 mm and MPD < 10 mm); 61% for type 3 (MN < 5 mm and MPD ≥ 10 mm); 72% for type 4 (MN < 5 mm and MPD < 10 mm), respectively. CONCLUSIONS PJC in IPMN is not a recommended examination because of its low overall sensitivity and no significant difference in diagnostic performance by type, location, or subclassification. Although the sensitivity is low, the positive predictive value is high, so we suggest that pancreatic juice cytology be performed only in cases where the patient is not sure about surgery.
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Affiliation(s)
- Rintaro Nagayama
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, Miyagi, Japan
| | - Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Mie, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akio Yanagisawa
- Department of Pathology and Laboratory Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takao Otuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiko Hirono
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Atsushi Kanno
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Noboru Ideno
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Akinori Shimizu
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yasutsugu Asai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kinki University School of Medicine, Osaka-sayama, Japan
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Lai T, Bull N, Goonawardena J, Bradshaw L, Fox A, Hassen S. Are the screening guidelines for branch duct intraductal papillary mucinous neoplasms cost-effective in an Australian setting? ANZ J Surg 2023; 93:2885-2891. [PMID: 37727043 DOI: 10.1111/ans.18697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUNDS Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms of the pancreatic ductal system. These incidental cystic lesions are increasingly found on radiological imaging and screened for malignant transformation. The Fukuoka consensus guidelines recommend screening with computed tomography, magnetic resonance imaging or endoscopic ultrasound. Branch duct IPMN (BD-IPMN) have significantly lower malignancy and mortality rates compared to main duct IPMN. Our aim was to assess the cost-effectiveness of guideline's recommendations for BD-IPMN screening of cysts between 2 and 3 cm in an Australian context. METHODS Markov model decision analysis was used to calculate the incremental cost-effectiveness ratio (ICER) of screening. The ICER was compared to a willingness to pay (WTP) threshold of $50 000. We performed scenario analysis to examine the effect of cyst size and non-linearity of malignancy rate on ICER. Probabilistic sensitivity analyses (PSA) were performed on our input parameters. RESULTS Screening resulted in 586 quality adjusted life years gained and a net present value of $20 379 939, resulting in a base-case ICER of $34 758. After scenario analysis for non-linearity of malignancy rate the ICER increases to $64 555, which is above the WTP threshold. PSA indicates that ICER is most susceptible to the pre-test malignancy rate. CONCLUSION This cost analysis demonstrates that screening of 2-3 cm BD-IPMN according to current guidelines is unlikely to be cost-effective in an Australian context. To determine the true ICER, a cost analysis on real-world data is required.
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Affiliation(s)
- Timothy Lai
- Department of Upper GI and HPB Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Nicholas Bull
- Department of Upper GI and HPB Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Janindu Goonawardena
- Department of Upper GI and HPB Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Luke Bradshaw
- Department of Upper GI and HPB Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Adrian Fox
- Department of Upper GI and HPB Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Sayed Hassen
- Department of Upper GI and HPB Surgery, Eastern Health, Box Hill, Victoria, Australia
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Roch AM, Kim RC, Nguyen TK, House MG, Zyromski NJ, Nakeeb A, Schmidt CM, Ceppa EP. Patients with deleterious germline mutations: A heterogeneous population for pancreatic cancer screening? J Surg Oncol 2023. [PMID: 37083062 DOI: 10.1002/jso.27289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Modest data exist on the benefits of screening and surveillance for pancreatic cancer (PC) in high-risk individuals. Intraductal papillary mucinous neoplasms (IPMN) are known precursors to PC. We hypothesized that patients with high-risk deleterious germline mutations have a higher prevalence of IPMN. METHODS All patients undergoing prospective screening at a single institution from 2013 to 2019 were reviewed. RESULTS Of 1166 patients screened, 358 (31%) possessed germline mutations and/or family history of PC (mutations n = 201/358, 56%, family history n = 226/358, 63%) (median follow-up 2.7 years). IPMN was found in 127 patients (35.5%). The prevalence of IPMN in mutation carriers (18%) was higher than in the general population (p < 0.01). Germline mutation was an independent predictor of IPMN (odds ratio [OR] = 3.2; p < 0.01), while family history was not (p = 0.22). IPMN prevalence was distributed unevenly between mutation types (67%-Peutz-Jeghers; 43%-HNPCC, 24%-BRCA2; 17%-ATM; 9%-BRCA1; 0%-CDKN2A and PALB2). CONCLUSION In this series, 18% of mutation carriers harbored IPMN, higher than the general population. Germline mutation, but not a family history of PC, was independently associated with IPMN. This prevalence varied across mutation subtypes, suggesting not all mutation carriers develop precancerous lesions. Genetic testing for patients with a positive family history may improve screening modalities for this high-risk population.
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Affiliation(s)
- Alexandra M Roch
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel C Kim
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Trang K Nguyen
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael G House
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicholas J Zyromski
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Attila Nakeeb
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - C Max Schmidt
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Eugene P Ceppa
- Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Satoh T, Kawaguchi S, Takeda S, Ishiguro Y, Asahara K, Terada S, Endo S, Shirane N, Kanemoto H, Ohno K. Comparison of Diagnostic Yield and Safety of Serial Pancreatic Juice Aspiration Cytologic Examination (SPACE) with Different Indications. Diagnostics (Basel) 2023; 13:diagnostics13081498. [PMID: 37189599 DOI: 10.3390/diagnostics13081498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
We assessed whether there are differences in the diagnostic yield and safety of serial pancreatic juice aspiration cytologic examination (SPACE) among different indications. We retrospectively analyzed 226 patients who underwent SPACE. They were classified into group A (patients with pancreatic masses, including advanced adenocarcinoma, sclerosing pancreatitis, or autoimmune pancreatitis), group B (suspicious pancreatic carcinoma patients without obvious pancreatic masses, including small pancreatic carcinoma, carcinoma in situ, or benign pancreatic duct stenosis), and group C (intraductal papillary mucinous neoplasm, IPMN). There were 41, 66, and 119 patients, with malignancy diagnosed in 29, 14, and 22 patients, in groups A, B, and C, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 69%, 100%, 100%, 57%, and 78% in group A; 79%, 98%, 92%, 94%, and 94% in group B; and 27%, 87%, 32%, 84%, and 76% in group C, respectively. PEP was observed in three (7.3%), three (4.5%), and fifteen (13%) patients in group A, B, and C, respectively (p = 0.20). SPACE is useful and safe in patients with suspicious small pancreatic carcinoma. However, it has limited efficacy and might not be recommended in patients with IPMN because of the high frequency of PEP.
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Affiliation(s)
- Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Shodai Takeda
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Yuya Ishiguro
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Kazuhisa Asahara
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Shuzo Terada
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Shinya Endo
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Naofumi Shirane
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Hideyuki Kanemoto
- Department of Surgery, Shizuoka General Hospital, Shizuoka 420-8527, Japan
| | - Kazuya Ohno
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan
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Gong TT, Wang W. Clinical Characteristics of Patients With Surgically Resected Pancreatic Cysts: A Retrospective Analysis of 136 Patients. J Ultrasound Med 2023; 42:901-913. [PMID: 36029231 DOI: 10.1002/jum.16085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To retrospectively analyze the characteristics of pancreatic cysts with respect to histopathological diagnosis and various diagnostic imaging tools. METHODS The clinical features of 136 patients and characteristics of histopathologically diagnosed cysts were retrospectively assessed. The diagnostic accuracy of endoscopic ultrasound (EUS), computed tomography (CT), and magnetic resonance imaging (MRI) for pancreatic cysts was compared. Risk factors for high-grade dysplasia/invasive cancer in patients with intraductal papillary mucinous neoplasms (IPMNs) were also determined. RESULTS The final analysis included 30 serous cystic neoplasms (SCNs) (21.6%), 13 mucinous cystic neoplasms (MCNs) (9.4%), 65 IPMNs (46.8%), and 13 solid pseudopapillary neoplasms (SPNs) (9.4%). The percentage of women with MCNs, SPNs, SCNs, and IPMNs was 100.0, 76.9, 73.3, and 47.7%, respectively (P < .001). The percentages of patients over 60 years of age with IPMNs, SCNs, MCNs, and SPNs were 73.9, 23.3, 0, and 0%, respectively (P < .001). The percentage of cysts located in the body and tail of the pancreas in MCNs, SCNs, SPNs, and IPMNs was 100, 70, 53.9, and 46.2%, respectively (P < .001). A unique honeycomb appearance was observed in 26.7% of SCNs. The overall diagnostic accuracy of EUS, CT, and MRI for pancreatic cysts was 82.6, 72.5, and 73.9%, respectively. Lesion size and presence of solid components were independent predictors of high-risk IPMNs. CONCLUSIONS Patient characteristics and cyst features can help to differentiate pancreatic cyst types and identify high-risk IPMNs. The diagnostic accuracy of EUS for pancreatic cysts is superior to that of CT and MRI.
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Affiliation(s)
- Ting-Ting Gong
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of General Surgery and Research Institute of Pancreatic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhou H, Chen X, Wang C, Lin T, Li X, Cui W, Wang J, Wang Y, Chen X. Diabetes in intraductal papillary mucinous neoplasm of the pancreas and its association with malignancy. J Surg Oncol 2023; 127:625-632. [PMID: 36409079 DOI: 10.1002/jso.27142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) have the potential to become malignant. Few studies have focused on the prevalence of the diabetes mellitus (DM) in IPMNs and its association with malignancy. We evaluated the association between DM and malignant IPMNs in this study. METHODS A total of 226 patients with pathologically confirmed IPMNs were included. Demographic data, serum biochemical data, and imaging findings were collected. The malignant IPMNs were defined as those with high-grade dysplasia and associated invasive carcinoma. The association between DM and malignant IPMNs was studied using logistic regression analysis. RESULTS The prevalence of DM was 17.7% for all type IPMNs and 31.7% for malignant IPMNs. Compared to patients without DM, those with DM had a 3.6-fold (odds ratio [OR]: 3.62; 95% confidence interval [CI]: 1.26-10.44) higher risk of invasive carcinoma and 2.5-fold (OR: 2.48; 95% CI: 1.06-5.77) higher risk of malignant IPMNs. Similar results were observed in main pancreatic duct (MPD) involved IPMNs. New-onset DM was associated with a 4.13-fold (OR: 4.13, 95% CI: 1.27-13.36) higher risk of invasive carcinoma. CONCLUSION DM is associated with a higher risk of malignant IPMNs and invasive carcinoma, especially in patients with MPD-involved IPMNs.
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Affiliation(s)
- Hao Zhou
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin Chen
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Wang
- Department of Radiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Tingting Lin
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaoshuang Li
- Department of Radiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenjing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Wang
- Department of Radiology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Koehler B, Ryoo DY, Krishna SG. A Review of Endoscopic Ultrasound-Guided Chemoablative Techniques for Pancreatic Cystic Lesions. Diagnostics (Basel) 2023; 13:diagnostics13030344. [PMID: 36766449 PMCID: PMC9914819 DOI: 10.3390/diagnostics13030344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Pancreatic cystic lesions (PCLs) are known precursors to pancreatic cancer, one of the deadliest types of cancer worldwide. Surgical removal or pancreatectomies remain the central approach to managing precancerous high-risk PCLs. Endoscopic ultrasound (EUS)-guided therapeutic management of PCLs is a novel management strategy for patients with prohibitive surgical risks. Various ablation techniques have been explored in previous studies utilizing EUS-guided fine needle injection (FNI) of alcohol and chemotherapeutic agents. This review article focuses on EUS-FNI and chemoablation, encompassing the evolution of chemoablation, pancreatic cyst selection, chemotherapy drug selection, including novel agents, and a discussion of its safety and efficacy.
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Affiliation(s)
- Bryn Koehler
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Da Yeon Ryoo
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Somashekar G. Krishna
- Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Correspondence:
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Zhou H, Li X, Wang Y, Wang Z, Zhu J, Wang Z, Chen X. Threshold of main pancreatic duct for malignancy in intraductal papillary mucinous neoplasm at head-neck and body-tail. BMC Gastroenterol 2022; 22:473. [PMCID: PMC9675150 DOI: 10.1186/s12876-022-02577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Main pancreatic duct (MPD) dilation is a high-risk stigmata/worrisome feature of malignancy in intraductal papillary mucinous neoplasms (IPMNs). The threshold of MPD diameter in predicting malignancy may be related to the lesion location. This study aimed to separately identify the thresholds of MPD for malignancy of IPMNs separately for the head-neck and body-tail. Materials and methods A total of 185 patients with pathologically confirmed IPMNs were included. Patient demographic information, clinical data, and pathological features were obtained from the medical records. Those IPMNs with high-grade dysplasia or with associated invasive carcinoma were considered as malignant tumor. Radiological data including lesion location, tumor size, diameter of the MPD, mural nodule, and IPMN types (main duct, MD; branch duct, BD; and mixed type, MT), were collected on computed tomography or magnetic resonance imaging. Serum carbohydrate antigen 19-9 levels, serum carcinoembryonic antigen levels, and the medical history of diabetes mellitus, chronic cholecystitis, and pancreatitis were also collected. Results Malignant IPMNs were detected in 31.6% of 117 patients with lesions in the pancreatic head-neck and 20.9% of 67 patients with lesions in the pancreatic body-tail. In MPD-involved IPMNs, malignancy was observed in 54.1% of patients with lesions in the pancreatic head-neck and 30.8% of patients with lesions in the pancreatic body-tail (p < 0.05). The cutoff value of MPD diameter for malignancy was 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail in all type of IPMNs. In MPD-involved IPMNs, the threshold was 8.2 mm for lesion in pancreatic head-neck and 7.7 mm for lesions in the body-tail. Multivariate analysis confirmed that MPD diameter ≥ 6.5 mm (pancreatic head-neck) and MPD diameter ≥ 7.7 mm (pancreatic body-tail) were independent predictors of malignancy (p < 0.05). Similar results were observed in MPD-involved IPMNs using 8.2 mm as a threshold. Conclusion The thresholds of the dilated MPD may be associated with IPMNs locations. Thresholds of 6.5 mm for lesions in the head-neck and 7.7 mm for lesions in the body-tail were observed. For MPD-involved IPMNs alone, threshold for lesions in the head-neck was close to that in the body-tail. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02577-3.
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Affiliation(s)
- Hao Zhou
- grid.410745.30000 0004 1765 1045Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 China
| | - Xiaoshuang Li
- grid.452511.6Department of Radiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210000 China
| | - Yajie Wang
- grid.410745.30000 0004 1765 1045Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 China
| | - Zhiyue Wang
- grid.452511.6Department of Radiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210000 China
| | - Jingrong Zhu
- grid.410745.30000 0004 1765 1045Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 China
| | - Zhongqiu Wang
- grid.410745.30000 0004 1765 1045Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 China
| | - Xiao Chen
- grid.410745.30000 0004 1765 1045Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029 China
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Xu Y, Xie C, Gao Z, Zhang M, Zhan M. Nomogram to predict malignancy in branch duct type intraductal papillary mucinous neoplasms. Medicine (Baltimore) 2022; 101:e30627. [PMID: 36197166 PMCID: PMC9509101 DOI: 10.1097/md.0000000000030627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prediction of malignancy in branch duct (BD)-type intraductal papillary mucinous neoplasms (BD-IPMNs) is difficult. In this retrospective study, we showed the performance of imaging biomarker and biochemical biomarker in identifying the malignant BD-IPMNs. A total of 97 patients with pathological proved BD-IPMNs were included in this study. Imaging data were collected from magnetic resonance imaging (MRI). Malignant BD-IPMNs were defined as those with high grade dysplasia and invasive carcinoma. There were 10 patients with malignant BD-IPMNs (10.3%). Significant difference was found in prevalence of mural nodule and tumor size >3.0 cm between patients with and without malignant BD-IPMNs (44.4% vs 3.1%, P < .01; 80.0% vs 33.3%, P < .01). Significant differences were observed in mural nodule and elevated carbohydrate antigen 19-9 (CA19-9) between patients with and without invasive carcinoma (40.0% vs 7.6, P = .05; 60% vs 15.3%, P = .04). Mural nodule and tumor size >3.0 cm were the independent associated factor for malignant BD-IPMNs. The odds ratio (OR) was 5.22 (95% confidence interval [CI]: 1.04-31.16) for mural nodule and was 6.80 (95% CI: 1.16-39.71) for cyst size >3.0 cm. The combined model of mural nodule and tumor size showed good performance in identifying malignant BD-IPMNs (area under the curve [AUC] = 0.82, 95%CI: 0.67-0.97). Our data show that mural nodule and cystic size can be used as predictor of malignancy in BD-IPMN. The predictive performance is acceptable.
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Affiliation(s)
- Yisheng Xu
- Department of Radiology, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou Zhenjiang, China
| | - Chunmei Xie
- Department of Radiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou Zhenjiang, China
| | - Zhiqin Gao
- Department of Radiology, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou Zhenjiang, China
| | - Meihua Zhang
- Department of Radiology, Hangzhou Ninth People’s Hospital, Hangzhou Zhenjiang, China
| | - Ming Zhan
- Department of Radiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou Zhenjiang, China
- *Correspondence: Ming Zhan, Department of Radiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, No. 728 Yucai North Road, Xiaoshan District, Hangzhou Zhenjiang 311201, China (e-mail: )
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Trinh VQH, Roland JT, Wong J, Revetta F, Patel K, Shi C, DelGiorno KE, Carter BD, Tan MCB. Peak density of immature nerve cells occurs with high-grade dysplasia in intraductal papillary mucinous neoplasms of the pancreas. J Pathol 2022; 258:69-82. [PMID: 35686747 PMCID: PMC9378585 DOI: 10.1002/path.5978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/10/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Abstract
The development of neural structures within tumors is now considered vital for carcinogenesis. However, the time course of this development in human pre-invasive neoplasia has been incompletely described. Therefore, we performed a detailed analysis of nerves across the neoplastic spectrum in resected intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Histology and multiplexed immunochemistry demonstrated that nerve density increased from low-grade (LG) to high-grade dysplasia (HG) but did not further increase once invasive IPMN (INV IPMN) was present. Higher nerve density correlated with increasing expression of nerve growth factor (NGF) by the tumor cells. Intra-tumoral nerves were immature and lacked markers of sympathetic, parasympathetic, and sensory lineages. Here, we show for the first time the presence of neural precursor cells (NPCs) within the stroma of pancreatic tumors. The density of these doublecortin (DCX)-positive NPCs increased from LG to HG, but not from HG to INV IPMN. We conclude that peak neural density of tumors is reached in high-grade dysplasia (often termed carcinoma in situ) rather than after invasion. These findings suggest that nerve-tumor interactions are important in IPMN progression and may serve as the basis for future mechanistic studies and novel therapeutic modalities. © 2022 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Vincent Quoc-Huy Trinh
- Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joseph Thomas Roland
- Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
- Epithelial Biology Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jahg Wong
- Département de pathologie et biologie cellulaire, Université de Montréal, Montréal, Québec, Canada
| | - Frank Revetta
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Krutika Patel
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chanjuan Shi
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen E. DelGiorno
- Epithelial Biology Center, Vanderbilt University School of Medicine, Nashville, TN, USA
- Cell and Developmental Biology, Vanderbilt University, Nashville TN, USA
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce D. Carter
- Department of Biochemistry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marcus Chuan Beng Tan
- Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
- Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Romanello Joaquim M, Furth EE, Fan Y, Song HK, Pickup S, Cao J, Choi H, Gupta M, Cao Q, Shinohara R, McMenamin D, Clendenin C, Karasic TB, Duda J, Gee JC, O’Dwyer PJ, Rosen MA, Zhou R. DWI Metrics Differentiating Benign Intraductal Papillary Mucinous Neoplasms from Invasive Pancreatic Cancer: A Study in GEM Models. Cancers (Basel) 2022; 14:cancers14164017. [PMID: 36011011 PMCID: PMC9406679 DOI: 10.3390/cancers14164017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
KPC (KrasG12D:Trp53R172H:Pdx1-Cre) and CKS (KrasG12D:Smad4L/L:Ptf1a-Cre) mice are genetically engineered mouse (GEM) models that capture features of human pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasms (IPMN), respectively. We compared these autochthonous tumors using quantitative imaging metrics from diffusion-weighted MRI (DW-MRI) and dynamic contrast enhanced (DCE)-MRI in reference to quantitative histological metrics including cell density, fibrosis, and microvasculature density. Our results revealed distinct DW-MRI metrics between the KPC vs. CKS model (mimicking human PDAC vs. IPMN lesion): the apparent diffusion coefficient (ADC) of CKS tumors is significantly higher than that of KPC, with little overlap (mean ± SD 2.24±0.2 vs. 1.66±0.2, p<10−10) despite intratumor and intertumor variability. Kurtosis index (KI) is also distinctively separated in the two models. DW imaging metrics are consistent with growth pattern, cell density, and the cystic nature of the CKS tumors. Coregistration of ex vivo ADC maps with H&E-stained sections allowed for regional comparison and showed a correlation between local cell density and ADC value. In conclusion, studies in GEM models demonstrate the potential utility of diffusion-weighted MRI metrics for distinguishing pancreatic cancer from benign pancreatic cysts such as IPMN.
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Affiliation(s)
| | - Emma E. Furth
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yong Fan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hee Kwon Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stephen Pickup
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jianbo Cao
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hoon Choi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mamta Gupta
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Quy Cao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Russell Shinohara
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Deirdre McMenamin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cynthia Clendenin
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas B. Karasic
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey Duda
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James C. Gee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter J. O’Dwyer
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mark A. Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rong Zhou
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence:
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12
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Lin T, Chen X, Liu J, Cao Y, Cui W, Wang Z, Wang C, Chen X. MRI-Based Pancreatic Atrophy Is Associated With Malignancy or Invasive Carcinoma in Intraductal Papillary Mucinous Neoplasm. Front Oncol 2022; 12:894023. [PMID: 35719938 PMCID: PMC9204001 DOI: 10.3389/fonc.2022.894023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Abrupt change in the caliber of the main pancreatic duct (MPD) with distal pancreatic atrophy (PA) was considered as one of worrisome features in the International Association of Pancreatology guideline and American College of Gastroenterology guideline for the management of intraductal papillary mucinous neoplasms (IPMNs). However, this feature was not included in other guidelines. Moreover, the association between PA alone and malignancy in IPMNs has not been fully evaluated. In the present study, we investigated the role of image-based PA in identifying malignant IPMNs or invasive carcinoma. Methods A total of 186 patients with IPMNs were included for analysis. The tumor size, location, MPD diameter, presence of a mural nodule (MN), and PA were evaluated using magnetic resonance imaging. Demographic information and serum carbohydrate antigen 19-9 and carcinoembryonic antigen (CEA) levels were also collected. IPMNs with high-grade dysplasia and associated invasive carcinoma were regarded as malignant IPMNs. Results PA was observed in 34 cases (18.3%). The occurrence of malignant IPMNs or invasive carcinoma in patients with PA were significantly higher than in those without PA (52.9% vs. 22.3%; 44.1% vs. 8.9%, all P < 0.01). Multivariate logistic regression analysis showed that PA was an independently associated factor for malignant IPMNs [odds ratio (OR) = 2.69, 95% confidence interval (CI): 1.07-6.78] or invasive carcinoma (OR = 7.78, 95%CI: 2.62-23.10) after modified with confounders. Subgroup analysis in MPD-involved IPMNs also indicated that PA was an independently associated factor for invasive carcinoma (OR = 9.72, 95%CI: 2.43-38.88). PA had a similar performance with MPD plus MN [the area under the curve (AUC) was both 0.71] in identifying malignancy. PA had a higher performance in identifying invasive carcinoma in MPD-involved IPMNs than MN (AUC = 0.71 vs. 0.65, P = 0.02). Conclusion Our data showed that imaging-based PA was associated with malignancy or invasive carcinoma regardless of abrupt change in the caliber of MPD in IPMNs. PA had an acceptable performance in identifying malignant IPMNs.
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Affiliation(s)
- Tingting Lin
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xin Chen
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai, China
| | - Jingjing Liu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yingying Cao
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenjing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Wang
- Department of Radiology, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Institute of Radiation Medicine, Fudan University, Shanghai, China
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13
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Zelnik Yovel D, Bear L, Scapa E, Shnell M, Bar Yishay I, Bar N, ZIv Baran T, Younis F, Phillips A, Lubezky N, Shibolet O, Ben-Ami Shor D. Increased prevalence of colorectal neoplasia in patients with intraductal papillary mucinous neoplasms. Therap Adv Gastroenterol 2022; 15:17562848221104306. [PMID: 35747617 PMCID: PMC9210092 DOI: 10.1177/17562848221104306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The association between intraductal papillary mucinous neoplasms (IPMNs) and colorectal cancer (CRC) and polyps is controversial. OBJECTIVES To compare the prevalence of CRC and colorectal polyps among patients with IPMN and matched average risk individuals. METHODS A match cross-sectional historical study comparing colonoscopy findings of 310 patients with IPMN cysts who underwent at least one colonoscopy examination from 2004 through 2019, with 310 age- and gender-matched average risk participants who underwent a screening colonoscopy. CRC and polyps were assessed in both groups. The prevalence and odds ratio were calculated. RESULTS CRC was diagnosed in 16 of 310 patients with IPMN (5.2%), and at least one polyp was detected in 96 patients (31%). The prevalence of CRC was greater among patients with IPMN than in matched individuals [5.2% versus 1.3%, p = 0.012, prevalence odds ratio (POR) 4, confidence interval (CI) 1.29-16.44]. The overall prevalence of polyps was not higher among patients with IPMN than in matched individuals (31% versus 26.8%, p = 0.291, POR 1.22, CI 0.85-1.76). However, the prevalence of colorectal adenomas with high-grade dysplasia was higher in patients with IPMN than in matched individuals (4.2% versus 1%, p = 0.02, POR 4.33, CI, 1.19-23.7). The prevalence of large polyps (i.e. more than 20 mm in size) was also greater in patients with IPMN than in matched individuals (6.1% versus 1.9%, p = 0.011, POR 3.6, CI, 1.29-12.40). CONCLUSION Patients with IPMN have a significantly higher prevalence of CRC and advanced polyps than the average risk population. In view of our findings, we suggest that once the diagnosis of IPMN is made, special consideration of CRC should be undertaken.
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Affiliation(s)
| | | | - Erez Scapa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mati Shnell
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iddo Bar Yishay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer ZIv Baran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fadi Younis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adam Phillips
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Lubezky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Unit of Liver Surgery Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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14
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Abstract
Pancreatic cystic lesions (PCLs) are increasingly being recognized due to improvements and widespread use of cross-sectional imaging. With an estimated prevalence of 15% in general population, incidentally discovered PCLs represent a dilemma in management. While pancreatectomies offer a chance of cure, the morbidity is considerable in patients with high surgical risks. More recently, EUS-guided approaches for cyst ablation are being offered in clinical trials for the management of PCLs. EUS-chemoablation studies have progressed from first investigating safety and efficacy of EUS-guided alcohol lavage to single-agent paclitaxel ablation. Recent studies have shown that alcohol lavage may not be required, and long-term resolution can be achieved by chemoablation alone. EUS-guided lauromacrogol ablation and EUS-guided radiofrequency ablation (RFA) are new techniques that have shown promising results in a few small studies. Overall, the current literature suggests that EUS-guided paclitaxel ablation has better cyst resolution rates compared to other existing minimally invasive techniques including ethanol injection, lauromacrogol ablation, or RFA. This article will review EUS-guided PCL ablation approaches and future directions the field is headed into.
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Affiliation(s)
- Devarshi R. Ardeshna
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Edward Woods
- College of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Somashekar G. Krishna
- Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA,Address for correspondence Dr. Somashekar G. Krishna, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 262, Columbus, Ohio 43210, USA. E-mail:
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15
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Abstract
The incidence of pancreatic incidentalomas (PIs) detected in otherwise asymptomatic patients is growing with the increasing quality and use of advanced imaging techniques. PI can present as isolated main pancreatic duct dilation or as a solid or cystic lesion. Although historically thought to be relatively rare, PIs are rather common, particularly cystic lesions of the pancreas, which can be detected in up to 49% of the general population. With the poor prognosis of pancreatic cancer, PIs are an opportunity for prevention and early diagnosis, but when managed poorly, they can also lead to overtreatment and unnecessary morbidity. The management of PI should begin with a dedicated pancreas protocol computed tomography (CT) scan or magnetic resonance imaging (MRI) to accurately characterize duct size, lesion characteristics and establish an accurate baseline for subsequent follow up. Diagnosis and subsequent management depends on the extent of main duct dilation and solid versus cystic appearance. Solid lesions are highly concerning for malignancy. Cystic lesions can be further categorized as intraductal papillary mucinous neoplasms of the pancreas (IPMNs) or mucinous cystic neoplasms (MCNs), both of which harbour malignant potential, or as serous cystic neoplasms (SCNs) that are benign. In this paper, we summarize the major challenges related to PI and present pragmatic suggestions for management.
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Affiliation(s)
- Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert J Torphy
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard D Schulick
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Wang C, Lin T, Wang X, Yu Z, Zhuge X, Cui W, Wang M, Wang Z, Guo C, Chen X. Low high-density lipoprotein cholesterol levels are associated with malignant intraductal papillary mucinous neoplasms: A multicenter study. Lipids Health Dis 2021; 20:94. [PMID: 34454509 PMCID: PMC8399724 DOI: 10.1186/s12944-021-01523-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) can potentially undergo malignant transformation. Studies have shown that high-density lipoprotein cholesterol (HDL-c) was associated with the risk of cancer. In this study, the association between HDL-c and the incidence of malignancy in IPMNs was investigated. MATERIALS AND METHODS 226 patients with histologically proven IPMNs who underwent surgery were included in the present study. Patients were assigned to a training group (n = 151) and validation group (n = 75). Patients' demographic information, clinical data, and histopathological evaluation findings were obtained from medical records. Malignant IPMNs were defined as lesions that showed high grade dysplasia and invasive carcinoma. Logistic regression analyses were used to show the association between HDL-c and malignant IPMNs. Receiver operating characteristic (ROC) curves were generated to analyze predictive performance. RESULTS The prevalence of low HDL-c levels was higher in patients with malignant IPMNs than in those with non-malignant IPMNs (P < 0.01) in both the training group and validation group. The prevalence of malignant IPMNs decreased with an increase in HDL-c levels both in patients with all types of IPMNs, as well as in those with branch-duct IPMNs (BD-IPMNs).Logistic analysis showed that low HDL-c levels were associated with malignant IPMNs (odds ratio (OR) = 20.56, 95 % confidence interval (CI): 2.58-163.64, P < 0.01) in all types of IPMNs and BD-IPMNs (OR = 17.6, 95 %CI: 1.16-268.46, P = 0.02 ).The predictive performance of mural nodules plus low HDL-c levels was higher than that of mural nodules alone or mural nodules plus cyst size for the identification of malignant BD-IPMNs. CONCLUSIONS HDL-c levels may serve a potential biomarker for identifying malignant IPMNs and improve the predictive ability of malignancy in BD-IPMNs.
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Affiliation(s)
- Cheng Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan road, 210008, Nanjing, China
| | - Tingting Lin
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China
| | - Xinru Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China
| | - Zhicheng Yu
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China
| | - Xiaoling Zhuge
- Department of Laboratory Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun road, 310003, Hangzhou, China
| | - Wenjing Cui
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China
| | - Miaomiao Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China
| | - Zhongqiu Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China
| | - Chuangen Guo
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun road, 310003, Hangzhou, China.
| | - Xiao Chen
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong road, 210029, Nanjing, China.
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17
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Xu F, Liang Y, Guo W, Liang Z, Li L, Xiong Y, Ye G, Zeng X. Diagnostic Performance of Diffusion-Weighted Imaging for Differentiating Malignant From Benign Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:637681. [PMID: 34290974 PMCID: PMC8287206 DOI: 10.3389/fonc.2021.637681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To assess the diagnostic accuracy of diffusion-weighted imaging (DWI) in predicting the malignant potential in patients with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Methods A systematic search of articles investigating the diagnostic performance of DWI for prediction of malignant potential in IPMNs was conducted from PubMed, Embase, and Web of Science from January 1997 to 10 February 2020. QUADAS-2 tool was used to evaluate the study quality. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratios (PLR), negative likelihood ratios (NLR), and their 95% confidence intervals (CIs) were calculated. The summary receiver operating characteristic (SROC) curve was then plotted, and meta-regression was also performed to explore the heterogeneity. Results Five articles with 307 patients were included. The pooled sensitivity and specificity of DWI were 0.74 (95% CI: 0.65, 0.82) and 0.94 (95% CI: 0.78, 0.99), in evaluating the malignant potential of IPMNs. The PLR was 13.5 (95% CI: 3.1, 58.7), the NLR was 0.27 (95% CI: 0.20, 0.37), and DOR was 50.0 (95% CI: 11.0, 224.0). The area under the curve (AUC) of SROC curve was 0.84 (95% CI: 0.80, 0.87). The meta-regression showed that the slice thickness of DWI (p = 0.02) and DWI parameter (p= 0.01) were significant factors affecting the heterogeneity. Conclusions DWI is an effective modality for the differential diagnosis between benign and malignant IPMNs. The slice thickness of DWI and DWI parameter were the main factors influencing diagnostic specificity.
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Affiliation(s)
- Fan Xu
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Yingying Liang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wei Guo
- Department of Radiology, Wuhan Third Hospital (Tongren Hospital of WuHan University), Wuhan, China
| | - Zhiping Liang
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Liqi Li
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Yuchao Xiong
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guoxi Ye
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Xuwen Zeng
- Department of Radiology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
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18
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Abstract
WNT signaling promotes the initiation and progression of pancreatic ductal adenocarcinoma (PDAC) through wide-ranging effects on cellular proliferation, survival, differentiation, stemness, and tumor microenvironment. Of therapeutic interest is a genetically defined subset of PDAC known to have increased WNT/β-catenin transcriptional activity, growth dependency on WNT ligand signaling, and response to pharmacologic inhibitors of the WNT pathway. Here we review mechanisms underlying WNT ligand addiction in pancreatic tumorigenesis, as well as the potential utility of therapeutic approaches that functionally antagonize WNT ligand secretion or frizzled receptor binding.
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Affiliation(s)
- Kristina Y. Aguilera
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - David W. Dawson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
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19
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Li B, Shi X, Gao S, Shen S, Bian Y, Cao K, Pan Y, Zhang G, Jiang H, Li G, Guo S, Jin G. Nomogram for the Prediction of High-Grade Dysplasia and Invasive Carcinoma in Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas Based on Variables of Noninvasive Examination. Front Oncol 2021; 11:609187. [PMID: 33767983 PMCID: PMC7985057 DOI: 10.3389/fonc.2021.609187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are a heterogeneous group of neoplasms and represent the most common identifiable precursor lesions of pancreatic cancer. Clinical decision-making of the risk for malignant disease, including high-grade dysplasia and invasive carcinoma, is challenging. Moreover, discordance on the indication for resection exists between the contemporary guidelines. Furthermore, most of the current nomogram models for predicting malignant disease depend on endoscopic ultrasonography to evaluate the precise size of mural nodules. Thus, this study aimed to propose a model to predict malignant disease using variables from a noninvasive examination. We evaluated patients who underwent resection of pathologically confirmed IPMNs between November 2010 and December 2018 and had preoperative clinical data available for review. Based on binary multivariable logistic regression analysis, we devised a nomogram model to predict malignant IPMNs. The area under the receiver operating characteristics curve (AUC) was used to evaluate the discrimination power of the model. Of the 333 patients who underwent resection of IPMNs, 198 (59.5%) had benign and 135 (40.5%) had malignant IPMNs. Multivariable logistic regression analysis showed that cyst size, cyst location, cyst wall enhancement, multicystic lesion, diameter of main pancreatic duct, neutrophil-to-lymphocyte ratio, serum carbohydrate antigen 19-9, and carcinoembryonic antigen were significantly associated with malignancy. The nomogram, constructed based on these variables, showed excellent discrimination power with an AUC of 0.859 (95% CI: 0.818–0.900, P < 0.001). In conclusion, we have developed a nomogram consisting of a combination of cross-sectional imaging features and blood markers, variables that can readily be obtained by noninvasive examinations during the surveillance period, which can distinguish benign from malignant IPMNs. Nevertheless, external validation is warranted.
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Affiliation(s)
- Bo Li
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China.,Department of General Surgery, Beidaihe Rehabilitation and Recuperation Center of PLA, Qinhuangdao, China
| | - Xiaohan Shi
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Suizhi Gao
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Shuo Shen
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Yun Bian
- Department of Radiology, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Kai Cao
- Department of Radiology, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Yaqi Pan
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Guoxiao Zhang
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Hui Jiang
- Department of Pathology, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Gang Li
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Shiwei Guo
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
| | - Gang Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China
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20
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Djordjevic V, Grubor N, Kovac JD, Micev M, Milic N, Knezevic D, Gregoric P, Lausevic Z, Kerkez M, Knezevic S, Radenkovic D. Comparison of Preoperative Evaluation with the Pathological Report in Intraductal Papillary Mucinous Neoplasms: A Single-Center Experience. J Clin Med 2021; 10:678. [PMID: 33578680 PMCID: PMC7916322 DOI: 10.3390/jcm10040678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/17/2022] Open
Abstract
The key to the successful management of pancreatic cystic neoplasm (PCN), among which intraductal papillary mucinous neoplasm (IPMN) is the one with the highest risk of advanced neoplasia in resected patients, is a careful combination of clinical, radiological, and histopathological findings. This study aims to perform the comparison of a preoperative evaluation with pathological reports in IPMN and further, to evaluate and compare the diagnostic performance of European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) and Fukuoka Consensus guidelines (FCG). We analyzed 106 consecutive patients diagnosed with different types of PCN, among whom 68 had IPMN diagnosis, at the Clinical Center of Serbia. All the patients diagnosed with IPMNs were stratified concerning the presence of the absolute and relative indications according to EEBGPCN and high-risk stigmata and worrisome features according to FCG. Final histopathology revealed that IPMNs patients were further divided into malignant (50 patients) and benign (18 patients) groups, according to the pathological findings. The preoperative prediction of malignancy according to EEBGPCN criteria was higher than 70% with high sensitivity of at least one absolute or relative indication for resection. The diagnostic performance of FCG was shown as comparable to EEBGPCN. Nevertheless, the value of false-positive rate for surgical resection showed that in some cases, overtreating patients or treating them too early cannot be prevented. A multidisciplinary approach is essential to adequately select patients for the resection considering at the same time both the risks of surgery and malignancy.
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Affiliation(s)
- Vladimir Djordjevic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
| | - Nikica Grubor
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Jelena Djokic Kovac
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, 11000 Belgrade, Serbia;
- Department for Radiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marjan Micev
- Department of Histopathology, Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; or
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, NY 55905, USA
| | - Djordje Knezevic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Pavle Gregoric
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
- Centre for Emergency Surgery, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Zeljko Lausevic
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
- Centre for Emergency Surgery, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Mirko Kerkez
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Srbislav Knezevic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
| | - Dejan Radenkovic
- Clinic for Digestive Surgery, First Surgical Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; (N.G.); (D.K.); (M.K.); (S.K.); (D.R.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.G.); (Z.L.)
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Kuwahara T, Hara K, Mizuno N, Haba S, Okuno N, Koda H, Miyano A, Fumihara D. Current status of artificial intelligence analysis for endoscopic ultrasonography. Dig Endosc 2021; 33:298-305. [PMID: 33098123 DOI: 10.1111/den.13880] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasonography (EUS) is an essential diagnostic tool for various types of pancreatic diseases such as pancreatic tumors and chronic pancreatitis; however, EUS imaging has low specificity for the diagnosis of pancreatic diseases. Artificial intelligence (AI) is a mathematical prediction technique that automates learning and recognizes patterns in data. This review describes the details and principles of AI and deep learning algorithms. The term AI does not have any definite definition; almost all AI systems fall under narrow AI, which can handle single or limited tasks. Deep learning is based on neural networks, which is a machine learning technique that is widely used in the medical field. Deep learning involves three phases: data collection and annotation, building the deep learning architecture, and training and ability validation. For medical image diagnosis, image classification, object detection, and semantic segmentation are performed. In EUS, AI is used for detecting anatomical features, differential pancreatic tumors, and cysts. For this, conventional machine learning architectures are used, and deep learning architecture has been used in only two reports. Although the diagnostic abilities in these reports were about 85-95%, these were exploratory research and very few reports have included substantial evidence. AI is increasingly being used for medical image diagnosis due to its high performance and will soon become an essential technique for medical diagnosis.
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Affiliation(s)
- Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Shin Haba
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Hiroki Koda
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Akira Miyano
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Daiki Fumihara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
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22
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Liu X, Xu W, Liu Z, Ye J. MRI Combined with Magnetic Resonance Cholangiopancreatography for Diagnosis of Benign and Malignant Pancreatic Intraductal Papillary Mucinous Neoplasms. Curr Med Imaging 2020; 15:504-510. [PMID: 32008558 DOI: 10.2174/1573405614666180807113422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) are among the important premalignant lesions. Early detection and intervention are critical to positive patient outcomes. Magnetic resonance imaging (MRI) can be used to evaluate the malignancy of IPMNs, and magnetic resonance cholangiopancreatography (MRCP) is recommended for follow-up of pancreatic cystic lesions. OBJECTIVE To evaluate the diagnostic performance of MRI combined with MRCP in determining the malignant potential of pancreas IPMN. METHODS This is a retrospective study of 55 patients with 58 pancreatic lesions confirmed after surgery, which were analyzed and divided into two groups, a benign IPMN group (n = 27) and a malignant IPMN group (n = 31). Two radiologists analyzed the high-risk stigmata and worrisome features of pancreas IPMN to evaluate the malignant potential. Score all the lesions as proposed by the international consensus guidelines 2012, and calculate the sensitivity, specificity and accuracy. RESULTS There were significant differences of size, enhancement of solid components, and degree of dilation of the main pancreatic duct between benign and malignant IPMN (P < 0.05). However, differences in gender, age and location of disease between the two groups were not statistically significant (P > 0.05). The sensitivity, specificity and accuracy of MRI combined with MRCP in preoperative diagnosis of malignant IPMNs were 90.3% (28/31), 70.4% (19/27) and 81.0% (47/58) respectively, when at least one worrisome feature was present. CONCLUSION MRI combined with MRCP is useful in the evaluation of the benign and malignant pancreas IPMN.
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Affiliation(s)
- Xiaojin Liu
- Department of Pharmacy, Dezhou People's Hospital, 1751 XinHu Street, Dezhou, Shandong 253000, China
| | - Wanbo Xu
- Department of Radiology, Dezhou People's Hospital, 1751 XinHu Street, Dezhou, Shandong 253000, China
| | - Zhenhe Liu
- Department of Radiology, Dezhou People's Hospital, 1751 XinHu Street, Dezhou, Shandong 253000, China
| | - Junli Ye
- Department of Pathophysiology, Medical College, Qingdao University, Qingdao, Shandong 266071, China
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23
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Nakano R, Nishiumi S, Kobayashi T, Ikegawa T, Kodama Y, Yoshida M. Possibility of detecting intraductal papillary mucinous neoplasms using metabolite biomarkers for pancreatic cancer. Biomark Med 2020; 14:1009-1020. [PMID: 32940075 DOI: 10.2217/bmm-2019-0587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: The aim of this study was to identify whether metabolite biomarker candidates for pancreatic cancer (PC) could aid detection of intraductal papillary mucinous neoplasms (IPMN), recognized as high-risk factors for PC. Materials & methods: The 12 metabolite biomarker candidates, which were found to be useful to detect PC in our previous study, were evaluated for plasma samples from patients with PC (n = 44) or IPMN (n = 24) or healthy volunteers (n = 46). Results: Regarding the performance of individual biomarkers of PC and PC high-risk IPMN, lysine exhibited the best performance (sensitivity: 67.8%; specificity: 86.9%). The multiple logistic regression analysis-based detection model displayed high sensitivity and specificity values of 92.5 and 90.6%, respectively. Conclusion: Metabolite biomarker candidates for PC are useful for detecting high-risk IPMN, which can progress to PC.
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Affiliation(s)
- Ryota Nakano
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shin Nishiumi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.,Department of Omics Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takuya Ikegawa
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Masaru Yoshida
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.,Division of Metabolomics Research, Department of Internal Related, Kobe University Graduate School of Medicine, Hyogo, Japan.,AMED-CREST, AMED, Hyogo, Japan
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24
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Hirashita T, Hirashita Y, Iwashita Y, Endo Y, Kiyonaga M, Matsumoto S, Hijiya N, Moriyama M, Murakami K, Inomata M. S6 ribosomal protein phosphorylation is associated with malignancy of intraductal papillary mucinous neoplasm of the pancreas. Ann Gastroenterol Surg 2020; 4:571-579. [PMID: 33005852 PMCID: PMC7511561 DOI: 10.1002/ags3.12367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Glucose metabolism of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is unclear. S6 ribosomal protein (S6) phosphorylation is involved not only in controlling cell growth but also in glucose metabolism in cancer. The aim of this study was to investigate the role of S6 phosphorylation and the significance of glucose metabolic changes in IPMN. METHODS Records of 39 patients who underwent preoperative FDG-PET and curative resection were enrolled in this study. S6 phosphorylation and GLUT1 expression were evaluated immunohistochemically in these patients. The effect of S6 phosphorylation on glucose uptake was examined in cancer cell lines. To examine the change of glucose metabolism in IPMN clinically, the relation between clinical factors including FDG-PET and malignancy of IPMN was investigated. RESULTS S6 phosphorylation and GLUT1 expression were significantly higher in carcinoma than in normal cells or adenoma. Cell lines with high level of S6 phosphorylation showed high glucose uptake, and inhibition of S6 phosphorylation reduced glucose uptake. In clinical examination, FDG-PET was the independent factor related to the diagnosis of adenoma or carcinoma (odds ratio = 20.0, 95% confidence interval = 1.837-539.9, P = .012). FDG-PET detected carcinoma with a sensitivity of 81.8%, specificity of 96.4%, and accuracy of 92.3%. CONCLUSION S6 phosphorylation was associated with glucose uptake and malignancy of IPMN. Moreover, glucose uptake increased in malignant cells of IPMN, and FDG-PET is useful for detecting malignancy of IPMN.
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Affiliation(s)
- Teijiro Hirashita
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityYufuJapan
| | - Yuka Hirashita
- GastroenterologyFaculty of MedicineOita UniversityYufuJapan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityYufuJapan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityYufuJapan
| | - Maki Kiyonaga
- RadiologyFaculty of MedicineOita UniversityYufuJapan
| | | | - Naoki Hijiya
- Molecular PathologyFaculty of MedicineOita UniversityYufuJapan
| | | | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryFaculty of MedicineOita UniversityYufuJapan
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25
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Harrington KA, Williams TL, Lawrence SA, Chakraborty J, Al Efishat MA, Attiyeh MA, Askan G, Chou Y, Pulvirenti A, McIntyre CA, Gonen M, Basturk O, Balachandran VP, Kingham TP, D’Angelica MI, Jarnagin WR, Drebin JA, Do RK, Allen PJ, Simpson AL. Multimodal radiomics and cyst fluid inflammatory markers model to predict preoperative risk in intraductal papillary mucinous neoplasms. J Med Imaging (Bellingham) 2020; 7:031507. [PMID: 32613028 PMCID: PMC7315109 DOI: 10.1117/1.jmi.7.3.031507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose: Our paper contributes to the burgeoning field of surgical data science. Specifically, multimodal integration of relevant patient data is used to determine who should undergo a complex pancreatic resection. Intraductal papillary mucinous neoplasms (IPMNs) represent cystic precursor lesions of pancreatic cancer with varying risk for malignancy. We combine previously defined individual models of radiomic analysis of diagnostic computed tomography (CT) with protein markers extracted from the cyst fluid to create a unified prediction model to identify high-risk IPMNs. Patients with high-risk IPMN would be sent for resection, whereas patients with low-risk cystic lesions would be spared an invasive procedure. Approach: Retrospective analysis of prospectively acquired cyst fluid and CT scans was undertaken for this study. A predictive model combining clinical features with a cyst fluid inflammatory marker (CFIM) was applied to patient data. Quantitative imaging (QI) features describing radiomic patterns predictive of risk were extracted from scans. The CFIM model and QI model were combined into a single predictive model. An additional model was created with tumor-associated neutrophils (TANs) assessed by a pathologist at the time of resection. Results: Thirty-three patients were analyzed (7 high risk and 26 low risk). The CFIM model yielded an area under the curve (AUC) of 0.74. Adding the QI model improved performance with an AUC of 0.88. Combining the CFIM, QI, and TAN models further increased performance to an AUC of 0.98. Conclusions: Quantitative analysis of routinely acquired CT scans combined with CFIMs provides accurate prediction of risk of pancreatic cancer progression. Although a larger cohort is needed for validation, this model represents a promising tool for preoperative assessment of IPMN.
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Affiliation(s)
- Kate A. Harrington
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | - Travis L. Williams
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, United States
| | - Sharon A. Lawrence
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Jayasree Chakraborty
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | | | - Marc A. Attiyeh
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Gokce Askan
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, United States
| | - Yuting Chou
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Alessandra Pulvirenti
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Caitlin A. McIntyre
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, United States
| | - Olca Basturk
- Memorial Sloan Kettering Cancer Center, Department of Pathology, New York, United States
| | - Vinod P. Balachandran
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - T. Peter Kingham
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Michael I. D’Angelica
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - William R. Jarnagin
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Jeffrey A. Drebin
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Richard K. Do
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | - Peter J. Allen
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, United States
| | - Amber L. Simpson
- Queen’s University, School of Computing, Kingston, Ontario, Canada
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Serafini S, Sperti C, Brazzale AR, Cecchin D, Zucchetta P, Pierobon ES, Ponzoni A, Valmasoni M, Moletta L. The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas. Cancers (Basel) 2020; 12:E807. [PMID: 32230809 DOI: 10.3390/cancers12040807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a heterogeneous group of tumors, increasingly diagnosed in clinical practice. An early differential diagnosis between malignant and benign lesions is crucial to patient management and the choice of surgery or observation. The therapeutic approach is currently based on a patient’s clinical, biochemical, and morphological characteristics. The latest published International Consensus Guidelines (ICG) make no mention of the role of metabolic assessments of IPMNs. The aim of this study was to review the current literature, examining the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in IPMN management. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 10 articles were analyzed in detail, focusing on the value of PET as opposed to other standard imaging criteria. Data were retrieved on 419 patients. The 18-FDG-PET proved more sensitive, specific, and accurate than the ICG criteria in detecting malignant IPMNs (reaching 80%, 95%, and 87% vs. 67%, 58%, and 63%, respectively). Metabolic assessments may be used as an additional tool for the appropriate management of patients with doubtful imaging findings.
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27
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Hao S, Takahashi C, Snyder RA, Parikh AA. Stratifying Intraductal Papillary Mucinous Neoplasms by Cyst Fluid Analysis: Present and Future. Int J Mol Sci 2020; 21:ijms21031147. [PMID: 32050465 PMCID: PMC7037360 DOI: 10.3390/ijms21031147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/11/2022] Open
Abstract
A significant proportion of patients with intraductal papillary mucinous neoplasms (IPMNs) undergo surgical resection in order to prevent or treat pancreatic cancer at the risk of significant perioperative morbidity. Efforts have been made to stratify the potential risk of malignancy based on the clinical and radiographic features of IPMN to delineate which cysts warrant resection versus observation. An analysis of the cyst fluid obtained by preoperative endoscopic examination appears to be correlative of cyst type and risk, whereas serum markers and radiographic findings have not yet reached a level of sensitivity or specificity that proves they are clinically meaningful. In this review, we investigate the current cyst fluid analysis studies and present those that have shown promise in effectively stratifying high-risk versus low-risk lesions. While new cyst fluid markers continue to be identified, additional efforts in testing panels and marker composites in conjunction with clinical algorithms have also shown promise in distinguishing dysplasia and the risk of malignancy. These should be tested prospectively in order to determine their role in guiding the surveillance of low-risk lesions and to evaluate the new markers detected by proteomics and genetic sequencing.
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Affiliation(s)
- Scarlett Hao
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA; (S.H.); (C.T.)
| | - Caitlin Takahashi
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA; (S.H.); (C.T.)
| | - Rebecca A. Snyder
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA;
| | - Alexander A. Parikh
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA;
- Correspondence: ; Tel.: +1-252-744-4110
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28
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Kaneko J, Matsubayashi H, Satoh T, Sato J, Takinami M, Ishiwatari H, Uesaka K, Abe M, Sasaki K, Ono H. Multilocular Cyst of Type 1 Autoimmune Pancreatitis Masquerading as Cancerization of Intraductal Papillary Mucinous Neoplasm. Intern Med 2020; 59:199-204. [PMID: 31484912 PMCID: PMC7008053 DOI: 10.2169/internalmedicine.3561-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A small proportion of intraductal papillary mucinous neoplasms (IPMNs) are accompanied by type 1 autoimmune pancreatitis (AIP); however their clinical courses and image characteristics have not been fully reported. A 65-year-old woman was referred to our hospital for the examination of a pancreatic head cyst that had shown exacerbation for two years. Several images demonstrated a multilocular cyst with a symmetrically thickened, enhanced, cyst wall. Cancerization of IPMN was suspected, and pancreatoduodenectomy was performed. The resected specimens showed a multilocular cyst with solid areas. The solid areas demonstrated pathological findings that corresponded with type 1 AIP. Papillary epithelia suggestive of IPMN was recognized in some parts of the cystic wall.
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Affiliation(s)
| | | | | | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | | | - Katsuhiko Uesaka
- Division of Hepato-pancreaticobiliary Surgery, Shizuoka Cancer Center, Japan
| | - Masato Abe
- Division of Pathology, Shizuoka Cancer Center, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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Chakraborty J, Midya A, Gazit L, Attiyeh M, Langdon-Embry L, Allen PJ, Do RKG, Simpson AL. CT radiomics to predict high-risk intraductal papillary mucinous neoplasms of the pancreas. Med Phys 2018; 45:5019-5029. [PMID: 30176047 DOI: 10.1002/mp.13159] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/15/2018] [Accepted: 08/15/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Intraductal papillary mucinous neoplasms (IPMNs) are radiographically visible precursor lesions of pancreatic cancer. Despite standard criteria for assessing risk, only 18% of cysts are malignant at resection. Thus, a large number of patients undergo unnecessary invasive surgery for benign disease. The ability to identify IPMNs with low or high risk of transforming into invasive cancer would optimize patient selection and improve surgical decision-making. The purpose of this study was to investigate quantitative CT imaging features as markers for objective assessment of IPMN risk. METHODS This retrospective study analyzed pancreatic cyst and parenchyma regions extracted from CT scans in 103 patients to predict IPMN risk. Patients who underwent resection between 2005 and 2015 with pathologically proven branch duct (BD)-IPMN and a preoperative CT scan were included in the study. Expert pathologists categorized IPMNs as low or high risk following resection as part of routine clinical care. We extracted new radiographically inspired features as well as standard texture features and designed prediction models for the categorization of high- and low-risk IPMNs. Five clinical variables were also combined with imaging features to design prediction models. RESULTS Using images from 103 patients and tenfold cross-validation technique, the novel radiographically inspired imaging features achieved an area under the receiver operating characteristic curve (AUC) of 0.77, demonstrating their predictive power. The combination of these features with clinical variables obtained the best performance (AUC = 0.81). CONCLUSION The present study demonstrates that features extracted from pretreatment CT images can predict the risk of IPMN. Development of a preoperative model to discriminate between low-risk and high-risk IPMN will improve surgical decision-making.
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Affiliation(s)
- Jayasree Chakraborty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Abhishek Midya
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Lior Gazit
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Marc Attiyeh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Liana Langdon-Embry
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Peter J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Amber L Simpson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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30
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Einama T, Kamachi H, Sakata T, Shibata K, Wakizaka K, Sugiyama K, Shibuya K, Shimada S, Wakayama K, Orimo T, Yokoo H, Kamiyama T, Mitsuhashi T, Taketomi A. Curative resection of pancreatic ductal adenocarcinoma developing in the remnant pancreas 13 years after distal pancreatectomy for intraductal papillary mucinous neoplasms: A case report. Mol Clin Oncol 2018; 8:417-420. [PMID: 29456847 PMCID: PMC5795772 DOI: 10.3892/mco.2018.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are characterized by the papillary proliferation of atypical mucinous epithelial cells in the pancreatic ductal system. There are two recurrence patterns following resection of IPMNs: Metachronous multifocal occurrence of IPMNs, and distinct pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas. Several recent studies investigated the development of distinct PDAC during follow-up evaluation of IPMNs and the incidence rate ranged from 4.5 to 8%. Thus, IMPNs may be a good predictor for the early detection of PDAC during observation or after the resection of IPMNs. We herein report the rare case of a patient who underwent resection of PDAC that developed in the remnant pancreas 13 years after distal pancreatectomy with splenectomy for IPMNs. PDAC may develop in the remnant pancreas after pancreatectomy for IPMNs; thus, careful long-term follow-up with periodic surveillance, at least every 6 months, is warranted.
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Affiliation(s)
- Takahiro Einama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Toshihiro Sakata
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kengo Shibata
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kazuki Wakizaka
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Ko Sugiyama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kazuaki Shibuya
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Shingo Shimada
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kenji Wakayama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Hideki Yokoo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
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Kim M, Mi Jang K, Kim SH, Doo Song K, Jeong WK, Kang TW, Kim YK, Cha DI, Kim K, Yoo H. Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with "high-risk stigmata" of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness. Acta Radiol 2017; 58:1157-1166. [PMID: 28084815 DOI: 10.1177/0284185116685921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background It is debated whether diagnostic performance of diffusion-weighted imaging (DWI), which is widely used for detection and characterization of various malignant tumors, is comparable with high-risk stigmata of 2012 international consensus guidelines (ICG) for diagnosis of intraductal papillary mucinous neoplasms (IPMNs). Purpose To evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 ICG. Material and Methods This retrospective study was institutional review board approved and informed consent was waived. A total of 132 patients with surgically proven IPMNs (49 malignant, 83 benign) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and DWI with a b-value of 0, 100, and 800 s/mm2 using a 3.0 T MR system were included. Two radiologists independently evaluated imaging parameters of high-risk stigmata and worrisome features of 2012 ICG and diffusion restriction in IPMNs. Univariate and multivariate logistic regression analyses and McNemar's test were used for statistical analysis. Results The presence of diffusion restriction in IPMNs was the only independent imaging parameter for prediction of malignancy (odds ratio [OR], 11.98; 95% confidence interval [CI], 3.60-39.87; P < 0.001) and invasiveness (OR, 17.92; 95% CI, 3.91-82.03; P < 0.001) on multivariate analysis. The diagnostic accuracy and specificity of diffusion restriction were significantly improved compared to high-risk stigmata of 2012 ICG to prediction of malignant ( P = 0.006 and P < 0.001, respectively) or invasive IPMNs ( P = 0.009 and P = 0.015, respectively). Conclusion The diffusion restriction in IPMNs could be considered as another high-risk stigma of malignancy and predictor for invasiveness.
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Affiliation(s)
- Mimi Kim
- 1 Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Kyung Mi Jang
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Hyun Kim
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Doo Song
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Ik Cha
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- 3 Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Heejin Yoo
- 3 Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
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Moris D, Damaskos C, Spartalis E, Papalampros A, Vernadakis S, Dimitroulis D, Griniatsos J, Felekouras E, Nikiteas N. Updates and Critical Evaluation on Novel Biomarkers for the Malignant Progression of Intraductal Papillary Mucinous Neoplasms of the Pancreas. Anticancer Res 2017; 37:2185-2194. [PMID: 28476781 DOI: 10.21873/anticanres.11553] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are presumed to evolve from low-grade dysplasia to high-grade dysplasia to invasive carcinoma. Resection of lesions before the development of pancreatic cancer may prevent the development of an incurable process as, once IPMNs progress to invasive cancer, the prognosis may be as poor as resected conventional pancreatic ductal adenocarcinoma. Resection of IPMNs, particularly in the setting of high-grade dysplasia, is presumed to provide a survival benefit. IPMNs also present many challenges as the identification of high-grade dysplasia and early invasive carcinoma and the timing and frequency of malignant progression are not yet established. The limited predictive accuracy presents a challenge as pancreatic resection is associated with a risk of substantial morbidity and mortality; 20-30% and 2-4%, respectively. Diagnostic armamentarium contains pancreas-protocol computed tomography (CT) scan, gadolinium-enhanced magnetic resonance imaging (MRI) with or without magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). The most promising method is endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as this technique allows analysis of cyst fluid using biomarkers. Until now, in clinical practice, we utilize two biomarkers, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9); however, DNA analysis of pancreatic cystic fluid and genomic analysis could offer new tools to the diagnosis and administration of IPMNs. Novel genomic and serum biomarkers could play an important future role to identify those individuals who will benefit from an early operation and those who will benefit from watchful waiting approach. More prospective studies are needed.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, U.S.A.
| | - Christos Damaskos
- 2nd Department of Propedeutic Surgery, University of Athens Medical School, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | | | - Spyridon Vernadakis
- Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Cancer, Riyadh, Kingdom of Saudi Arabia
| | - Dimitrios Dimitroulis
- 2nd Department of Propedeutic Surgery, University of Athens Medical School, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, University of Athens Medical School, Athens, Greece
| | - Evangelos Felekouras
- First Department of Surgery, University of Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
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Ohya A, Yamanoi K, Shimojo H, Fujii C, Nakayama J. Gastric gland mucin-specific O-glycan expression decreases with tumor progression from precursor lesions to pancreatic cancer. Cancer Sci 2017; 108:1897-1902. [PMID: 28685935 PMCID: PMC5581519 DOI: 10.1111/cas.13317] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/20/2017] [Accepted: 07/01/2017] [Indexed: 01/06/2023] Open
Abstract
Pancreatic cancer is lethal, as it is often detected late. Thus, novel biomarkers of precursor lesions are needed to devise timely therapies. Pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN) are major precursors of pancreatic cancer. In normal gastric mucosa, gastric gland mucin‐specific O‐glycans are unique in having α1,4‐linked N‐acetylglucosamine (αGlcNAc) residues attached to MUC6. Recently we reported that αGlcNAc functions as a tumor suppressor for differentiated‐type gastric adenocarcinoma (Karasawa et al., J Clin Invest 122, 923, 2012). MUC6 is also expressed in pancreatic neoplasms, including PanIN and IPMN, but the role of αGlcNAc expression in pancreatic neoplasms remains unknown. Here, we analyze expression patterns of αGlcNAc, MUC6 and MUC5AC in pancreatic neoplasms and compare them with progression from PanIN to invasive ductal adenocarcinoma (IDAC) (the PanIN‐IDAC sequence; 20 cases) and from IPMN to IPMN with associated invasive carcinoma (IPMNAIC) (the IPMN‐IPMNAIC sequence; 20 cases). At both sequences, the frequency of MUC6‐positive and αGlcNAc‐positive lesions decreased with tumor progression. We then compared expression levels of αGlcNAc and MUC6 at each step of the progression. At the PanIN‐IDAC sequence, αGlcNAc expression significantly decreased relative to MUC6 in low‐grade PanIN (P = 0.021), high‐grade PanIN/intraductal spread of IDAC (P = 0.031) and IDAC (P = 0.013). At the IPMN‐IPMNAIC sequence, decreased αGlcNAc expression was also observed in low‐grade IPMN exhibiting gastric‐type morphology (P = 0.020). These results suggest that decreased expression of αGlcNAc relative to MUC6 occurs early and marks the initiation of tumor progression to pancreatic cancer.
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Affiliation(s)
- Ayumi Ohya
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Yamanoi
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan
| | - Hisashi Shimojo
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Chifumi Fujii
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan
| | - Jun Nakayama
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan.,Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, Matsumoto, Japan
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Xu W, Liu X, Zhang J, Yang L. Intraductal Papillary Mucinous Neoplasms of the Pancreas: Correlation of Helical Computed Tomography (CT) Features With Pathologic Findings. Acad Radiol 2017; 24:609-614. [PMID: 28153575 DOI: 10.1016/j.acra.2016.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/09/2016] [Accepted: 12/14/2016] [Indexed: 01/06/2023]
Abstract
RATIONALE AND OBJECTIVES Intraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions of the pancreas. Computed tomography (CT) has been recommended to screen the malignant potential of IPMNs. However, data evaluating the use of CT to differentiate categories of IPMN based on disease progression are limited. This study aimed to explore the correlation between CT characteristics and pathology in IPMN associated with invasive carcinoma. MATERIALS AND METHODS A total of 31 patients with intraductal papillary mucinous carcinoma (IPMC) treated at one local regional hospital in Shanghai, China, were enrolled in this study. Patients were divided into two groups based on invasion component and characterized as follows: group A, an invasive component of less than 50% (IPMC-I); and group B, with invasion of 50% or greater and defined as pancreatic ductal adenocarcinoma associated with IPMN (PDAC-IPMN). First, we analyzed the imaging information of the 31 patients retrospectively. Then, we compared the imaging differences between the two groups. RESULTS Fifteen patients with IPMC-1 and 16 patients with PDAC-IPMN were identified. There was no statistically significant difference in sex, age, lesion location, radiologic type, tumor size, mural nodule size, and lymphatic metastasis between the two groups. However, the arterial increased CT values were significantly different between the two groups (P < .01), with values of 29.2 ± 12.4 HU for group A and 14.2 ± 8.8 HU for group B. The venous increased CT values were 44.6 ± 12.0 HU for group A and 28.4 ± 12.3 HU for group B, and these were significantly different between the two groups (P < .01). In group A, 13 cases (86.7%) were classified as T1 or T2 stage, and in group B, eight cases (50.0%) were classified as T1 and T2 stage. There was a statistically significant difference in tumor classification between group A and group B patients (P < .05). CONCLUSIONS IPMC-I and PDAC-IPMN have different characteristics in CT imaging, and we demonstrated that CT scans based on blood supply and lymphatic metastasis could be used to evaluate and potentially screen for variation in IPMC disease outcomes.
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Affiliation(s)
- Wanbo Xu
- Department of Radiology, Dezhou People's Hospital, Dezhou, China
| | - Xiaojin Liu
- Department of Pharmacy, Dezhou People's Hospital, Dezhou, China
| | - Jiawen Zhang
- Department of Radiology, Huashan Hospital of Fudan University, 12 WuLuMuQi Rd, Shanghai, China.
| | - Li Yang
- Department of Medical Imaging and Nuclear Medicine, Fudan University, Shanghai, China
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Tabrizian P, Berger Y, Pierobon ES, Aycart S, Argiriadi P, Fei K, Carrasco-Avino G, Labow DM, Sarpel U. Are Clinical Guidelines for the Management of Intraductal Papillary Mucinous Neoplasms Followed?: A Single-Center Analysis. Pancreas 2017; 46:198-202. [PMID: 28060184 DOI: 10.1097/MPA.0000000000000747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study aimed to determine how frequently guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) are followed and establish factors associated with failure. METHODS Four hundred forty-five patients with radiographic diagnosis of IPMN 1 cm or greater between January 1, 2003 and January 1, 2013 were included. We defined failure of guideline adherence if the following occurred: (a) failure of acknowledgment of IPMN, (b) failure to undergo endoscopic ultrasound, (c) failure to undergo resection, or (d) failure to undergo at least 1 surveillance image within 2 years after diagnosis. RESULTS Failure of guideline adherence was observed in 58% of patients and evident across all the respective criteria (A: 38%, B: 25%, C: 29%, D: 33%). Age older than 68 years (P < 0.01), American Society of Anesthesiologists score of 3 or higher (P < 0.0001), benign findings on imaging (P < 0.0001), and major comorbid conditions (P < 0.01) were factors associated with higher rate of failure to compliance. On multivariate logistic regression, American Society of Anesthesiologists score of 3 or higher and benign features were associated with 4.0 times (95% confidence interval, 2.02-8.06) and 2.6 times (95% confidence interval, 1.60-4.07) higher odds of failure to compliance with guidelines, respectively. CONCLUSIONS Compliance with clinical guidelines for the management of IPMN is poor. Socioeconomic factors do not seem to create a disparity to care. However, many patients with IPMN have other medical diagnoses that take priority over IPMN surveillance and treatment.
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Kadayifci A, Atar M, Wang JL, Forcione DG, Casey BW, Pitman MB, Brugge WR. Value of adding GNAS testing to pancreatic cyst fluid KRAS and carcinoembryonic antigen analysis for the diagnosis of intraductal papillary mucinous neoplasms. Dig Endosc 2017; 29:111-117. [PMID: 27514845 DOI: 10.1111/den.12710] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/28/2016] [Accepted: 08/10/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Molecular analysis of pancreatic cyst fluid (PCF) has been proposed as a novel method for differentiating pancreatic cystic lesions (PCL). The present study aimed to investigate the value of GNAS testing when added to KRAS and carcinoembryonic antigen (CEA) testing of PCF for the diagnosis of intraductal papillary mucinous neoplasms (IPMN). METHODS Prospectively collected endoscopic ultrasonography fine-needle aspiration (EUS-FNA) data were analyzed retrospectively for GNAS and KRAS mutations and CEA results. IPMN were histologically confirmed or supported by imaging and EUS-FNA findings (KRAS, CEA, cytology). Performance characteristics of GNAS added to KRAS and CEA for the diagnosis of IPMN were calculated. RESULTS The study population consisted of 197 patients with cyst fluid test results. Cysts were histologically classified in 33 patients and by clinical criteria in 164 patients. The IPMN group included 108 patients and the non-IPMN group included 89 patients. GNAS was positive in 51 patients (47.2%) with IPMN. Forty-two of these patients (82.3%) also had a KRAS mutation. Adding GNAS to KRAS increased the diagnostic accuracy from 76.6% to 79.1% (P > 0.05). Adding GNAS to CEA increased the diagnostic accuracy from 66.4% to 80.7 % (P < 0.05), but did not achieve a diagnostic superiority to KRAS testing alone (80.7% vs 76.6%, P > 0.05). The diagnostic accuracy of the triple combination was significantly better than all single tests (P < 0.05). CONCLUSION GNAS mutation is a highly specific test for IPMN. When GNAS testing is added to CEA and KRAS, a significantly greater overall accuracy (86.2%) is achieved.
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Affiliation(s)
- Abdurrahman Kadayifci
- Division of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey.,Division of Gastroenterology, Harvard Medical School, Boston, USA
| | - Mustafa Atar
- Division of Gastroenterology, Harvard Medical School, Boston, USA
| | - Jessica L Wang
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David G Forcione
- Division of Gastroenterology, Harvard Medical School, Boston, USA
| | - Brenna W Casey
- Division of Gastroenterology, Harvard Medical School, Boston, USA
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - William R Brugge
- Division of Gastroenterology, Harvard Medical School, Boston, USA
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Baiocco JA, Ackerman CT, Crawford JL, Yeo CJ. Intraductal Papillary Mucinous Neoplasm and Pancreas Divisum: Two Cases. J Pancreat Cancer 2016; 2:28-31. [PMID: 28758161 PMCID: PMC5529052 DOI: 10.1089/crpc.2016.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Pancreatic intraductal papillary mucinous neoplasms (IPMNs) are a subset of ductal cell tumors with potential for malignancy. Because it is difficult to predict whether and when they will become malignant, management and resection are widely debated. Case 1: A 70-year-old male with a 1-year history of epigastric pain was found to have pancreas divisum with a dominant 2.4 cm multicystic uncinate process lesion communicating with the main pancreatic duct and associated uncinate duct dilation. Case 2: An 83-year-old male with pancreas divisum had a 7.3 cm uncinate cystic lesion with mural nodularity that had increased in size from 2.1 cm in 2008. Conclusion: Management of patients with IPMNs can be challenging and may require resection to prevent malignant transformation.
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Affiliation(s)
- Joseph A Baiocco
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin T Ackerman
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James L Crawford
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
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Goh BKP, Tan DMY, Chan CY, Lee SY, Lee VTW, Thng CH, Low ASC, Tai DWM, Cheow PC, Chow PKH, Ooi LLPJ, Chung AYF. Are preoperative blood neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios useful in predicting malignancy in surgically-treated mucin-producing pancreatic cystic neoplasms? J Surg Oncol 2015; 112:366-71. [PMID: 26280242 DOI: 10.1002/jso.23997] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/12/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The aim of this study was to determine if neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in mucin-producing pancreatic cystic neoplasms (MpPCN). METHODS One hundred and twenty patients with MpPCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma or high grade dysplasia. A high NLR and PLR were defined as ≥2.551 and ≥208.1, respectively. RESULTS High NLR was significantly associated with symptomatic tumors, larger tumors, solid component, main-duct IPMN, and Sendai high risk category. High PLR was significantly associated with jaundice and Sendai high risk category. On univariate analyses, symptomatic tumors, jaundice, solid component, dilated pancreatic duct, and both a high NLR and PLR were significant predictors of malignant and invasive MpPCN. On multivariate analyses, solid component and dilated pancreatic duct were independent predictors of malignant and invasive MpPCN. PLR was an independent predictor for invasive MpPCN. When MpPCN were stratified by the Fukuoka and Sendai Guidelines, both a high NLR and PLR were significantly associated with malignant neoplasms within the high risk categories. CONCLUSIONS PLR is an independent predictor of invasive carcinoma. The addition of PLR as a criterion to the FCG and SCG significantly improved the predictive value of these guidelines in detecting invasive neoplasms.
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Affiliation(s)
- Brian K P Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Damien M Y Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Ser-Yee Lee
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Victor T W Lee
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Choon-Hua Thng
- Department of Oncologic Imaging, National Cancer Centre, Singapore
| | - Albert S C Low
- Department of Radiology, Singapore General Hospital, Singapore
| | - David W M Tai
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Pierce K H Chow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - London L P J Ooi
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
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Einama T, Kamachi H, Nishihara H, Homma S, Kanno H, Ishikawa M, Kawamata F, Konishi Y, Sato M, Tahara M, Okada K, Muraoka S, Kamiyama T, Taketomi A, Matsuno Y, Furukawa H, Todo S. Importance of luminal membrane mesothelin expression in intraductal papillary mucinous neoplasms. Oncol Lett 2015; 9:1583-1589. [PMID: 25789005 PMCID: PMC4356290 DOI: 10.3892/ol.2015.2969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 11/28/2014] [Indexed: 12/28/2022] Open
Abstract
The present study demonstrated that luminal membrane mesothelin expression is a reliable prognostic factor in gastric cancer. Intraductal papillary mucinous neoplasms (IPMNs) often exhibit a spectrum of dysplasia, ranging between adenoma and carcinoma. Therefore, an immunohistochemical analysis of mesothelin expression in IPMN was performed in the present study, focusing on the localization of mesothelin. IPMNs were classified into two groups, IPMNs associated with invasive carcinoma and low-high (L-H) grade dysplasias. The tumors were classified as mesothelin-positive or -negative and in the mesothelin-positive cases, the localization of mesothelin was evaluated as luminal membrane- or cytoplasmic-positive. Among the 37 IPMNs, mesothelin expression was observed in 21 samples (56.8%), including 46.2% (12 out of 26) of the L-H dysplasia and 81.8% (9 out of 11) of the invasive carcinoma samples (P=0.071). Luminal membrane localization was observed in 10 samples (27%), including 15.4% (4/26) of the L-H dysplasia samples and 54.5% (6 out of 11) of the invasive carcinoma samples (P=0.022). Six patients experienced post-operative recurrence, with five of the recurrent tumors exhibiting mesothelin expression and all six exhibiting luminal membrane localization. It was concluded that immunohistochemical examinations for mesothelin expression and localization are clinically useful for prognostic assessments and decision making regarding further treatment subsequent to surgical procedures in patients with IPMN.
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Affiliation(s)
- Takahiro Einama
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan ; Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805, Japan ; Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Hirofumi Kamachi
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Shigenori Homma
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Hiromi Kanno
- Department of Pathology, Laboratory of Cancer Research, Hokkaido University School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Marin Ishikawa
- Department of Pathology, Laboratory of Cancer Research, Hokkaido University School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Futoshi Kawamata
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Yuji Konishi
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Masanori Sato
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Munenori Tahara
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Kuniaki Okada
- Department of Surgery, JA Sapporo Kosei Hospital, Sapporo, Hokkaido 060-0033, Japan
| | - Shunji Muraoka
- Department of Pathology, JA Sapporo Kosei Hospital, Sapporo, Hokkaido 060-0033, Japan
| | - Toshiya Kamiyama
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Akinobu Taketomi
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroyuki Furukawa
- Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan
| | - Satoru Todo
- Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
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Ikemoto T, Sugimoto K, Shimada M, Utsunomiya T, Morine Y, Imura S, Arakawa Y, Kanamoto M, Iwahashi SI, Saito Y, Yamada S. Clinical role of Notch signaling pathway in intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol Hepatol 2015; 30:217-22. [PMID: 25041344 DOI: 10.1111/jgh.12660] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM This study was performed to elucidate the expression of the Notch signaling pathway and its correlations to clinicopathological factors of intraductal papillary mucinous neoplasms (IPMNs). It is incontrovertible that regulatory T cells (Tregs) play an important role in tumor immunity. However, the whole mechanism of control of peripheral Tregs remains unclear. It is also known that the Notch signaling pathway is involved in Treg suppressor function. Moreover, IPMNs have a high malignant potential. METHODS Peripheral blood samples and resected specimens from 18 patients with IPMN were evaluated. All patients were pathologically diagnosed with IPMN. Resected specimens were immunohistochemically evaluated (anti-Notch1, anti-Notch2, and anti-Notch2-intracellular domain antibody staining) and compared in terms of clinicopathological factors. Peripheral Treg populations were analyzed with an automated flow cytometer. RESULTS Disease-free survival was significantly worse in the Notch1 high-expression group (P = 0.023). Notch2 family expressions were higher in intraductal papillary mucinous carcinoma (IPMC) than in intraductal papillary mucinous adenoma (IPMA) (Notch2, P = 0.012; Notch2-intracellular domain, P = 0.036). Jagged1 expression was significantly higher in IPMC than in IPMA (P < 0.05) and was significantly related to recurrence. The Treg population in peripheral blood was higher in patients with IPMC than in those with IPMA (P < 0.01). CONCLUSIONS Notch signaling, especially Jagged1 expression, reflects IPMN aggressiveness. Our data may suggest that the Notch signaling pathway is a key pathway that determines IPMN pathological aggressiveness and reflects the peripheral Treg population.
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Affiliation(s)
- Tetsuya Ikemoto
- Department of Surgery, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan
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Wang W, Zhang L, Chen L, Wei J, Sun Q, Xie Q, Zhou X, Zhou D, Huang P, Yang Q, Xie H, Zhou L, Zheng S. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 for prediction of malignancy and invasiveness in intraductal papillary mucinous neoplasms of the pancreas: A meta-analysis. Biomed Rep 2014; 3:43-50. [PMID: 25469245 DOI: 10.3892/br.2014.376] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 09/16/2014] [Indexed: 12/14/2022] Open
Abstract
The clinical importance of intraductal papillary mucinous neoplasms (IPMN) of the pancreas has been increasing due to the large number of newly diagnosed cases. A meta-analysis was used to assess the accuracy of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) for the identification of malignant and invasive IPMN. A literature search of PubMed and Web of Knowledge was conducted. Studies included in the analysis addressed the diagnostic accuracy of serum CEA and CA19-9 and pooled estimates of sensitivity, specificity, positive- and negative-likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR) and receiver operating characteristic curves were calculated using random-effects models. Predefined subgroup analysis was performed. Fifteen studies (published between 2001 and 2013) were analyzed, including a total of 1,629 patients. Pooled estimates of CEA in malignant and invasive IPNM prediction were: Pooled sensitivity, 18 and 18%; pooled specificity, 93 and 95%; PLR, 2.83 and 3.54; NLR, 0.89 and 0.89; and DOR, 3.35 and 3.6, respectively. Pooled estimates of CA19-9 in malignant and invasive IPMN prediction were: Pooled sensitivity, 40 and 52%; pooled specificity, 89 and 88%; PLR, 2.93 and 3.78; NLR, 0.74 and 0.6; and DOR, 4.34 and 6.33, respectively. In conclusion, serum CEA has low sensitivity and high specificity for malignant and invasive IPMN. Serum CA19-9 is a useful non-invasive preoperative tool for differentiating between invasive and benign IPMN and should be taken into account in the decision to perform surgery.
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Affiliation(s)
- Weilin Wang
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Lufei Zhang
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Linghui Chen
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jianfeng Wei
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Qiang Sun
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Qingshong Xie
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Xiaohu Zhou
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Dongkai Zhou
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Pengfei Huang
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Qifan Yang
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Haiyang Xie
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Lin Zhou
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Shusen Zheng
- Key Laboratories of Combined Multi-Organ Transplantation, Ministry of Public Health, and The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Key Laboratories of Organ Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11:913-21; quiz e59-60. [PMID: 23416279 DOI: 10.1016/j.cgh.2013.02.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/17/2013] [Accepted: 02/01/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS International guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas recommend surgical resection of those with specific characteristics. We performed a meta-analysis to evaluate the risk of malignancy associated with each of these features of IPMNs. METHODS We performed a comprehensive search of MEDLINE from January 1, 1996, to November 11, 2011, for studies that included any of the features mentioned in the consensus guidelines for surgical resection of main duct and branch duct IPMNs. Data were analyzed from 41 studies for the following features: cyst size greater than 3 cm, the presence of mural nodules, dilated main pancreatic duct, symptoms, and main duct vs branch duct IPMNs. Malignant IPMNs were defined as those with carcinoma in situ or more advanced histology. A separate meta-analysis was performed for each risk factor to calculate pooled odds ratios (ORs). A random-effects model was used, based on the assumption of variation among study populations. RESULTS The risks of malignancy associated with individual cyst features were as follows: cyst size greater than 3 cm (OR, 62.4; 95% confidence interval [CI], 30.8-126.3), presence of a mural nodule (OR, 9.3; 95% CI, 5.3-16.1), dilatation of the main pancreatic duct (OR, 7.27; 95% CI, 3.0-17.4), and main vs branch duct IPMN (OR, 4.7; 95% CI, 3.3-6.9). There was a moderate level of heterogeneity among studies (I(2) range, 34-67). CONCLUSIONS Based on a meta-analysis, cyst features proposed by the international guidelines for resection of IPMN were highly associated with malignancy. However, based on our findings, not all cyst features should be weighted equally when considering risk of malignancy; cyst size greater than 3 cm was associated most strongly with malignant IPMN.
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Affiliation(s)
- Neeraj Anand
- Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
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Correa-Gallego C, Ferrone CR, Thayer SP, Wargo JA, Warshaw AL, Fernández-del Castillo C. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology 2010; 10:144-50. [PMID: 20484954 PMCID: PMC3214832 DOI: 10.1159/000243733] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 09/21/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most cystic neoplasms of the pancreas (CNPs) are incidentally discovered. Their management continues to be debated and preoperative diagnosis is often inaccurate. METHODS Retrospective review of 330 patients with incidentally discovered CNPs. Preoperative and final histological diagnoses were correlated. RESULTS 41% (136/330) of patients were operated on at diagnosis. 50 patients underwent resection for a presumed branch-duct (Bd) intraductal papillary mucinous neoplasm (IPMN), which was confirmed in only 64% (32/50); of the remaining patients, 20% had main-duct involvement. Mucinous cystic neoplasm was the preoperative diagnosis in 30/136 patients, histologic examination was confirmatory in only 60% (18/30). Most lesions presumed to be main-duct or combined IPMNs or serous cystadenomas were confirmed as such after resection (15/16 and 11/12, respectively). Multifocality was not only associated with Bd-IPMN, and 5% of all cysts were non-neoplastic. Overall, in only 68% of cases did the preoperative and histological diagnoses match. CONCLUSIONS In an experienced, high-volume center, preoperative diagnosis was incorrect in one-third of incidentally discovered CNPs who underwent resection. Of particular concern, 20% of presumed Bd-IPMN had a main-duct component. Conversely, 5% of resected cysts were not even neoplastic. Clearly, better diagnostic methods are needed to aid in formulating appropriate treatment strategies.
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Affiliation(s)
| | | | | | | | | | - Carlos Fernández-del Castillo
- *Carlos Fernández-del Castillo, Department of Surgery, Massachusetts General Hospital, 15 Parkman St., WAC 460, Boston, MA 02114 (USA), Tel. +1 617 726 5644, Fax +617 726 3383, E-Mail
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Fritz S, Fernández-del Castillo C, Iafrate AJ, Mino-Kenudson M, Neyhard N, LaFemina J, Stirman A, Warshaw AL, Thayer SP. Novel xenograft and cell line derived from an invasive intraductal papillary mucinous neoplasm of the pancreas give new insights into molecular mechanisms. Pancreas 2010; 39:308-14. [PMID: 19924021 DOI: 10.1097/MPA.0b013e3181bd5c10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a unique entity with malignant potential. Histologically, pancreatic ductal adenocarcinoma (PDAC) arising in IPMN (intraductal papillary mucinous carcinoma [IPMC]) appears similar to sporadic PDAC; biologically, however, IPMC seems to have a less aggressive clinical course. Little is known about the genetic signature of IPMC. In this study, we describe a novel xenograft model and cell culture created to biologically and genetically characterize these tumors. METHODS Xenograft mice and cell lines were created from IPMC. Global genomic changes were evaluated by cytogenetic analysis and array comparative genomic hybridization. Specific mutations and sonic hedgehog (Shh) pathway activity were examined and xenografts evaluated for sensitivity to anti-Shh therapy. RESULTS Cytogenetic analysis showed a tetraploid karyotype with multiple aberrations. KRAS and p53 mutations and overexpression of the Shh pathway were identified. Array comparative genomic hybridization revealed multiple chromosomal aberrations comparable with previously published data in IPMNs. Murine xenograft tumors were sensitive to anti-Shh treatment. CONCLUSIONS Characterization of IPMC cell lines and xenografts reveals similarities to previously published data on IPMN. In comparison to PDAC, moreover, these data reveal shared aberrations and distinct genomic changes. Thus, these xenograft model and cell lines may be useful for future preclinical investigations.
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Cheung W, Darfler MM, Alvarez H, Hood BL, Conrads TP, Habbe N, Krizman DB, Mollenhauer J, Feldmann G, Maitra A. Application of a global proteomic approach to archival precursor lesions: deleted in malignant brain tumors 1 and tissue transglutaminase 2 are upregulated in pancreatic cancer precursors. Pancreatology 2008; 8:608-16. [PMID: 18849643 PMCID: PMC2711211 DOI: 10.1159/000161012] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 07/01/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic cancer is an almost uniformly fatal disease, and early detection is a critical determinant of improved survival. A variety of noninvasive precursor lesions of pancreatic adenocarcinoma have been identified, which provide a unique opportunity for intervention prior to onset of invasive cancer. Biomarker discovery in precursor lesions has been hampered by the ready availability of fresh specimens, and limited yields of proteins suitable for large scale screening. METHODS We utilized Liquid Tissue, a novel technique for protein extraction from archival formalin-fixed material, and mass spectrometry to conduct a global proteomic analysis of an intraductal papillary mucinous neoplasm (IPMN). Tissue microarrays comprised of 38 IPMNs were used for validation of candidate proteins. RESULTS The proteomic analysis of the IPMN Liquid Tissue lysate resulted in identification of 1,534 peptides corresponding to 523 unique proteins. A subset of 25 proteins was identified that had previously been reported as upregulated in pancreatic cancer. Immunohistochemical analysis for two of these, deleted in malignant brain tumors 1 (DMBT1) and tissue transglutaminase 2 (TGM2), confirmed their overexpression in IPMNs. CONCLUSION Global proteomics analysis using the Liquid Tissue workflow is a feasible approach for unbiased biomarker discovery in limited archival material, particularly applicable to precursor lesions of cancer.
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Affiliation(s)
- Wang Cheung
- Departments of Pathology, Baltimore, Md., USA
| | | | | | - Brian L. Hood
- Department of Pharmacology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA
| | - Thomas P. Conrads
- Department of Pharmacology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA
| | - Nils Habbe
- Departments of Pathology, Baltimore, Md., USA
| | | | - Jan Mollenhauer
- Department of Molecular Genome Analysis, Deutsches Krebsforschungszentrum, Heidelberg, Germany,Department of Molecular Oncology, Institute of Medical Biology, University of Southern Denmark, Odense, Denmark
| | - Georg Feldmann
- Departments of Pathology, Baltimore, Md., USA,*Georg Feldmann, MD, The Sol Goldman Pancreatic Cancer Research Center, Room 316, CRB II, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD 21231 (USA), Tel. +1 410 955 3511, Fax +1 410 614 0671, E-Mail
| | - Anirban Maitra
- Departments of Pathology, Baltimore, Md., USA,Oncology, Johns Hopkins University School of Medicine, Baltimore, Md., USA,Genetic Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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