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Pea A, Bevere M, Gkountakos A, Pasini D, Fiorini D, Mafficini A, Golovco S, Simbolo M, Pedron S, Sciammarella C, Mattiolo P, Mombello A, Villanova M, Franzina C, Masetto F, Ciulla C, Sperandio N, Fujikura K, Ahadi MS, Samra JS, Johns AL, Verheij J, Stommel MWJ, van Santvoort H, Schubert Santana L, Malleo G, Milella M, Brosens LAA, Wood LD, Chang DK, De Robertis R, D'Onofrio M, Gill AJ, Salvia R, Corbo V, Lawlor RT, Scarpa A, Luchini C. Mucinous cystic neoplasms and simple mucinous cysts are two distinct precursors of pancreatic cancer: clinicopathological, genomic, and transcriptomic characterization. J Pathol 2025. [PMID: 40371932 DOI: 10.1002/path.6437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 03/15/2025] [Accepted: 04/25/2025] [Indexed: 05/16/2025]
Abstract
Mucinous cystic neoplasms (MCNs) of the pancreas are macroscopic precursors of pancreatic cancer. A similar cystic lesion but lacking the ovarian-type subepithelial stroma has been recently defined as a simple mucinous cyst (SMC); however, its nature remains unclear. This study aims to define the clinicopathological and molecular profiles of a cohort of MCNs and SMCs of the pancreas and their associated invasive carcinoma. Overall, 23 cases were identified, comprising 19 MCNs and 4 SMCs with co-occurring invasive carcinoma. A multiregional (two samples from each cystic lesion and one from the adenocarcinoma) DNA and RNA sequencing approach was used. The key findings can be summarized as follows: (1) Molecular association: In 22/23 cases (95.7%), the concomitant mucinous cyst and invasive carcinoma shared specific genomic alterations, establishing for the first time that SMC is a true precursor of pancreatic cancer. (2) Clinical behavior: carcinomas arising from SMC appeared to be more aggressive than those arising from MCN. (3) Mutational profile: both cyst types showed significant similarities to conventional pancreatic ductal adenocarcinoma (PDAC), with KRAS and TP53 the most commonly altered genes. (4) Intracystic heterogeneity: while most molecular alterations were present in both analyzed cystic areas, RNF43 showed the highest heterogeneity. (5) CDKN2A: its alterations were predominantly restricted to the invasive component, suggesting a role in driving the invasion in a subset of cases. CNKN2A may also serve as a potential biomarker for identifying high-risk cysts. (6) RNAseq: most cases showed a switch from the classical to the basal transcriptome subtype during the progression from cystic neoplasms to invasive cancers. These findings establish SMCs as new precursors of pancreatic cancer and provide critical insights into the tumorigenesis of MCNs, with potential immediate implications for tumor taxonomy and clinical management. © 2025 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Antonio Pea
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Verona, Italy
| | - Michele Bevere
- ARC-Net Research Center, University of Verona, Verona, Italy
| | | | - Davide Pasini
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
| | - Denise Fiorini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Andrea Mafficini
- ARC-Net Research Center, University of Verona, Verona, Italy
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Stela Golovco
- ARC-Net Research Center, University of Verona, Verona, Italy
| | - Michele Simbolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Serena Pedron
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Concetta Sciammarella
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Aldo Mombello
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Manuela Villanova
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Carlotta Franzina
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | | | - Calogero Ciulla
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | | | - Kohei Fujikura
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Masha S Ahadi
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, and Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jaswinder S Samra
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amber L Johns
- The Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hjalmar van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht and St Antonius Hospital, Utrecht, Netherlands
| | - Leonor Schubert Santana
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Verona, Italy
| | - Michele Milella
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Lodewijk A A Brosens
- Department of Pathology, UMC Utrecht, Utrecht University, Utrecht, and Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura D Wood
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David K Chang
- Wolfson Wohl Cancer Research Centre, Research Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo De Robertis
- Department of Diagnostics and Public Health, Section of Radiology, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Diagnostics and Public Health, Section of Radiology, University of Verona, Verona, Italy
| | - Anthony J Gill
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, and Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Roberto Salvia
- Department of General and Pancreatic Surgery-The Pancreas Institute, Verona University Hospital Trust, Verona, Italy
| | - Vincenzo Corbo
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Rita T Lawlor
- ARC-Net Research Center, University of Verona, Verona, Italy
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Aldo Scarpa
- ARC-Net Research Center, University of Verona, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Claudio Luchini
- ARC-Net Research Center, University of Verona, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
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Hamada T, Oyama H, Takahara N, Nakai Y, Fujishiro M. Role of Endoscopy in Clinical Management of Intraductal Papillary Mucinous Neoplasms. J Gastroenterol Hepatol 2025; 40:1045-1058. [PMID: 40159838 PMCID: PMC12062927 DOI: 10.1111/jgh.16938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 02/21/2025] [Accepted: 03/09/2025] [Indexed: 04/02/2025]
Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a well-recognized precursor of pancreatic carcinoma. Along with cross-sectional abdominal imaging tests, endoscopic examinations remain the cornerstone in the diagnosis of pancreatic cysts, early detection of IPMN-derived carcinomas, and risk stratification of patients with IPMNs for subsequent surveillance strategies. In particular, endoscopic ultrasound (EUS) facilitates the optimal patient management by providing high-resolution morphological information, and the contrast-enhanced harmonic mode may further enhance diagnostic accuracy. EUS-guided fine-needle aspiration for solid mass and/or cyst fluid is considered for pathological and molecular examinations for the diagnosis of pancreatic cysts and malignancy. Emerging evidence suggests the usefulness of through-the-needle biopsy and confocal laser microendoscopy in this setting. In addition to the undoubtful diagnostic utility, recent studies have demonstrated the potential effect of endoscopic interventions (i.e., ablation) on the control of IPMNs. Despite the increasing role of endoscopy in the clinical management of IPMNs, there remains a gap in our understanding of how to utilize endoscopy in the personalized care for patients with IPMNs (e.g., the optimal interval of EUS) and the prevention of deaths due to pancreatic carcinomas developing concomitantly with IPMNs. This review summarizes the current evidence on the role of endoscopy in both the diagnostic and therapeutic landscapes of clinical management of IPMNs and identifies key clinical unmet needs that should be addressed in future research. Combined with emerging technologies (e.g., artificial intelligence and high-throughput molecular profiling), endoscopy would offer more effective and tailored management strategies for patients with IPMNs.
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Affiliation(s)
- Tsuyoshi Hamada
- Graduate School of MedicineDepartment of GastroenterologyThe University of TokyoTokyoJapan
- The Cancer Institute HospitalDepartment of Hepato‐Biliary‐Pancreatic MedicineJapanese Foundation for Cancer ResearchTokyoJapan
| | - Hiroki Oyama
- Graduate School of MedicineDepartment of GastroenterologyThe University of TokyoTokyoJapan
| | - Naminatsu Takahara
- Graduate School of MedicineDepartment of GastroenterologyThe University of TokyoTokyoJapan
| | - Yousuke Nakai
- Graduate School of MedicineDepartment of GastroenterologyThe University of TokyoTokyoJapan
- Institute of GastroenterologyDepartment of Internal MedicineTokyo Women's Medical UniversityTokyoJapan
| | - Mitsuhiro Fujishiro
- Graduate School of MedicineDepartment of GastroenterologyThe University of TokyoTokyoJapan
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Song B, Shuang L, Zhang S, Tong C, Chen Q, Li Y, Hao M, Niu W, Jin CH. Research progress of nano drug delivery systems in the anti-tumor treatment of traditional Chinese medicine monomers. PeerJ 2025; 13:e19332. [PMID: 40292112 PMCID: PMC12034246 DOI: 10.7717/peerj.19332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 03/25/2025] [Indexed: 04/30/2025] Open
Abstract
Tumors pose a serious threat to global public health and are usually treated from two aspects: tumor cells and tumor microenvironment. Compared with traditional chemotherapy drugs, traditional Chinese medicine (TCM) monomers have advantages in tumor treatment, such as multiple targets, multiple levels and synergistic intervention. However, most TCM active ingredients have disadvantages such as poor water solubility and stability, which restrict their clinical application. Nano drug delivery systems have the functions of improving the bioavailability of TCM anti-tumor active ingredients, enhancing tissue targeting, achieving controlled drug release, and inhibiting tumor multidrug resistance. Compared with free monomers, they have higher therapeutic effects and fewer side effects. This article summarizes five commonly used anti-tumor TCM monomer nanocarriers, including lipid nanomaterials, exosomes, polymer micelles, carbon nanotubes, and dendrimers, and explains their anti-tumor mechanisms after combining with TCM, such as inhibiting tumor cell proliferation and metastasis, regulating tumor microenvironment, etc. At the same time, the potential of nano drug delivery systems combined with radiotherapy and immunotherapy is discussed, as well as the current problems of potential toxicity, long-term stability, and complex amplification process, as well as future development directions, aiming to provide a reference for promoting the clinical application of nano drug delivery systems for TCM anti-tumor active ingredients.
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Affiliation(s)
- Bocui Song
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Li Shuang
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Shuang Zhang
- Comprehensive Service Center, Yongji Economic Development Zone, Jilin, Jilin, China
| | - Chunyu Tong
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Qian Chen
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Yuqi Li
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Meihan Hao
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Wenqi Niu
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
| | - Cheng-Hao Jin
- College of Life Science and Technology, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang, China
- College of Life Science and Technology, College of Life Science and Technology, Daqing, Heilongjiang, China
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Liao H, Huang C, Liu C, Zhang J, Tao F, Liu H, Liang H, Hu X, Li Y, Chen S, Li Y. Deep learning-based MVIT-MLKA model for accurate classification of pancreatic lesions: a multicenter retrospective cohort study. LA RADIOLOGIA MEDICA 2025; 130:508-523. [PMID: 39832039 DOI: 10.1007/s11547-025-01949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 01/01/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND Accurate differentiation between benign and malignant pancreatic lesions is critical for effective patient management. This study aimed to develop and validate a novel deep learning network using baseline computed tomography (CT) images to predict the classification of pancreatic lesions. METHODS This retrospective study included 864 patients (422 men, 442 women) with confirmed histopathological results across three medical centers, forming a training cohort, internal testing cohort, and external validation cohort. A novel hybrid model, Multi-Scale Large Kernel Attention with Mobile Vision Transformer (MVIT-MLKA), was developed, integrating CNN and Transformer architectures to classify pancreatic lesions. The model's performance was compared with traditional machine learning methods and advanced deep learning models. We also evaluated the diagnostic accuracy of radiologists with and without the assistance of the optimal model. Model performance was assessed through discrimination, calibration, and clinical applicability. RESULTS The MVIT-MLKA model demonstrated superior performance in classifying pancreatic lesions, achieving an AUC of 0.974 (95% CI 0.967-0.980) in the training set, 0.935 (95% CI 0.915-0.954) in the internal testing set, and 0.924 (95% CI 0.902-0.945) in the external validation set, outperforming traditional models and other deep learning models (P < 0.05). Radiologists aided by the MVIT-MLKA model showed significant improvements in diagnostic accuracy and sensitivity compared to those without model assistance (P < 0.05). Grad-CAM visualization enhanced model interpretability by effectively highlighting key lesion areas. CONCLUSION The MVIT-MLKA model efficiently differentiates between benign and malignant pancreatic lesions, surpassing traditional methods and significantly improving radiologists' diagnostic performance. The integration of this advanced deep learning model into clinical practice has the potential to reduce diagnostic errors and optimize treatment strategies.
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Affiliation(s)
- Hongfan Liao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Cheng Huang
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Chunhua Liu
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jiao Zhang
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fengming Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Haotian Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongwei Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoli Hu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Li
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Shanxiong Chen
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China.
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Maher MH, Treekitkarnmongkol W, Ghatak S, Dai J, Liu S, Nguyen T, Duose DY, Kim MP, Hu TY, Hurd MW, Paris PL, Kirkwood KS, Maitra A, Luthra R, Sen S, Roy-Chowdhuri S. An integrated multi-omics biomarker approach using molecular profiling and microRNAs for evaluation of pancreatic cyst fluid. Cancer Cytopathol 2025; 133:e70008. [PMID: 40106268 DOI: 10.1002/cncy.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 01/07/2025] [Accepted: 01/17/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND Classification and risk stratification of pancreatic cysts are challenging because of limited radiographic and cytomorphologic features. Although molecular profiling has emerged as an ancillary test for pancreatic cyst fluid (PCF), additional high-sensitivity and -specificity biomarkers are still needed for improved classification. METHODS In this study, PCF from 93 patients, including intraductal papillary mucinous neoplasms (n = 65), mucinous cystic neoplasms (n = 9), serous cystadenomas (n = 9), pancreatic cyst not otherwise specified (n = 8), and pseudocysts (n = 2), were evaluated for biomarkers. Molecular profiling by next-generation sequencing was performed, and a subset of the cases (n = 32) were interrogated with 2083 microRNAs (miRNAs) to evaluate their use for pancreatic cyst risk stratification. RESULTS As independent PCF biomarkers in 32 cases with histologic diagnoses, three miRNAs performed significantly better than mutant KRAS, mutant GNAS, carcinoembryonic antigen (CEA), and serum carbohydrate antigen 19-9 (CA19-9) in discriminating high-risk from low-risk cysts. The three elevated miRNAs in combination with mutant KRAS, mutant GNAS, and serum CA19-9 displayed similar diagnostic performance (miR-4461: area under the curve [AUC], 0.950; 95% confidence interval [CI], 0.800-1; miR-6723-5p: AUC, 0.958; 95% CI, 0.850-1; miR-6755-3p: AUC, 0.942; 95% CI, 0.816-1) in discriminating high-risk from low-risk cysts, when compared to mutant KRAS, mutant GNAS, CEA, and serum CA19-9 (AUC, 0.950; 95% CI, 0.825-1). In the absence of CA19-9, the three-marker panel of KRAS, GNAS, and miRNAs showed marginally improved performance compared with KRAS, GNAS, and CEA, which highlights the potential utility of miRNAs as biomarkers in PCF analysis. CONCLUSIONS These findings demonstrate that a multiomics biomarker approach with elevated PCF miRNAs with mutant KRAS, mutant GNAS, and serum CA19-9 may help in better detecting high-risk cysts for early clinical intervention.
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Affiliation(s)
- Mohamed H Maher
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Warapen Treekitkarnmongkol
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sayak Ghatak
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Suyu Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tristian Nguyen
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dzifa Y Duose
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tony Y Hu
- Center for Cellular and Molecular Diagnostics, Department of Cell and Molecular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mark W Hurd
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Sheikh Ahmed Center for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pamela L Paris
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Kimberly S Kirkwood
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Section of Hepatopancreaticobiliary Surgery, Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Anirban Maitra
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Sheikh Ahmed Center for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajyalakshmi Luthra
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Subrata Sen
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sinchita Roy-Chowdhuri
- Division of Pathology and Laboratory Medicine, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Pathology and Laboratory Medicine, Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Hamada T, Oyama H, Nevo D, Tange S, Takaoka S, Kawaguchi Y, Ishigaki K, Noguchi K, Saito T, Sato T, Suzuki T, Takahara N, Tanaka M, Hasegawa K, Ushiku T, Nakai Y, Petrov MS, Fujishiro M. Risk factors for pancreatic cancer in individuals with intraductal papillary mucinous neoplasms and no high-risk stigmata during up to 5 years of surveillance: a prospective longitudinal cohort study. Gut 2025:gutjnl-2024-333259. [PMID: 39870394 DOI: 10.1136/gutjnl-2024-333259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 01/11/2025] [Indexed: 01/29/2025]
Abstract
BACKGROUND Cyst size, its growth rate, and diameter of the main pancreatic duct (MPD) are all associated with pancreatic carcinoma prevalence in intraductal papillary mucinous neoplasms (IPMNs). OBJECTIVE To examine the above factors in relation to future risk of incident pancreatic carcinoma in individuals with IPMNs harbouring no high-risk stigmata. DESIGN In a prospective longitudinal cohort, we analysed 2549 patients with IPMNs. A multivariable cause-specific Cox proportional hazards regression model was built to estimate HRs for incident pancreatic carcinoma. RESULTS IPMN size at baseline and its annual growth rate over 2 years of follow-up were associated with incident pancreatic carcinoma (ptrend<0.001). The multivariable cause-specific HR per 10 mm increase in IPMN size was 1.28 (95% CI 1.10 to 1.50). The annual growth rates of 1.5-2.4 mm/year and ≥2.5 mm/year over 2 years were associated with multivariable cause-specific HRs of 1.91 (95% CI 0.78 to 4.67) and 4.52 (95% CI 2.28 to 8.98), respectively (vs <1.5 mm/year). Neither IPMN size at 5 years nor its maximum growth rate during 5 years was associated with incident pancreatic carcinoma (ptrend>0.07). MPD diameter at 5 years was associated with incident pancreatic carcinoma (multivariable cause-specific HR per 2 mm increase, 2.12; 95% CI 1.72 to 2.63). A predictive nomogram was generated for calculating the risk of incident pancreatic carcinoma. CONCLUSION IPMN size and its growth rate predict future pancreatic carcinoma risk only during first 5 years of follow-up. MPD diameter at 5 years may identify patients who still harbour a high risk for pancreatic carcinoma.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroki Oyama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Shuichi Tange
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Takaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunaga Ishigaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensaku Noguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsunori Suzuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Tanaka
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Maxim S Petrov
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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7
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Singh S, Chandan S, Vinayek R, Dhar J, Samanta J, Capurso G, Boskoski I, Spada C, Machicado JD, Crinò SF, Facciorusso A. Endoscopic techniques for the diagnosis of pancreatic cystic lesions. World J Gastroenterol 2025; 31:101082. [PMID: 39777250 PMCID: PMC11684177 DOI: 10.3748/wjg.v31.i1.101082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 10/17/2024] [Accepted: 11/06/2024] [Indexed: 12/09/2024] Open
Abstract
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans, with few patients presenting with abdominal pain or other symptoms. The accurate diagnosis of cysts is important as management depends on the type (neoplastic or non-neoplastic). Cross-sectional imaging is fast being replaced with endoscopic ultrasound (EUS) and various techniques based on that such as EUS-guided fine needle aspiration, EUS-guided needle confocal laser endomicroscopy, EUS-through-the-needle biopsy, and contrast-enhanced EUS. Clinical studies have reported varying diagnostic and adverse event rates with these modalities. In addition, American, European, and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations. In this editorial, we elaborate on the clinical guidelines, recent studies, and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
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Affiliation(s)
- Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68131, United States
| | - Rakesh Vinayek
- Department of Gastroenterology, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
| | - Jahnvi Dhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Gabriele Capurso
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training, Roma 00168, Italy
| | - Cristiano Spada
- Department of Gastroenterology and Endoscopy, Catholic University, Roma 00168, Italy
| | - Jorge D Machicado
- Department of Gastroenterology, University of Michigan Health, Ann Arbor, MI 48107, United States
| | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia 71122, Italy
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Vege SS. Comments on "Diagnosis and Management of Pancreatic Cysts". Gastroenterology 2025; 168:186. [PMID: 39284555 DOI: 10.1053/j.gastro.2024.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 10/03/2024]
Affiliation(s)
- Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Gardner TB, Park WG, Allen PJ. Reply. Gastroenterology 2025; 168:186-187. [PMID: 39284556 DOI: 10.1053/j.gastro.2024.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 10/03/2024]
Affiliation(s)
- Timothy B Gardner
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Walter G Park
- Section of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Peter J Allen
- Division of Surgical Oncology, Duke University Medical Center, Durham, North Carolina
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Bruni A, Eusebi LH, Lisotti A, Ricci C, Maida M, Fusaroli P, Barbara G, Sadik R, Pagano N, Hedenström P, Marasco G. Intracystic Glucose Measurement for On-Site Differentiation Between Mucinous and Non-Mucinous Pancreatic Cystic Lesions. Cancers (Basel) 2024; 16:4198. [PMID: 39766096 PMCID: PMC11674768 DOI: 10.3390/cancers16244198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/02/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Pancreatic cystic lesions (PCLs) are frequently detected incidentally and vary from benign to malignant. Accurate differentiation between mucinous (M-PCLs) and non-mucinous PCLs (NM-PCLs) is essential for appropriate management. This study aims to validate the accuracy of on-site glucose measurement using a glucometer with a cut-off of 50 mg/dL for distinguishing M-PCLs from NM-PCLs. METHODS In this prospective multicenter study, conducted at three European academic hospitals, patients who underwent endoscopic ultrasound-guided fine-needle aspiration for PCLs between 2019 and 2020 were included. On-site glucose measurement was performed using a conventional glucometer. Data on demographics, clinical features, EUS findings, and histopathology were collected. RESULTS Fifty patients were enrolled, with 37 having glucose levels < 50 mg/dL and 13 ≥ 50 mg/dL. M-PCLs were more common in the <50 mg/dL group (81%) compared to the ≥50 mg/dL group (23%, p < 0.001). The median CEA was higher in the <50 mg/dL group (146 ng/mL) than in the ≥50 mg/dL group (3 ng/mL, p = 0.047). On-site glucose testing < 50 mg/dl demonstrated a sensitivity of 93.2%, a specificity of 76.5%, and an accuracy of 89% for detecting M-PCLs with an AUC of 0.74 and an OR of 14.29 (p < 0.001). In comparison, CEA > 192 ng/mL had a sensitivity of 55.6%, a specificity of 87.5%, and an accuracy of 75.8% for M-PCLs, with an AUC of 0.65 and an OR of 4.44. CONCLUSIONS On-site glucose measurement using a glucometer with a cut-off of <50 mg/dL is a highly accurate, rapid, and cost-effective method for differentiating M-PCLs from NM-PCLs. Our results validate the glucose cut-off in a multicentric prospective cohort supporting its integration into standard diagnostic protocols for PCLs.
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Affiliation(s)
- Angelo Bruni
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy; (A.B.); (C.R.); (G.B.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Leonardo Henry Eusebi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy; (A.B.); (C.R.); (G.B.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40138 Bologna, Italy; (A.L.); (P.F.)
| | - Claudio Ricci
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy; (A.B.); (C.R.); (G.B.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Marcello Maida
- Department of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy;
- Gastroenterology Unit, Umberto I Hospital, 94100 Enna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, 40138 Bologna, Italy; (A.L.); (P.F.)
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy; (A.B.); (C.R.); (G.B.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Riadh Sadik
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg University, 413 45 Gothenburg, Sweden; (R.S.)
| | - Nico Pagano
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, University Hospital Maggiore della Carità, 28100 Novara, Italy
| | - Per Hedenström
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg University, 413 45 Gothenburg, Sweden; (R.S.)
| | - Giovanni Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola, 40138 Bologna, Italy; (A.B.); (C.R.); (G.B.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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Belfrage H, Boyd S, Louhimo J, Kytölä S, Johansson K, Tenca A, Puustinen L, Kokkola A, Arkkila P, Arola J, Seppänen H. Next-generation sequencing improves diagnostic accuracy of imaging and carcinoembryonic antigen alone for pancreatic cystic neoplasms. Pancreatology 2024; 24:1322-1331. [PMID: 39567272 DOI: 10.1016/j.pan.2024.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/22/2024] [Accepted: 11/06/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND New tools are needed to determine the pancreatic cysts that require surgical resection. This study aimed to evaluate whether next-generation sequencing (NGS) is useful for identifying mucinous, malignant, or pre-malignant cysts leading to surgery. METHODS Laboratory, cytological, and histological data from 97 patients with worrisome features on imaging or an unclear pancreatic cystic lesion (PCL) who were indicated for further investigation and who underwent endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) between 2018 and 2022 were analyzed. A multidisciplinary team evaluated MRI, CT, EUS-FNA, and NGS findings. RESULTS Among the 40 mucinous cysts, 53 % had KRAS and/or GNAS mutations, yielding a sensitivity of 53 % and specificity of 92 % compared to 33 and 100 % for cytology and 53 and 89 % for cystic fluid CEA. Combining NGS findings with CEA levels increased sensitivity and specificity in detecting mucinous lesions to 78 and 87 %, respectively. Surgically treated high-grade dysplasia PCLs did not show worrisome mutations in cyst fluid, while 80 % of the malignant lesions had mutations typical for advanced lesions. The advanced neoplasias showed 95 % specificity for worrisome gene mutations, with the highest diagnostic accuracy observed for NGS mutations, achieving an AUC of 0.777 in the ROC curve analysis compared to 0.631 for CEA. Patients with worrisome gene mutations were offered surgical treatment. NGS results contributed to the decision to operate in 11 out of 23 cases. In 71 % of all cases, NGS supported the diagnosis, with 3 % false positives and 12 % false negatives. CONCLUSIONS NGS analysis of pancreatic cyst fluid demonstrates high specificity and may serve as an additional diagnostic tool to CEA. Combining cystic fluid CEA and NGS increases the accuracy in determining whether a lesion is mucinous and NGS showed a higher diagnostic accuracy in advanced lesions compared to CEA. While the absence of alarming NGS findings should not preclude surgical treatment, patients with alarming mutations should be considered for surgery.
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Affiliation(s)
- Hanna Belfrage
- Abdominal Center, Department of Gastrointestinal Surgery, Helsinki University Hospital and Helsinki University, Finland.
| | - Sonja Boyd
- Diagnostic Center, Department of Pathology, Helsinki University Hospital and Helsinki University, Finland
| | - Johanna Louhimo
- Abdominal Center, Department of Gastrointestinal Surgery, Helsinki University Hospital and Helsinki University, Finland
| | - Soili Kytölä
- Diagnostic Center, Department of Genetics, Helsinki University Hospital and Helsinki University, Finland
| | - Katarina Johansson
- Diagnostic Center, Department of Radiology, Helsinki University Hospital and Helsinki University, Finland
| | - Andrea Tenca
- Abdominal Center, Department of Gastroenterology, Helsinki University Hospital and Helsinki University, Finland
| | - Lauri Puustinen
- Abdominal Center, Department of Gastroenterology, Helsinki University Hospital and Helsinki University, Finland
| | - Arto Kokkola
- Abdominal Center, Department of Gastrointestinal Surgery, Helsinki University Hospital and Helsinki University, Finland
| | - Perttu Arkkila
- Abdominal Center, Department of Gastroenterology, Helsinki University Hospital and Helsinki University, Finland
| | - Johanna Arola
- Diagnostic Center, Department of Pathology, Helsinki University Hospital and Helsinki University, Finland
| | - Hanna Seppänen
- Abdominal Center, Department of Gastrointestinal Surgery, Helsinki University Hospital and Helsinki University, Finland
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Gonda TA, Cahen DL, Farrell JJ. Pancreatic Cysts. N Engl J Med 2024; 391:832-843. [PMID: 39231345 DOI: 10.1056/nejmra2309041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Affiliation(s)
- Tamas A Gonda
- From the Division of Gastroenterology and Hepatology, Department of Medicine, New York University (NYU) Grossman School of Medicine and NYU Langone Health, New York (T.A.G.); the Division of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (D.L.C); and the Division of Digestive Diseases, Department of Medicine, Yale University School of Medicine and Yale New Haven Health, New Haven, CT (J.J.F.)
| | - Djuna L Cahen
- From the Division of Gastroenterology and Hepatology, Department of Medicine, New York University (NYU) Grossman School of Medicine and NYU Langone Health, New York (T.A.G.); the Division of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (D.L.C); and the Division of Digestive Diseases, Department of Medicine, Yale University School of Medicine and Yale New Haven Health, New Haven, CT (J.J.F.)
| | - James J Farrell
- From the Division of Gastroenterology and Hepatology, Department of Medicine, New York University (NYU) Grossman School of Medicine and NYU Langone Health, New York (T.A.G.); the Division of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (D.L.C); and the Division of Digestive Diseases, Department of Medicine, Yale University School of Medicine and Yale New Haven Health, New Haven, CT (J.J.F.)
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Lou F, Li M, Chu T, Duan H, Liu H, Zhang J, Duan K, Liu H, Wei F. Comprehensive analysis of clinical data and radiomic features from contrast enhanced CT for differentiating benign and malignant pancreatic intraductal papillary mucinous neoplasms. Sci Rep 2024; 14:17218. [PMID: 39060387 PMCID: PMC11282090 DOI: 10.1038/s41598-024-68067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
The primary aim of this investigation was to leverage radiomics features derived from contrast-enhanced abdominal computed tomography (CT) scans to devise a predictive model to discern the benign and malignant nature of intraductal papillary mucinous neoplasms (IPMNs). Radiomic signatures were meticulously crafted to delineate benign from malignant IPMNs by extracting pertinent features from contrast-enhanced CT images within a designated training cohort (n = 84). Subsequent validation was conducted with data from an independent test cohort (n = 37). The discriminative ability of the model was quantitatively evaluated through receiver operating characteristic (ROC) curve analysis, with the integration of carefully selected clinical features to improve the comparative analysis. Arterial-phase images were utilized to construct a model comprising 8 features for distinguishing between benign and malignant cases. The model achieved an accuracy of 0.891 [95% confidence interval (95% CI), 0.816-0.996] in the cross-validation set and 0.553 (95% CI 0.360-0.745) in the test set. Conversely, employing 9 features from the venous-phase resulted in a model with a cross-validation accuracy of 0.862 (95%CI 0.777-0.946) and a test set accuracy of 0.801 (95% CI 0.653-0.950).Integrating the identified clinical features with imaging features yielded a model with a cross-validation accuracy of 0.934 (95% CI 0.879-0.990) and a test set accuracy of 0.904 (95% CI 0.808-0.999), thereby further improving its discriminatory ability. Our findings distinctly illustrate that venous-phase radiomics features eclipse arterial-phase radiomic features in terms of predictive accuracy regarding the nature of IPMNs. Furthermore, the synthesis and meticulous screening of clinical features with radiomic data significantly increased the diagnostic efficacy of our model, underscoring the pivotal importance of a comprehensive and integrated approach for accurate risk stratification in IPMN management.
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Affiliation(s)
- Fengxiang Lou
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Mingyang Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, 130000, China
| | - Tongjia Chu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Haoyu Duan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Huan Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Jian Zhang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Kehang Duan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Han Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China
| | - Feng Wei
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130000, China.
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Zhang XL, Chen K, He YP, Yang XJ, Liu JQ. Reassessment of EUS features in preoperative diagnosis of pancreatic serous cystic neoplasm: Lessons to avoid misdiagnosis. J Dig Dis 2024; 25:463-469. [PMID: 39004929 DOI: 10.1111/1751-2980.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis. METHODS Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed. RESULTS Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of the lesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin-producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%. CONCLUSIONS Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin-producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN.
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Affiliation(s)
- Xiao Lan Zhang
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ke Chen
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yi Ping He
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiu Jiang Yang
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Qiang Liu
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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Kramer RJ, Shi C, Moris D, Allen PJ. Benign Etiology for High-Risk Intraductal Papillary Mucinous Neoplasm: A Case Report and Literature Review. Cureus 2024; 16:e62054. [PMID: 38989360 PMCID: PMC11234795 DOI: 10.7759/cureus.62054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
Intraductal papillary mucinous neoplasms are relatively common and entail a variable risk of malignant potential. The Fukuoka guidelines present criteria for the risk of malignant transformation and are used for risk stratification and treatment decision-making. However, these guidelines entail some fallibility with limited sensitivity and specificity. In this case, we present an individual who had many of the hallmarks of malignant transformation but was found to have no evidence of malignancy or high-grade dysplasia. We discuss the suspected etiology of this individual's condition and how it might arise in others, as well as a brief review of the literature on risk factors in intraductal papillary mucinous neoplasms.
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Affiliation(s)
- Ryan J Kramer
- School of Medicine, Duke University School of Medicine, Durham, USA
| | - Chanjuan Shi
- Department of Pathology, Duke University Medical Center, Durham, USA
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, USA
| | - Peter J Allen
- Department of Surgical Oncology, Duke University Medical Center, Durham, USA
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