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Huang C, Hecht EM, Soloff EV, Tiwari HA, Bhosale PR, Dasayam A, Galgano SJ, Kambadakone A, Kulkarni NM, Le O, Liau J, Luk L, Rosenthal MH, Sangster GP, Goenka AH. Imaging for Early Detection of Pancreatic Ductal Adenocarcinoma: Updates and Challenges in the Implementation of Screening and Surveillance Programs. AJR Am J Roentgenol 2024; 223:e2431151. [PMID: 38809122 DOI: 10.2214/ajr.24.31151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDA) is one of the most aggressive cancers. It has a poor 5-year survival rate of 12%, partly because most cases are diagnosed at advanced stages, precluding curative surgical resection. Early-stage PDA has significantly better prognoses due to increased potential for curative interventions, making early detection of PDA critically important to improved patient outcomes. We examine current and evolving early detection concepts, screening strategies, diagnostic yields among high-risk individuals, controversies, and limitations of standard-of-care imaging.
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Affiliation(s)
- Chenchan Huang
- Department of Radiology, NYU Langone Health, 660 First Ave, 3rd Fl, New York, NY 10016
| | | | - Erik V Soloff
- Department of Radiology, University of Washington, Seattle, WA
| | - Hina Arif Tiwari
- Department of Radiology, University of Arizona College of Medicine, Banner University Medicine, Tucson, AZ
| | - Priya R Bhosale
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Bellaire, TX
| | - Anil Dasayam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Naveen M Kulkarni
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Ott Le
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Bellaire, TX
| | - Joy Liau
- Department of Radiology, University of California at San Diego, San Diego, CA
| | - Lyndon Luk
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Michael H Rosenthal
- Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Kim HS, Choi YH, Jo IH, Paik CN, Lee IS, Chang JH. Tracking incidentally discovered pancreatic cysts smaller than 30 mm: Natural course and predictors of malignancy. Dig Liver Dis 2024; 56:137-143. [PMID: 37455153 DOI: 10.1016/j.dld.2023.07.004] [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: 04/28/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to assess the natural course and predictors of malignancy in incidentally detected small pancreatic cysts (PCs). METHOD We retrospectively included patients with PCs smaller than 30 mm followed up with the same cross-sectional imaging modality at least 12 months apart between January 2010 and December 2019 in three academic institutions. Cyst growth, pancreatic cancer incidence, and associated factors associated with pancreatic cancer were analyzed. RESULTS A total of 1109 patients were followed up for a median of 34 months (range, 12‒118 months). Cyst growth and rapid cyst growth (≥ 5 mm/2 years) during follow-up were observed in 20.7% and 8.3%, respectively, both with higher rates for 15‒30 mm sized PCs. Eight patients were diagnosed with pancreatic cancer. The standardized incidence ratio for pancreatic cancer in small PCs was calculated as 5.2 [95% Confidence interval (CI): 1.3‒20.5]. The development of pancreatic cancer was associated with rapid growth [hazard ratio (HR): 8.1, 95% CI: 1.5‒43.4, p = 0.015] and newly developed worrisome features (HR: 11.7, 95% CI: 1.7‒79.6, p = 0.012) in competing risk analysis. CONCLUSIONS One-fifth of small incidentally detected PCs increased in size. Rapid growth and newly developed worrisome features were predictors of malignancy.
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Affiliation(s)
- Hyo Suk Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ik Hyun Jo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Huang XT, Xie JZ, Cai JP, Chen W, Chen LH, Yin XY. Learning curve of robotic-assisted splenic vessel-preserving spleen-preserving distal pancreatectomy by one single surgeon: a retrospective cohort study. BMC Surg 2023; 23:382. [PMID: 38114974 PMCID: PMC10729345 DOI: 10.1186/s12893-023-02294-y] [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: 06/14/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
AIM Splenic vessel-preserving spleen-preserving distal pancreatectomy (SVP-SPDP) has a lower risk of splenic infarction than the splenicvessel-sacrificing SPDP, but it is more technically demanding. Learning curve of robotic-assisted SVP-SPDP (RSVP-SPDP) remains unreported. This study sought to analyze the perioperative outcomes and learning curve of RSVP-SPDP by one single surgeon. METHODS Seventy-four patients who were intended to receive RSVP-SPDP at the First Affiliated Hospital of Sun Yat-sen University between May 2015 and January 2023 were included. The learning curve were retrospectively analyzed by using cumulative sum (CUSUM) analyses. RESULTS Sixty-two patients underwent RSVP-SPDP (spleen preservation rate: 83.8%). According to CUSUM curve, the operation time (median, 318 vs. 220 min; P < 0.001) and intraoperative blood loss (median, 50 vs. 50 mL; P = 0.012) was improved significantly after 16 cases. Blood transfusion rate (12.5% vs. 3.4%; P = 0.202), postoperative major morbidity rate (6.3% vs. 3.4%; P = 0.524), and postoperative length-of-stay (median, 10 vs. 8 days; P = 0.120) improved after 16 cases but did not reach statistical difference. None of the patients had splenic infarction or abscess postoperatively. CONCLUSION RSVP-SPDP was a safe and feasible approach for selected patients after learning curve. The improvement of operation time and intraoperative blood loss was achieved after 16 cases.
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Affiliation(s)
- Xi-Tai Huang
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, P. R. China
| | - Jin-Zhao Xie
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, P. R. China
| | - Jian-Peng Cai
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, P. R. China
| | - Wei Chen
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, P. R. China
| | - Liu-Hua Chen
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, P. R. China
| | - Xiao-Yu Yin
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou, Guangdong, 510080, P. R. China.
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Kim D, Margolskee E, Goyal A, Siddiqui MT, Heymann JJ, Rao R, Hayden J. Optimal carcinoembryonic antigen (CEA) cutoff values in the diagnosis of neoplastic mucinous pancreatic cysts differ among assays. J Clin Pathol 2023:jcp-2023-209136. [PMID: 37940376 DOI: 10.1136/jcp-2023-209136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
AIM Pancreatic cyst fluid carcinoembryonic antigen (CEA) is a pivotal test in the diagnosis and management of neoplastic mucinous cysts (NMC) of the pancreas. Cyst fluid CEA levels of 192 ng/mL have been widely used to identify NMC. However, CEA values are unique to and significantly differ between individual assays with various optimal cutoffs reported in the literature for NMC. Here, we investigate the optimal CEA cut-off value of pancreatic cysts from two different assays to identify differences in thresholds. METHODS Pancreatic cyst fluid CEA levels, CEA assay platform (Beckman Dxl (BD) or Siemens Centaur XP (SC)), and clinical/pathological information were retrospectively collected. Cases were categorised into either NMC or non-NMC. Optimal CEA cut-off values were calculated via a receiver operator characteristic curve. Cut-off values were then identified separately by assay platform. RESULTS In total, 149 pancreatic cystic lesions with concurrent CEA values (SC: n=47; BD: n=102) were included. Histological correlation was available for 26 (17%) samples. The optimal CEA cut-off value for all samples at the study institution was 45.9 ng/mL (area under the curve (AUC)=86, Sn=85.7%, Sp=73.8%). When analysed separately by CEA assay, the cut-off values were 45.9 ng/mL (AUC=84.27, Sn=89.7%, Sp=71.4%) for BD and 24.4 ng/mL (AUC=77, Sn=81.8%, Sp=75%) for SC (p=0.48). CONCLUSIONS This study showed an optimal pancreas cyst CEA cut-off threshold of 45.9 ng/mL, which is lower than commonly cited literature with different cutoffs on the two separate platforms (BD: 45.9 ng/mL, SC: 24.4 ng/mL).
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Affiliation(s)
- David Kim
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Margolskee
- Department of Pathology & Laboratory Medicine, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Abha Goyal
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Momin T Siddiqui
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jonas J Heymann
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Rema Rao
- Department of Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Hayden
- Department of Chemistry, Norton Healthcare, Louisville, Kentucky, USA
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Zhang Y, Wu J, He J, Xu S. Preoperative differentiation of pancreatic cystic neoplasm subtypes on computed tomography radiomics. Quant Imaging Med Surg 2023; 13:6395-6411. [PMID: 37869288 PMCID: PMC10585572 DOI: 10.21037/qims-22-1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/28/2023] [Indexed: 10/24/2023]
Abstract
Background Serous cystic neoplasm (SCN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN) comprise a large proportion of pancreatic cystic neoplasms (PCNs). Patients with MCN and IPMN require surgery due to the potential of malignant transformation, whereas those with SCN require periodic surveillance. However, the differential diagnosis of patients with PCNs before treatment remains a great challenge for all surgeons. Therefore, the establishment of a reliable diagnostic tool is urgently required for the improvement of precision diagnostics. Methods Between February 2015 and December 2020, 143 consecutive patients with PCNs who were confirmed by postoperative pathology were retrospectively included in the study cohort, then randomized into development and test cohorts at a ratio of 7:3. The predictors of preoperative clinical-radiologic parameters were evaluated by univariate and multivariable logistic regression analyses. A total of 1,218 radiomics features were computationally extracted from the enhanced computed tomography (CT) scans of the tumor region, and a radiomics signature was established by the random forest algorithm. In the development cohort, multi- and binary-class radiomics models integrating preoperative variables and radiomics features were constructed to distinguish between the 3 types of PCNs. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive efficiency of the model. An independent internal test cohort was applied to validate the classification models. Results All preoperative prediction models were built by integrating the radiomics signature with 13 diagnosis-related radiomics features and 3 important clinical-radiologic parameters: age, sex, and tumor diameter. The multiclass prediction model presented an overall accuracy of 0.804 in the development cohort and 0.707 in the test cohort. The binary-class prediction models displayed higher overall accuracies of 0.853, 0.866, and 0.928 in the development dataset and 0.750, 0.839, and 0.889 in the test dataset. In the test cohort, the binary-class radiomics models showed better predictive performances {AUC =0.914 [95% confidence interval (CI): 0.786 to 1.000], 0.863 (95% CI: 0.714 to 0.941), and 0.926 (95% CI: 0.824 to 1.000)} than the multiclass radiomics model [AUC =0.850 (95% CI: 0.696 to 1.000)], with a large net benefit in the decision curve analysis (DCA). The radiomics-based nomogram provided the correct predicted probability for the diagnosis of PCNs. Conclusions The proposed radiomics models with clinical-radiologic parameters and radiomics features help to predict the accurate diagnosis among PCNs to advance personalized medicine.
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Affiliation(s)
- Yifan Zhang
- Department of PET/CT Center, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Wu
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shanshan Xu
- Department of PET/CT Center, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
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Chhoda A, Schmidt J, Farrell JJ. Surveillance of Pancreatic Cystic Neoplasms. Gastrointest Endosc Clin N Am 2023; 33:613-640. [PMID: 37245939 DOI: 10.1016/j.giec.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pancreatic cystic neoplasms (PCNs) are increasingly detected because of the widespread use of cross-sectional imaging and overall aging population. While the majority of these cysts are benign, some can progress to advanced neoplasia (defined as high-grade dysplasia and invasive cancer). As the only widely accepted treatment for PCNs with advanced neoplasia is surgical resection, accurate preoperative diagnosis, and stratification of malignant potential for deciding about surgery, surveillance or doing nothing remains a clinical challenge. Surveillance strategies for pancreatic cysts (PCNs) combine clinical evaluation and imaging to assess changes in cyst morphology and symptoms that may indicate advanced neoplasia. PCN surveillance heavily relies on various consensus clinical guidelines that focus on high-risk morphology, surgical indications, and surveillance intervals and modalities. This review will focus on current concepts in the surveillance of newly diagnosed PCNs, especially on low-risk presumed intraductal papillary mucinous neoplasms (those without worrisome features and high-risk stigmata), and appraise current clinical surveillance guidelines.
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Affiliation(s)
- Ankit Chhoda
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julie Schmidt
- Yale Multidisciplinary Pancreatic Cyst Clinic (Yale MPaCC), Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA
| | - James J Farrell
- Yale Multidisciplinary Pancreatic Cyst Clinic (Yale MPaCC), Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA.
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Kloth C, Haggenmüller B, Beck A, Wagner M, Kornmann M, Steinacker JP, Steinacker-Stanescu N, Vogele D, Beer M, Juchems MS, Schmidt SA. Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines. Diagnostics (Basel) 2023; 13:diagnostics13030454. [PMID: 36766560 PMCID: PMC9914853 DOI: 10.3390/diagnostics13030454] [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] [Received: 11/18/2022] [Revised: 01/01/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Benedikt Haggenmüller
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Annika Beck
- Institute of Pathology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Martin Wagner
- Department of Internal Medicine 1, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Marko Kornmann
- Department of General and Visceral Surgery, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jochen P. Steinacker
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Nora Steinacker-Stanescu
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Markus S. Juchems
- Department of Diagnostic and Interventional Radiology, Konstanz Hospital, Mainaustraße 35, 78464 Konstanz, Germany
| | - Stefan A. Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-500-61004; Fax: +49-731-500-61005
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Choe J, Lee SM, Ahn Y, Kim CH, Seo JB, Lee HY. Characteristics and outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI: implications for management of cystic lesions. Insights Imaging 2022; 13:136. [PMID: 35976511 PMCID: PMC9385942 DOI: 10.1186/s13244-022-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest MRI is a useful diagnostic modality for the evaluation of anterior mediastinal lesions but the outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI are unclear. METHODS In this multicenter retrospective study, patients who underwent contrast-enhanced chest MRI in two tertiary centers to assess anterior mediastinal cystic lesions were included after excluding overt solid tumors and thymic hyperplasia. Anterior mediastinal cystic lesions were classified into two categories: probable (simple) cyst or indeterminate lesion (complex cyst). Size and imaging features of lesions during follow-up were evaluated and clinical outcomes were assessed. RESULTS A total of 204 patients (mean age, 59 ± 11 years; M:F = 111:93) were studied; 186 (91.2%) were classified as probable cysts and 18 (8.8%) as indeterminate lesions on MRI. Among patients with probable cysts and more than 2 years of follow-up, lesion size was unchanged in 39.6% (36/91), decreased in 16.5% (15/91), and fluctuated in 8.8% (8/91). All patients who underwent surgery were confirmed cysts. None developed mural nodules or irregular wall thickening, suspicious for malignancy during follow-up. In patients with indeterminate lesions, 16.7% (3/18) had pathologically confirmed thymoma and 44.4% (8/18) had proven cysts. Follow-up numbers and intervals after MRI in patients with probable cysts were variable among physicians and institutions in clinical practice (p < 0.05) but more than half were followed for up to 2 years in two centers. CONCLUSION Diagnosing anterior mediastinal cysts using MRI is reliable. MRI-based management of anterior mediastinal lesions may reduce the number of unnecessary follow-ups and surgeries.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea.
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Chu Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea.
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Chhoda A, Singh S, Sheth AH, Grimshaw AA, Gunderson CG, Sharma P, Kunstman JW, Sharma A, Ahuja N, Gonda TA, Farrell JJ. Benefit of Extended Surveillance of Low-Risk Pancreatic Cysts After 5-Year Stability: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2022; 21:1430-1446. [PMID: 35568304 DOI: 10.1016/j.cgh.2022.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) lacking worrisome features (WF) and high-risk stigmata (HRS) warrant surveillance. However, their optimal duration, especially among cysts with initial 5 years of size stability, warrants further investigation. We systematically reviewed the surveillance of low-risk BD-IPMNs and investigated the incidence of WF/HRS and advanced neoplasia, high-grade dysplasia, and pancreatic cancer during the initial (<5 years) and extended surveillance period (>5-years). METHODS A systematic search (CRD42020117120) identified studies investigating long-term IPMN surveillance outcomes of low-risk IPMN among the Cochrane Library, Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science, from inception until July 9, 2021. The outcomes included the incidence of WF/HRS and advanced neoplasia, disease-specific mortality, and surveillance-related harm (expressed as percentage per patient-years). The meta-analysis relied on time-to-event plots and used a random-effects model. RESULTS Forty-one eligible studies underwent systematic review, and 18 studies were meta-analyzed. The pooled incidence of WF/HRS among low-risk BD-IPMNs during initial and extended surveillance was 2.2% (95% CI, 1.0%-3.7%) and 2.9% (95% CI, 1.0%-5.7%) patient-years, respectively, whereas the incidence of advanced neoplasia was 0.6% (95% CI, 0.2%-1.00%) and 1.0% (95% CI, 0.6%-1.5%) patient-years, respectively. The pooled incidence of disease-specific mortality during initial and extended surveillance was 0.3% (95% CI, 0.1%-0.6%) and 0.6% (95% CI, 0.0%-1.6%) patient-years, respectively. Among BD-IPMNs with initial size stability, extended surveillance had a WF/HRS and advanced neoplasia incidence of 1.9% (95% CI, 1.2%-2.8%) and 0.2% (95% CI, 0.1%-0.5%) patient-years, respectively. CONCLUSIONS A lower incidence of advanced neoplasia during extended surveillance among low-risk, stable-sized BD-IPMNs was a key finding of this study. However, the survival benefit of surveillance among this population warrants further exploration through high-quality studies before recommending surveillance cessation with certainty.
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Affiliation(s)
- Ankit Chhoda
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
| | - Sidhant Singh
- Yale Waterbury Internal Medicine Program,Yale School of Medicine, New Haven, Connecticut
| | | | - Alyssa A Grimshaw
- Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G Gunderson
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Prabin Sharma
- Department of Advanced Gastroenterology, NYU Winthrop Hospital, Mineola, New York
| | - John W Kunstman
- Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Anup Sharma
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Tamas A Gonda
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Langone Health, New York, New York
| | - James J Farrell
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut.
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Nakhaei M, Bligh M, Chernyak V, Bezuidenhout AF, Brook A, Brook OR. Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm. Eur Radiol 2022; 32:3369-3376. [PMID: 35013764 DOI: 10.1007/s00330-021-08428-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the long-term malignancy risk of incidental small pancreatic cysts. MATERIALS AND METHODS In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and < 2.0 cm in maximal diameter, detected on MRI performed between 1999 and 2011, represented the "small pancreatic cyst" group. Patients that underwent MRI between 2005 and 2011 and had no reported pancreatic cysts represented the comparison "no cyst" group. RESULTS The "small pancreatic cyst" group included 267 patients, ages 63.4 ± 11.8 years, 166/267 (62%) women with a mean follow-up of 8.6 ± 4.3 years, median 9.2 years; the "no cyst" group included 1,459 patients, ages 64.6 ± 12 years, 794/1,459 (54%) women with a mean follow-up of 7.0 ± 4.2 years, median 7.8 (p values 0.12, 0.02, < 0.001, respectively). Two/267 (0.7%) patients developed pancreatic cancer at a separate location from the known cyst in the "small pancreatic cyst" group, with a cancer rate of 0.9 (95% CI 0.1-3.1) cases per 1,000 patient-years. In the "no cyst" cohort, 18/1,459 (1.2%) patients developed pancreatic cancer, with a cancer rate of 1.8 (95% CI 1.2-3.1) cases per 1,000 patient-years (p = 0.6). The all-cause mortality was similar in both groups: 57/267 (21%) vs. 384/1,459 (26%) (p = 0.09). CONCLUSION The long-term risk of pancreatic malignancy in asymptomatic patients with incidental pancreatic cysts less than 2 cm is 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. These very few pancreatic cancers developed at a separate location from the known cyst. KEY POINTS • After a median of 9.2 years of follow-up, the risk of pancreatic malignancy in patients with an asymptomatic small pancreatic cyst was 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. • Very few pancreatic cancer cases developed in the location separate from the known pancreatic cyst.
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Affiliation(s)
- Masoud Nakhaei
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Mathew Bligh
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Radiology, Montefiore, Bronx, NY, USA
| | | | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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11
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Sharma I, Kakkar C, Narang V, Virk SS, Saggar K. Case 300: Ruptured Mucinous Cystadenoma of the Pancreas. Radiology 2022; 303:236-240. [DOI: 10.1148/radiol.203780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Isha Sharma
- From the Departments Radiodiagnosis and Imaging (I.S. C.K., K.S.), Pathology (V.N.), and Gastrosurgery (S.S.V.), Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana Punjab, India 141001
| | - Chandan Kakkar
- From the Departments Radiodiagnosis and Imaging (I.S. C.K., K.S.), Pathology (V.N.), and Gastrosurgery (S.S.V.), Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana Punjab, India 141001
| | - Vikram Narang
- From the Departments Radiodiagnosis and Imaging (I.S. C.K., K.S.), Pathology (V.N.), and Gastrosurgery (S.S.V.), Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana Punjab, India 141001
| | - Satpal Singh Virk
- From the Departments Radiodiagnosis and Imaging (I.S. C.K., K.S.), Pathology (V.N.), and Gastrosurgery (S.S.V.), Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana Punjab, India 141001
| | - Kavita Saggar
- From the Departments Radiodiagnosis and Imaging (I.S. C.K., K.S.), Pathology (V.N.), and Gastrosurgery (S.S.V.), Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana Punjab, India 141001
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12
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Yamashita R, Bird K, Cheung PYC, Decker JH, Flory MN, Goff D, Morimoto LN, Shon A, Wentland AL, Rubin DL, Desser TS. Automated Identification and Measurement Extraction of Pancreatic Cystic Lesions from Free-Text Radiology Reports Using Natural Language Processing. Radiol Artif Intell 2022; 4:e210092. [PMID: 35391762 DOI: 10.1148/ryai.210092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/26/2021] [Accepted: 12/02/2021] [Indexed: 01/04/2023]
Abstract
Purpose To automatically identify a cohort of patients with pancreatic cystic lesions (PCLs) and extract PCL measurements from historical CT and MRI reports using natural language processing (NLP) and a question answering system. Materials and Methods Institutional review board approval was obtained for this retrospective Health Insurance Portability and Accountability Act-compliant study, and the requirement to obtain informed consent was waived. A cohort of free-text CT and MRI reports generated between January 1991 and July 2019 that covered the pancreatic region were identified. A PCL identification model was developed by modifying a rule-based information extraction model; measurement extraction was performed using a state-of-the-art question answering system. The system's performance was evaluated against radiologists' annotations. Results For this study, 430 426 free-text radiology reports from 199 783 unique patients were identified. The NLP model for identifying PCL was applied to 1000 test samples. The interobserver agreement between the model and two radiologists was almost perfect (Fleiss κ = 0.951), and the false-positive rate and true-positive rate were 3.0% and 98.2%, respectively, against consensus of radiologists' annotations as ground truths. The overall accuracy and Lin concordance correlation coefficient for measurement extraction were 0.958 and 0.874, respectively, against radiologists' annotations as ground truths. Conclusion An NLP-based system was developed that identifies patients with PCLs and extracts measurements from a large single-institution archive of free-text radiology reports. This approach may prove valuable to study the natural history and potential risks of PCLs and can be applied to many other use cases.Keywords: Informatics, Abdomen/GI, Pancreas, Cysts, Computer Applications-General (Informatics), Named Entity Recognition Supplemental material is available for this article. © RSNA, 2022See also commentary by Horii in this issue.
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Affiliation(s)
- Rikiya Yamashita
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Kristen Bird
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Philip Yue-Cheng Cheung
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Johannes Hugo Decker
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Marta Nicole Flory
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Daniel Goff
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Linda Nayeli Morimoto
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Andy Shon
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Andrew Louis Wentland
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Daniel L Rubin
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
| | - Terry S Desser
- Departments of Biomedical Data Science (R.Y., D.L.R.) and Radiology (K.B., P.Y.C.C., J.H.D., M.N.F., D.G., L.N.M., A.S., A.L.W., D.L.R., T.S.D.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305
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13
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Chen X, Yu Z, Wang J, Cui W, Cui C, Wang Y, Liu Y, Zhou H, Wang C, Wang Z, Chen X. Opportunistic Detection for Pancreatic Cystic Lesions During Chest Multidetector CT Scans for Lung Cancer Screening. Cancer Manag Res 2021; 13:7559-7568. [PMID: 34629902 PMCID: PMC8495141 DOI: 10.2147/cmar.s327022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose The purpose of this study was to analyze the prevalence of and risk factors for incidental pancreatic cystic lesions (PCLs) in the Chinese general population. Furthermore, the association between baseline imaging findings and PCL progression was also investigated. Patients and Methods A total of 9826 individuals who underwent computed tomography (CT) examinations for lung cancer screening between January 1, 2018 and January 1, 2019 were included in this study. The participants’ CT imaging findings and biochemical biomarker levels were reviewed and analyzed. PCLs detected during the screening were followed up for 12 months. Associations between imaging findings and clinical factors with PCL progression were explored. Results PCLs were observed in 172 of the 9826 participants. The crude prevalence of PCLs in total population was 1.75%. In subjects aged >60 years, the prevalence of PCLs was 3.2% (102/3151). The occurrence of PCLs was significantly increased with an increase of age in both men and women (p < 0.001). High-risk PCLsL commonly located in pancreatic head showed extrapancreatic growth, and had high urea levels (p = 0.005, p = 0.015, p = 0.002, respectively) compared with low-risk PCLs. Location in the pancreatic head (odds ratio (OR) = 6.286, 95% confidence interval (CI): 1.842–21.452) and extrapancreatic growth (OR = 4.049, 95% CI: 1.235–13.333) were risk factors for PCL progression. Conclusion PCLs are not uncommon in the Chinese general population. Location in the pancreatic head and extrapancreatic growth are the independent predictors of high-risk of PCLs and PCL progression.
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Affiliation(s)
- Xin Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China.,Department of Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Zhicheng Yu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China.,Department of Radiology, Jiading Central Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, 201800, People's Republic of China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Wenjing Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Can Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Yajie Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Yongkang Liu
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Hao Zhou
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Cheng Wang
- Department of Radiology, Nanjing Drum Tower Hospital the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, People's Republic of China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China
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Navarro SM, Corwin MT, Katz DS, Lamba R. Incidental Pancreatic Cysts on Cross-Sectional Imaging. Radiol Clin North Am 2021; 59:617-629. [PMID: 34053609 DOI: 10.1016/j.rcl.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Incidental pancreatic cysts are commonly encountered in radiology practice. Although some of these are benign, mucinous varieties have a potential to undergo malignant transformation. Characterization of some incidental pancreatic cysts based on imaging alone is limited, and given that some pancreatic cysts have a malignant potential, various societies have created guidelines for the management and follow-up of incidental pancreatic cysts. This article reviews the imaging findings and work-up of pancreatic cysts and gives an overview of the societal guidelines for the management and follow-up of incidental pancreatic cysts.
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Affiliation(s)
- Shannon M Navarro
- Department of Radiology, UC Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.
| | - Michael T Corwin
- Department of Radiology, UC Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Douglas S Katz
- Department of Radiology, NYU Winthrop, 259 First Street, Mineola, NY 11501, USA
| | - Ramit Lamba
- Department of Radiology, UC Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
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15
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Automated Detection of Pancreatic Cystic Lesions on CT Using Deep Learning. Diagnostics (Basel) 2021; 11:diagnostics11050901. [PMID: 34069328 PMCID: PMC8158747 DOI: 10.3390/diagnostics11050901] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 12/21/2022] Open
Abstract
Pancreatic cystic lesions (PCL) are a frequent and underreported incidental finding on CT scans and can transform into neoplasms with devastating consequences. We developed and evaluated an algorithm based on a two-step nnU-Net architecture for automated detection of PCL on CTs. A total of 543 cysts on 221 abdominal CTs were manually segmented in 3D by a radiology resident in consensus with a board-certified radiologist specialized in abdominal radiology. This information was used to train a two-step nnU-Net for detection with the performance assessed depending on lesions' volume and location in comparison to three human readers of varying experience. Mean sensitivity was 78.8 ± 0.1%. The sensitivity was highest for large lesions with 87.8% for cysts ≥220 mm3 and for lesions in the distal pancreas with up to 96.2%. The number of false-positive detections for cysts ≥220 mm3 was 0.1 per case. The algorithm's performance was comparable to human readers. To conclude, automated detection of PCL on CTs is feasible. The proposed model could serve radiologists as a second reading tool. All imaging data and code used in this study are freely available online.
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16
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Application of the ACR Pancreatic Cyst Recommendations in Clinical Practice: Point-A Happy Medium to Balance Cancer Prevention With Resource Utilization and Risks of Overtreatment. AJR Am J Roentgenol 2021; 217:1053-1054. [PMID: 33825500 DOI: 10.2214/ajr.21.25816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Application of the ACR Pancreatic Cyst Recommendations in Clinical Practice: Counterpoint-Ample Cost, Unknown Value. AJR Am J Roentgenol 2021; 217:1055-1056. [PMID: 33825499 DOI: 10.2214/ajr.21.25882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Noda Y, Tochigi T, Parakh A, Joseph E, Hahn PF, Kambadakone A. Low keV portal venous phase as a surrogate for pancreatic phase in a pancreatic protocol dual-energy CT: feasibility, image quality, and lesion conspicuity. Eur Radiol 2021; 31:6898-6908. [PMID: 33744992 DOI: 10.1007/s00330-021-07744-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the feasibility of a proposed pancreatic protocol CT generated from portal-venous phase (PVP) dual-energy CT (DECT) acquisition and its impact on image quality, lesion conspicuity, and arterial visualization/involvement. METHODS We included 111 patients (mean age, 66.8 years) who underwent pancreatic protocol DECT (pancreatic phase, PP, and PVP). The original DECT acquisition was used to create two data sets-standard protocol (50 keV PP/65 keV PVP) and proposed protocol (40 keV/65 keV PVP). Three reviewers evaluated the two data sets for image quality, lesion conspicuity, and arterial visualization/involvement using a 5-point scale. The signal-to-noise ratio (SNR) of pancreas and lesion-to-pancreas contrast-to-noise ratio (CNR) was calculated. Qualitative scores, quantitative parameters, and dose-length product (DLP) were compared between standard and proposed protocols. RESULTS The image quality, SNR of pancreas, and lesion-to-pancreas CNR of the standard and proposed protocol were comparable (p = 0.11-1.00). Lesion conspicuity was comparable between the standard and proposed protocols for pancreatic ductal adenocarcinoma (p = 0.55) and pancreatic cysts (p = 0.28). The visualization of larger arteries and arterial involvement were comparable between the two protocols (p = 0.056-1.00) while the scores were higher for smaller vessels in the standard protocol (p < 0.0001-0.0015). DLP of the proposed protocol (670.4 mGy·cm) showed a projected 42% reduction than the standard protocol (1145.9 mGy·cm) (p < 0.0001). CONCLUSION Pancreatic protocol CT generated from a single PVP DECT acquisition is feasible and could potentially be an alternative to the standard pancreatic protocol with PP and PVP. KEY POINTS • The lesion conspicuity for focal pancreatic lesions was comparable between the proposed protocol and standard dual-phase pancreatic protocol CT. • Qualitative and quantitative image assessments were almost comparable between two protocols. • The radiation dose of a proposed protocol showed a projected 42% reduction from the conventional protocol.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Toru Tochigi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Evita Joseph
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Guo Y, Asch E, Benson CB. Sonographic characteristics and follow-up of pancreatic cysts. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:184-188. [PMID: 33305462 DOI: 10.1002/jcu.22960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To assess sonographic characteristics and outcome of patients with pancreatic cystic lesions seen by ultrasound. METHODS From our ultrasound electronic reporting database we identified all patients in which "pancreatic cyst" or "pancreatic cysts" were reported from 1995 to 2018. In patients with more than one sonogram, the first was used for our study. For each case, we recorded sonographic characteristics, maximal diameter, cyst location, and results of follow-up ultrasound, CT or magnetic resonance imaging, as well as patient sex, age, relative clinical history, and endoscopic ultrasound (EUS) or surgical findings when available. RESULTS Our study included 177 patients of whom 121 were female (68.4%). Mean age at diagnosis was 65 (±16, SD, range 22-99). Ultrasound was the initial diagnostic test in 122 (68.9%). Mean diameter of the index cyst was 13.7 mm (±11.5 mm, SD, range 2-91 mm). Among 177 index cysts, 155 were simple and 22 complex. Three complex cysts were surgically resected, yielding a primary pancreatic malignancy, a metastasis, and an epithelial-lined cyst. One simple cyst was resected, yielding a benign intraductal papillary mucinous neoplasm. Seventeen patients underwent EUS showing six mucinous cysts and 11 nonmucinous cysts. One hundred-eighteen patients had follow-up imaging for a mean time of 5.6 years (±3.8, range 0.25-21 years). One patient was presumed to have primary pancreatic cancer. The overall rate for primary pancreatic malignancy was 1.7% (2/118). CONCLUSIONS Cystic pancreatic lesions seen on ultrasound are most often benign, with a low risk of pancreatic malignancy. Ultrasound is an excellent method to follow-up these cysts.
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Affiliation(s)
- Yang Guo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Asch
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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20
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Assessment of malignant potential in intraductal papillary mucinous neoplasms of the pancreas using MR findings and texture analysis. Eur Radiol 2020; 31:3394-3404. [PMID: 33140171 DOI: 10.1007/s00330-020-07425-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate the utility of MR findings and texture analysis for predicting the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs). METHODS Two hundred forty-eight patients with surgically confirmed IPMNs (106 malignant [invasive carcinoma/high-grade dysplasia] and 142 benign [low/intermediate-grade dysplasia]) and who underwent magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) were included. Two reviewers independently analyzed MR findings as proposed by the 2017 international consensus guidelines. Texture analysis of MRCP was also performed. A multivariate logistic regression analysis was used to identify predictors for malignant IPMNs. Diagnostic performance was also analyzed using receiver operating curve analysis. RESULTS Among MR findings, enhancing mural nodule size ≥ 5 mm, main pancreatic duct (MPD) ≥ 10 mm or MPD of 5 to 9 mm, and abrupt change of MPD were significant predictors for malignant IPMNs (p < 0.05). Among texture variables, significant predictors were effective diameter, surface area, sphericity, compactness, entropy, and gray-level co-occurrence matrix entropy (p < 0.05). At multivariate analysis, enhancing mural nodule ≥ 5 mm (odds ratios (ORs), 6.697 and 6.968, for reviewers 1 and 2, respectively), MPD ≥ 10 mm or MPD of 5 to 9 mm (ORs, 4.098 and 4.215, and 2.517 and 3.055, respectively), larger entropy (ORs, 1.485 and 1.515), and smaller compactness (ORs, 0.981 and 0.977) were significant predictors for malignant IPMNs (p < 0.05). When adding texture variable to MR findings, diagnostic performance for predicting malignant IPMNs improved from 0.80 and 0.78 to 0.85 and 0.85 in both reviewers (p < 0.05), respectively. CONCLUSIONS MRCP-derived texture features are useful for predicting malignant IPMNs, and the addition of texture analysis to MR features may improve diagnostic performance for predicting malignant IPMNs. KEY POINTS • Among the MR imaging findings, an enhancing mural nodule size ≥ 5 mm and dilated main pancreatic ducts are independent predictors for malignant IPMNs. • Greater entropy and smaller compactness on MR texture analysis are independent predictors for malignant IPMNs. • The addition of MR texture analysis improved the diagnostic performance for predicting malignant IPMNs from 0.80 and 0.78 to 0.85 and 0.85, respectively.
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21
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Boraschi P, Tarantini G, Donati F, Scalise P, Cervelli R, Caramella D. Side-branch intraductal papillary mucinous neoplasms of the pancreas: outcome of MR imaging surveillance over a 10 years follow-up. Eur J Radiol Open 2020; 7:100250. [PMID: 32884981 PMCID: PMC7452648 DOI: 10.1016/j.ejro.2020.100250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/18/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the outcome of a MR imaging procotol in assessing the evolution of individuals with branch duct - intraductal papillary mucinous neoplasms (BD-IPMN) without worrisome features (WF) and/or high risk stigmata (HRS) at the time of the diagnosis in a follow-up period of at least 10 years. Material and methods A retrospective revision of a prospectively collected radiological database including a total number of 600 patients who were investigated and diagnosed with "presumed" diagnosis of BD-IPMN at MRI/MRCP at our Department since 2008 was performed. Inclusion criteria were: 1) absence of worrisome features and/or high-risk stigmata at the time of diagnosis (baseline); 2) a radiological follow-up with abdominal MRI/MRCP of at least 10 years. Changes in cysts size, development of WF, HRS and pancreatic cancer, and any other modification during the follow-up were retrospectively analysed by two observers in consensus. Results Sixty-nine patients fulfilled all the inclusion criteria. During surveillance, the cysts remained dimensionally unchanged or slightly reduced in size in 26.2% and 4.3% of cases respectively, whereas cyst enlargement was demonstrated in 69.5% of cases. Median annual growth rate was of 0.97 ± 0.87 mm/yr (range 0.13-5.0). WF and HRS developed in 10/69 (14.5%) and 3/69 (4.3%) cases, respectively. The incidence of pancreatic cancer in patients with BD-IPMN was 2.9%. Conclusion Our data confirm the low risk of pancreatic cancer development in patients with BD-IPMN, thus justifying an imaging follow-up. Worrisome features and high-risk stigmata were promptly identified during the follow-up, supporting the utility of our surveillance MR imaging protocol.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Gaia Tarantini
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Francescamaria Donati
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Paola Scalise
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Rosa Cervelli
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
| | - Davide Caramella
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy
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