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Lopes Vendrami C, Hammond NA, Escobar DJ, Zilber Z, Dwyer M, Moreno CC, Mittal PK, Miller FH, Rogers LF. Imaging of pancreatic serous cystadenoma and common imitators. Abdom Radiol (NY) 2024:10.1007/s00261-024-04337-1. [PMID: 38825609 DOI: 10.1007/s00261-024-04337-1] [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: 03/26/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 06/04/2024]
Abstract
Pancreatic cystic neoplasms are lesions comprised of cystic components that show different biological behaviors, epidemiology, clinical manifestations, imaging features, and malignant potential and management. Benign cystic neoplasms include serous cystic neoplasms (SCAs). Other pancreatic cystic lesions have malignant potential, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. SCAs can be divided into microcystic (classic appearance), honeycomb, oligocystic/macrocystic, and solid patterns based on imaging appearance. They are usually solitary but may be multiple in von Hippel-Lindau disease, which may depict disseminated involvement. The variable appearances of SCAs can mimic other types of pancreatic cystic lesions, and cross-sectional imaging plays an important role in their differential diagnosis. Endoscopic ultrasonography has helped in improving diagnostic accuracy of pancreatic cystic lesions by guiding tissue sampling (biopsy) or cyst fluid analysis. Immunohistochemistry and newer techniques such as radiomics have shown improved performance for preoperatively discriminating SCAs and their mimickers.
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Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Nancy A Hammond
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - David J Escobar
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Zachary Zilber
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Meaghan Dwyer
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, 30322, USA
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA, 30912, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
| | - Lee F Rogers
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
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2
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Ansari G, Mirza-Aghazadeh-Attari M, Afyouni S, Mohseni A, Shahbazian H, Kamel IR. Utilization of texture features of volumetric ADC maps in differentiating between serous cystadenoma and intraductal papillary neoplasms. Abdom Radiol (NY) 2024; 49:1175-1184. [PMID: 38378839 DOI: 10.1007/s00261-024-04187-x] [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] [Received: 07/10/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The rising incidence of incidental detection of pancreatic cystic neoplasms has compelled radiologists to determine new diagnostic methods for the differentiation of various kinds of lesions. We aim to demonstrate the utility of texture features extracted from ADC maps in differentiating intraductal papillary mucinous neoplasms (IPMN) from serous cystadenomas (SCA). METHODS This retrospective study was performed on 136 patients (IPMN = 87, SCA = 49) split into testing and training datasets. A total of 851 radiomics features were extracted from volumetric contours drawn by an expert radiologist on ADC maps of the lesions. LASSO regression analysis was used to determine the most predictive set of features and a radiomics score was developed based on their respective coefficients. A hyper-optimized support vector machine was then utilized to classify the lesions based on their radiomics score. RESULTS A total of four Wavelet features (LHL/GLCM/LCM2, HLL/GLCM/LCM2, /LLL/First Order/90percent, /LLL/GLCM/MCC) were selected from all of the features to be included in our classifier. The classifier was optimized by altering hyperparameters and the trained model was applied to the validation dataset. The model achieved a sensitivity of 92.8, specificity of 90%, and an AUC of 0.97 in the training data set, and a sensitivity of 83.3%, specificity of 66.7%, and AUC of 0.90 in the testing dataset. CONCLUSION A support vector machine model trained and validated on volumetric texture features extracted from ADC maps showed the possible beneficence of these features in differentiating IPMNs from SCAs. These results are in line with previous regarding the role of ADC maps in classifying cystic lesions and offers new evidence regarding the role of texture features in differentiation of potentially neoplastic and benign lesions.
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Affiliation(s)
- Golnoosh Ansari
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Mohammad Mirza-Aghazadeh-Attari
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Shadi Afyouni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Haneyeh Shahbazian
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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Elmi N, McEvoy D, McInnes MDF, Alabousi M, Hecht EM, Luk L, Asghar S, Jajodia A, de Carvalho TL, Warnica WJ, Zha N, Ullah S, van der Pol CB. Percentage of Pancreatic Cysts on MRI With a Pancreatic Carcinoma: Systematic Review and Meta-Analysis. J Magn Reson Imaging 2023. [PMID: 38053468 DOI: 10.1002/jmri.29168] [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: 10/22/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Pancreatic cystic lesions (PCLs) are frequent on MRI and are thought to be associated with pancreatic adenocarcinoma (PDAC) necessitating long-term surveillance based on older studies suffering from selection bias. PURPOSE To establish the percentage of patients with PCLs on MRI with a present or future PDAC. STUDY TYPE Systematic review, meta-analysis. POPULATION Adults with PCLs on MRI and a present or future diagnosis of PDAC were eligible. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus were searched to April 2022 (PROSPERO:CRD42022320502). Studies limited to PCLs not requiring surveillance, <100 patients, or those with a history/genetic risk of PDAC were excluded. FIELD STRENGTH/SEQUENCE ≥1.5 T with ≥1 T2-weighted sequence. ASSESSMENT Two investigators extracted data, with discrepancies resolved by a third. QUADAS-2 assessed bias. PDAC was diagnosed using a composite reference standard. STATISTICAL TESTS A meta-analysis of proportions was performed at the patient-level with 95% confidence intervals (95% CI). RESULTS Eight studies with 1289 patients contributed to the percentage of patients with a present diagnosis of PDAC, and 10 studies with 3422 patients to the percentage with a future diagnosis. Of patients with PCLs on MRI, 14.8% (95% CI 2.4-34.9) had a PDAC at initial MRI, which decreased to 6.0% (2.2-11.3) for studies at low risk of bias. For patients without PDAC on initial MRI, 2.0% (1.1-3.2) developed PDAC during surveillance, similar for low risk of bias studies at 1.9% (0.7-3.6), with no clear trend of increased PDAC for longer surveillance durations. For patients without worrisome features or high-risk stigmata, 0.9% (0.1-2.2) developed PDAC during surveillance. Of 10, eight studies had a median surveillance ≥3 years (range 3-157 months). Sources of bias included retrospectively limiting PCLs to those with histopathology and inconsistent surveillance protocols. DATA CONCLUSION A low percentage of patients with PCLs on MRI develop PDAC while on surveillance. The first MRI revealing a PCL should be scrutinized for PDAC. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Nika Elmi
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David McEvoy
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Matthew D F McInnes
- Department of Radiology and Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Imaging, Ottawa Hospital Research Institute Clinical Epidemiology Program, The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Mostafa Alabousi
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Lyndon Luk
- Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, New York, USA
| | - Sunna Asghar
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ankush Jajodia
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tiago Lins de Carvalho
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - William J Warnica
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nanxi Zha
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadaf Ullah
- Library Services, Unity Health Toronto St. Michael's Hospital, East Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Christian B van der Pol
- Department of Medical Imaging, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Miller FH, Lopes Vendrami C, Hammond NA, Mittal PK, Nikolaidis P, Jawahar A. Pancreatic Cancer and Its Mimics. Radiographics 2023; 43:e230054. [PMID: 37824413 DOI: 10.1148/rg.230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common primary pancreatic malignancy, ranking fourth in cancer-related mortality in the United States. Typically, PDAC appears on images as a hypovascular mass with upstream pancreatic duct dilatation and abrupt duct cutoff, distal pancreatic atrophy, and vascular encasement, with metastatic involvement including lymphadenopathy. However, atypical manifestations that may limit detection of the underlying PDAC may also occur. Atypical PDAC features include findings related to associated conditions such as acute or chronic pancreatitis, a mass that is isointense to the parenchyma, multiplicity, diffuse tumor infiltration, associated calcifications, and cystic components. Several neoplastic and inflammatory conditions can mimic PDAC, such as paraduodenal "groove" pancreatitis, autoimmune pancreatitis, focal acute and chronic pancreatitis, neuroendocrine tumors, solid pseudopapillary neoplasms, metastases, and lymphoma. Differentiation of these conditions from PDAC can be challenging due to overlapping CT and MRI features; however, certain findings can help in differentiation. Diffusion-weighted MRI can be helpful but also can be nonspecific. Accurate diagnosis is pivotal for guiding therapeutic planning and potential outcomes in PDAC and avoiding biopsy or surgical treatment of some of these mimics. Biopsy may still be required for diagnosis in some cases. The authors describe the typical and atypical imaging findings of PDAC and features that may help to differentiate PDAC from its mimics. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Zins in this issue.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Nancy A Hammond
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Paul Nikolaidis
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Anugayathri Jawahar
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
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5
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Sheik DA, Byers K, Thomas M, Rajesh UC, Ifuku K, Kirkwood K, Al-Haddad M, Craik CS, Davisson VJ. Addressing the unmet clinical need for low-volume assays in early diagnosis of pancreatic cancer. FRONTIERS IN GASTROENTEROLOGY (LAUSANNE, SWITZERLAND) 2023; 2:1258998. [PMID: 38846269 PMCID: PMC11156210 DOI: 10.3389/fgstr.2023.1258998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
The incidental detection of pancreatic cysts, an opportunity for the early detection of pancreatic cancer, is increasing, owing to an aging population and improvements in imaging technology. The classification of pancreatic cystic precursors currently relies on imaging and cyst fluid evaluations, including cytology and protein and genomic analyses. However, there are persistent limitations that obstruct the accuracy and quality of information for clinicians, including the limited volume of the complex, often acellular, and proteinaceous milieu that comprises pancreatic cyst fluid. The constraints of currently available clinical assays lead clinicians to the subjective and inconsistent application of diagnostic tools, which can contribute to unnecessary surgery and missed pancreatic cancers. Herein, we describe the pathway toward pancreatic cyst classification and diagnosis, the volume requirements for several clinically available diagnostic tools, and some analytical and diagnostic limitations for each assay. We then discuss current and future work on novel markers and methods, and how to expand the utility of clinical pancreatic cyst fluid samples. Results of ongoing studies applying SERS as a detection mode suggest that 50 μL of pancreatic cyst fluid is more than sufficient to accurately rule out non-mucinous pancreatic cysts with no malignant potential from further evaluation. This process is expected to leave sufficient fluid to analyze a follow-up, rule-in panel of markers currently in development that can stratify grades of dysplasia in mucinous pancreatic cysts and improve clinical decision-making.
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Affiliation(s)
- Daniel A. Sheik
- Research and Technology Department, Amplified Sciences, Inc, West Lafayette, IN, United States
| | - Kaleb Byers
- Research and Technology Department, Amplified Sciences, Inc, West Lafayette, IN, United States
| | - Mini Thomas
- Research and Technology Department, Amplified Sciences, Inc, West Lafayette, IN, United States
| | | | - Kelli Ifuku
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Kimberly Kirkwood
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Mohammed Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Charles S. Craik
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, United States
| | - V. Jo Davisson
- Research and Technology Department, Amplified Sciences, Inc, West Lafayette, IN, United States
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University College of Pharmacy, West Lafayette, IN, United States
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6
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Koh S, Lee NK, Kim S, Hong SB, Kim DU, Han SY. The efficacy of low-dose CT with deep learning image reconstruction in the surveillance of incidentally detected pancreatic cystic lesions. Abdom Radiol (NY) 2023; 48:2585-2595. [PMID: 37204510 DOI: 10.1007/s00261-023-03958-2] [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] [Received: 03/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE To evaluate the efficacy of low-dose CT (LDCT) with deep learning image reconstruction (DLIR) for the surveillance of pancreatic cystic lesions (PCLs) compared with standard-dose CT (SDCT) with adaptive statistical iterative reconstruction (ASIR-V). METHODS The study enrolled 103 patients who underwent pancreatic CT for follow-up of incidentally detected PCLs. The CT protocol included LDCT in the pancreatic phase with 40% ASIR-V, DLIR at medium (DLIR-M) and high levels (DLIR-H), and SDCT in the portal-venous phase with 40% ASIR-V. The overall image quality and conspicuity of PCLs were qualitatively assessed using five-point scales by two radiologists. The size of PCLs, presence of thickened/enhancing walls, enhancing mural nodules, and main pancreatic duct dilatation were reviewed. CT noise and cyst-to-pancreas contrast-to-noise ratio (CNR) were measured. Qualitative and quantitative parameters were analyzed using the chi-squared test, one-way ANOVA, and t-test. Additionally, interobserver agreement was analyzed using the kappa and weighted-kappa statistics. RESULTS The volume CT dose-indexes in LDCT and SDCT were 3.0 ± 0.6 mGy and 8.4 ± 2.9 mGy, respectively. LDCT with DLIR-H showed the highest overall image quality, the lowest noise, and the highest CNR. The PCL conspicuity in LDCT with either DLIR-M or DLIR-H was not significantly different from that in SDCT with ASIR-V. Other findings depicting PCLs also revealed no significant differences between LDCT with DLIR and SDCT with ASIR-V. Moreover, the results revealed good or excellent interobserver agreement. CONCLUSION LDCT with DLIR has a comparable performance with SDCT for the follow-up of incidentally detected PCLs.
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Affiliation(s)
- Sungho Koh
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan National University, #179, Gudeok-Ro, Seo-Gu, Busan, 49241, Republic of Korea
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan National University, #179, Gudeok-Ro, Seo-Gu, Busan, 49241, Republic of Korea.
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan National University, #179, Gudeok-Ro, Seo-Gu, Busan, 49241, Republic of Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan National University, #179, Gudeok-Ro, Seo-Gu, Busan, 49241, Republic of Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, and Pusan National University School of Medicine, Pusan National University, Busan, Republic of Korea
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Fang X, Zhang Q, Liu F, Li J, Wang T, Cao K, Zhang H, Li Q, Yu J, Zhou J, Zhu M, Li N, Jiang H, Shao C, Lu J, Wang L, Bian Y. T2-Weighted Image Radiomics Nomogram to Predict Pancreatic Serous and Mucinous Cystic Neoplasms. Acad Radiol 2023; 30:1562-1571. [PMID: 36379815 DOI: 10.1016/j.acra.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Xu Fang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Qianru Zhang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Fang Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Tiegong Wang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Kai Cao
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Hao Zhang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Qi Li
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jieyu Yu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jian Zhou
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Mengmeng Zhu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Na Li
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Hui Jiang
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Yun Bian
- Department of Radiology, Changhai Hospital, Shanghai, China.
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8
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Megibow AJ. Pancreatic Cysts: Radiology. Gastrointest Endosc Clin N Am 2023; 33:519-531. [PMID: 37245933 DOI: 10.1016/j.giec.2023.03.008] [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: 05/30/2023]
Abstract
This article reviews the types of pancreatic cysts encountered in Radiologic practice. It summarizes the malignancy risk of each of the following: serous cystadenoma, mucinous cystic tumor, intraductal papillary mucinous neoplasm main duct and side branch, and some miscellaneous cysts such as neuroendocrine tumor and solid pseudopapillary epithelial neoplasm. Specific reporting recommendations are given. The choice between radiology follow-up versus endoscopic analysis is discussed.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, NYU-Langone Health, 550 1st Avenue, Room HCC 232, New York, NY 10016, USA.
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9
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Alomair AA, Almohaimeed RA, Alsaud JS, Alotaibi DF, Alharbi OT. Mucinous Cystic Neoplasm of the Pancreas in a Pregnant Woman: A Case Report and Review of the Literature. Cureus 2023; 15:e37787. [PMID: 37214006 PMCID: PMC10195075 DOI: 10.7759/cureus.37787] [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: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
Mucinous cystic neoplasms of the pancreas are rare tumors that represent 10% of cystic pancreatic tumors. They are potentially sex hormone-sensitive. However, mucinous cystic neoplasms occurring during pregnancy are relatively uncommon. A 33-year-old woman in her ninth week of gestation was referred to us due to abdominal pain for two months. Magnetic resonance imaging revealed a well-defined unilocular cystic lesion at the tail of the pancreas, measuring 7x6.4 cm. The patient underwent tumor resection with distal pancreatectomy and splenectomy during the second trimester to prevent the potential risk of rupture of the neoplasm, rapid growth, and/or intrauterine growth restriction. Histopathological examination revealed a mucinous cystadenoma with no atypia or malignancy. The patient completely recovered from the surgery and had a healthy full-term baby. This case shows the benefit of performing the surgery during the second trimester compared to the potential risk of delaying the surgery.
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10
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Elbanna KY, Jang HJ, Kim TK. Imaging for Screening/Surveillance of Pancreatic Cancer: A Glimpse of Hope. Korean J Radiol 2023; 24:271-273. [PMID: 36907596 PMCID: PMC10067696 DOI: 10.3348/kjr.2022.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/14/2023] Open
Affiliation(s)
- Khaled Y Elbanna
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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11
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Toshima F, Inoue D, Kozaka K, Komori T, Takamatsu A, Katagiri A, Gabata T. Can solid pseudopapillary neoplasm of the pancreas without degeneration be diagnosed with imaging? a comparison study of the solid component of solid pseudopapillary neoplasm, neuroendocrine neoplasm, and ductal adenocarcinoma. Abdom Radiol (NY) 2023; 48:936-951. [PMID: 36708377 DOI: 10.1007/s00261-023-03814-3] [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] [Received: 10/13/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the MR findings of the solid components within pancreatic solid pseudopapillary neoplasms (SPNs) to characterize solid SPN without degeneration. METHODS After case matching, 23 patients with SPNs, 23 with pancreatic neuroendocrine neoplasms (PNENs), and 46 pancreatic ductal adenocarcinomas (PDACs) were included in this retrospective comparative study. The MR findings of the solid components within the pancreatic tumors were assessed qualitatively and semi-quantitatively. RESULTS In the qualitative assessment, significant differences were noted in T2-weighted imaging and MR cholangiopancreatography (MRCP). SPNs with a score of 4-5 (iso- to hyper-intense compared with the renal cortex) were observed in 18/19 (94.7%) by reader 1 and 15/19 (78.9%) by reader 2 (score 5, 52.6% and 47.4%) on fast spin-echo (FSE) T2-weighted imaging. On MRCP, the two readers identified 12 (63.2%) and 8 (42.1%) SPNs, respectively. The semi-quantitative signal-intensity ratio (SIR, signal intensity of tumor/signal intensity of the pancreatic parenchyma) of SPNs on FSE T2-weighted imaging was significantly higher (mean, 1.99-2.01) than that of PNENs (1.30-1.31) or PDACs (1.26-1.28). The sensitivity/specificity of 'hyper' on T2-weighted imaging (qualitative score of 4-5, or SIR of ≥ 1.5) were 78.9-100.0%/63.8-79.7%. The sensitivity/specificity of 'remarkably hyper' (score of 5, SIR of ≥ 2.0, or visible on MRCP) or salt-and-pepper pattern were 36.8-68.4%/85.5-98.6%. CONCLUSION T2-weighted imaging may be the key sequence for solid SPN. Solid tumors with hyper-intensity on T2-weighted imaging (especially, more hyper-intense than the renal cortex, more than twice the signal of the pancreatic parenchyma, depicted on MRCP, or salt-and-pepper appearance) may be suspected to be SPNs.
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Affiliation(s)
- Fumihito Toshima
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan.
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Takahiro Komori
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Atsushi Takamatsu
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Ayako Katagiri
- Department of Radiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsuki-Higashi, Kanazawa, Ishikawa, 920-8530, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-Machi, Kanazawa, Ishikawa, 920-8640, Japan
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12
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Gastrointestinal malignancies in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1709-1723. [PMID: 36607401 DOI: 10.1007/s00261-022-03788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
Gastrointestinal malignancies, though uncommon in pregnancy, present several unique challenges with regards to diagnosis, staging, and treatment. Imaging the pregnant patient with a suspected or confirmed GI malignancy requires modifications to the radiologic modality of choice and protocol in order to minimize harm to the fetus, ensure accuracy in diagnosis and staging and guide treatment decisions. In this review article, we discuss the imaging approach to the pregnant patient with GI cancer, including safe radiologic modalities and modifications to imaging protocols. We also review the most common GI cancers encountered in pregnancy, including colorectal, pancreatic, gastric, and small bowel tumors, with emphasis to imaging findings, staging, and treatment considerations.
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13
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Standardization of MRI Screening and Reporting in Individuals With Elevated Risk of Pancreatic Ductal Adenocarcinoma: Consensus Statement of the PRECEDE Consortium. AJR Am J Roentgenol 2022; 219:903-914. [PMID: 35856454 DOI: 10.2214/ajr.22.27859] [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: 12/14/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies, with a dismal survival rate. Screening the general population for early detection of PDAC is not recommended, but because early detection improves survival, high-risk individuals, defined as those meeting criteria based on a family history of PDAC and/or the presence of known pathogenic germline variant genes with PDAC risk, are recommended to undergo screening with MRI and/or endoscopic ultrasound at regular intervals. The Pancreatic Cancer Early Detection (PRECEDE) Consortium was formed in 2018 and is composed of gastroenterologists, geneticists, pancreatic surgeons, radiologists, statisticians, and researchers from 40 sites in North America, Europe, and Asia. The overarching goal of the PRECEDE Consortium is to facilitate earlier diagnosis of PDAC for high-risk individuals to increase survival of the disease. A standardized MRI protocol and reporting template are needed to enhance the quality of screening examinations, improve consistency of clinical management, and facilitate multiinstitutional research. We present a consensus statement to standardize MRI screening and reporting for individuals with elevated risk of pancreatic cancer.
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14
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Alwahbi O, Ghumman Z, van der Pol CB, Patlas M, Gopee-Ramanan P. Pancreatic Cystic Lesions: Review of the Current State of Diagnosis and Surveillance. Can Assoc Radiol J 2022:8465371221130524. [PMID: 36220377 DOI: 10.1177/08465371221130524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pancreatic cystic lesions (PCLs) are both common and often incidental. These encompass a range of pathologies with varying degrees of concern for malignancy. Although establishing a diagnosis is helpful for determining malignant potential, many PCLs are either too small to characterize or demonstrate nonspecific morphologic features. The most salient modalities involved in diagnosis and surveillance are magnetic resonance imaging, multidetector computerized tomography, and endoscopic ultrasound. Fine needle aspiration has a role in conjunction with molecular markers as a diagnostic tool, particularly for identifying malignant lesions. Although several major consensus guidelines exist internationally, there remains uncertainty in establishing the strength of the association between all PCLs and pancreatic adenocarcinoma, and in showing a benefit from extended periods of imaging surveillance. No consensus exists between the major guidelines, particularly regarding surveillance duration, frequency, or endpoints. This review paper discusses PCL subtypes, diagnosis, and compares the major consensus guidelines with considerations for local adaptability along with questions regarding current and future priorities for research.
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Affiliation(s)
- Omar Alwahbi
- Department of Radiology, 62703McMaster University Health Sciences Centre (HSC - 3N26), Hamilton, ON, Canada
| | - Zonia Ghumman
- Department of Radiology, 62703McMaster University Health Sciences Centre (HSC - 3N26), Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Christian B van der Pol
- Department of Radiology, 62703McMaster University Health Sciences Centre (HSC - 3N26), Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael Patlas
- Department of Radiology, 62703McMaster University Health Sciences Centre (HSC - 3N26), Hamilton, ON, Canada.,Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Prasaanthan Gopee-Ramanan
- Department of Radiology, 62703McMaster University Health Sciences Centre (HSC - 3N26), Hamilton, ON, Canada.,Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
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15
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Alwahbi O, Larocque N, Kulkarni A, Gopee-Ramanan PP, Ghumman Z, Sarkar R, Kagoma Y, Alabousi A, Tsai S, Wat J, McInnes M, van der Pol CB. Pancreatic Cystic Lesions on MRI: What Is The Likelihood of a Present or Future Diagnosis of Pancreatic Carcinoma? J Magn Reson Imaging 2022; 57:1567-1575. [PMID: 36151888 DOI: 10.1002/jmri.28438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pancreatic cystic lesions (PCLs) are followed for years due to older and likely biased works demonstrating a strong association with pancreatic carcinoma; more recent data are needed clarifying this relationship. PURPOSE To determine the association between PCLs on MRI and a synchronous or future diagnosis of pancreatic carcinoma. STUDY TYPE Single-center retrospective cohort. POPULATION A total of 192 patients (111 female, 58%) with median age 66 years (range 26-87 years) with PCLs on abdominal MRI from 2011 to 2016. FIELD STRENGTH/SEQUENCES 1.5 T and 3 T, including T2 WI, T1 WI, diffusion weighted imaging and contrast-enhanced T1 WI. ASSESSMENT Each PCL was reviewed independently by 2 of 10 fellowship-trained abdominal radiologists. Fukuoka guideline worrisome features and high-risk stigmata were evaluated. Follow-up imaging and clinical notes were reviewed within a system that captures pancreatic carcinoma for the region, for a median follow-up of 67 months (interquartile range: 43-88 months). STATISTICAL TESTS Pancreatic carcinoma prevalence and incidence rate for future carcinoma with 95% confidence intervals (95% CI). Fisher exact test, logistic regression with odds ratios (OR) and the Wilcoxon rank-sum test were used to assess PCL morphologic features with the Kolmogorov-Smirnov test used to assess for normality. P < 0.05 defined statistical significance. RESULTS The prevalence of pancreatic carcinoma on initial MRI showing a PCL was 2.4% (95% CI: 0.9%, 5.2%). Thickened/enhancing cyst wall was associated with pancreatic carcinoma, OR 52 (95% CI: 4.5, 1203). Of 189 patients with a PCL but without pancreatic carcinoma at the time of initial MRI, one developed high-grade dysplasia and none developed invasive carcinoma for an incidence rate of 0.97 (95% CI: 0.02, 5.43) and 0 (95% CI: 0, 3.59) cases per 1000 person-years, respectively. DATA CONCLUSION A low percentage of patients with a PCL on MRI had a pancreatic carcinoma at the time of initial evaluation and none developed carcinoma over a median 67 months of follow-up. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: 5.
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Affiliation(s)
- Omar Alwahbi
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Natasha Larocque
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ameya Kulkarni
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Prasaanthan Prasa Gopee-Ramanan
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Zonia Ghumman
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Rahul Sarkar
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Yoan Kagoma
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Abdullah Alabousi
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Scott Tsai
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Josephine Wat
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Matthew McInnes
- Department of Radiology and Epidemiology, University of Ottawa, Canada.,Ottawa Hospital Research Institute Clinical Epidemiology Program, Ontario, Canada
| | - Christian B van der Pol
- Department of Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
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16
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Legrand T, Salleron J, Conroy T, Marchal F, Thomas J, Monard L, Biagi JJ, Lambert A. Preneoplastic Lesions in Surgical Specimens Do Not Worsen the Prognosis of Patients Who Underwent Surgery for Pancreatic Adenocarcinoma: Post-Hoc Analysis of the PRODIGE 24-CCTG PA 6 Trial. Cancers (Basel) 2022; 14:cancers14163945. [PMID: 36010938 PMCID: PMC9406034 DOI: 10.3390/cancers14163945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Pancreatic cancer patients who undergo curative surgery are still likely to recur. We therefore analyzed the data of the 493 patients from the PRODIGE 24-CCTG PA 6 trial, which validated the benefit of adjuvant mFOLFIRINOX regimen over gemcitabine after pancreatic adenocarcinoma resection. We investigated whether the presence of dysplasia (noninvasive intraductal papillary mucinous neoplasm, mucinous cystic neoplasm or pancreatic intraepithelial neoplasia) might decrease in disease-free survival. A preneoplastic lesion was identified in 226 patients (45.8%). In a multivariate analysis, the presence of dysplasia is not an independent predictor of diminished disease-free survival. This finding should be useful for future prospective trials and for surgeons’ decision making, as the pre-existence of a preneoplastic lesion should not preclude a plan for curative surgery. Abstract Objective: The prognosis of pancreatic cancer after curative surgery is burdened by frequent recurrence. The aim of this study was to evaluate the impact of dysplasia in the surgical specimen on disease-free survival (DFS). Methods: A post-hoc analysis of the phase III PRODIGE 24-CCTG PA 6 trial was performed. From April 2012 to October 2016, 493 patients were included in the primary study. Assessment for dysplasia in the surgical specimens was secondarily performed. Dysplasia was defined based on presence and grade of three most common pre-malignant lesions (intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN) and pancreatic intraepithelial neoplasia (PanIN). The primary endpoint was DFS validated through multivariate analysis. Results: Two hundred twenty-six patients (45.9%) had a preneoplastic lesion. PanIN lesions were found in 193 patients (39.2%), including 100 high-grade lesions (20.6%); 43 patients had IPMN lesions (8.7%), including high-grade lesions in 32 (6.5%). Three MCN were described (0.6%). In bivariate analysis, the presence of dysplasia was not associated with poorer DFS (HR = 0.82, 95% CI [0.66; 1.03]). In multivariate analysis, risk factors for poorer DFS were poorly differentiated/undifferentiated tumor, N1 status, R1 surgical margins and perineural invasion. Conclusions: The presence of dysplasia in the surgical specimen after pancreatic cancer surgery does not worsen DFS.
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Affiliation(s)
- Théo Legrand
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Biostatistic Unit, Institut de Cancérologie de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Thierry Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Frédéric Marchal
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Jacques Thomas
- Department of Biopathology, Institut de Cancérologie de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | | | - James Jim Biagi
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
| | - Aurélien Lambert
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, 54500 Vandœuvre-lès-Nancy, France
- Correspondence: ; Tel.: +33-(0)-3-83-59-85-64
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17
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Ardeshna DR, Rangwani S, Cao T, Pawlik TM, Stanich PP, Krishna SG. Intraductal Papillary Mucinous Neoplasms in Hereditary Cancer Syndromes. Biomedicines 2022; 10:biomedicines10071475. [PMID: 35884779 PMCID: PMC9313108 DOI: 10.3390/biomedicines10071475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Hereditary pancreatic cancer, which includes patients with familial pancreatic cancer (FPC) and hereditary pancreatic cancer syndromes, accounts for about 10% of all pancreatic cancer diagnoses. The early detection of pre-cancerous pancreatic cysts has increasingly become a focus of interest in recent years as a potential avenue to lower pancreatic cancer incidence and mortality. Intraductal papillary mucinous cystic neoplasms (IPMNs) are recognized precursor lesions of pancreatic cancer. IPMNs have high prevalence in patients with hereditary pancreatic cancer and their relatives. While various somatic mutations have been identified in IPMNs, certain germline mutations associated with hereditary cancer syndromes have also been identified in IPMNs, suggesting a role in their formation. While the significance for the higher prevalence of IPMNs or similar germline mutations in these high-risk patients remain unclear, IPMNs do represent pre-malignant lesions that need close surveillance. This review summarizes the available literature on the incidence and prevalence of IPMNs in inherited genetic predisposition syndromes and FPC and speculates if IPMN and pancreatic cancer surveillance in these high-risk individuals needs to change.
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Affiliation(s)
- Devarshi R. Ardeshna
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.R.A.); (S.R.)
| | - Shiva Rangwani
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.R.A.); (S.R.)
| | - Troy Cao
- College of Medicine, Ohio State University, Columbus, OH 43210, USA;
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Peter P. Stanich
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
- Correspondence:
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