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For: Harima H, Kaino S, Shinoda S, Kawano M, Suenaga S, Sakaida I. Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography. World J Gastroenterol 2015; 21(20): 6252-6260 [PMID: 26034360 DOI: 10.3748/wjg.v21.i20.6252] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] Open

For:	Harima H, Kaino S, Shinoda S, Kawano M, Suenaga S, Sakaida I. Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography. World J Gastroenterol 2015; 21(20): 6252-6260 [PMID: 26034360 DOI: 10.3748/wjg.v21.i20.6252] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] Open

Number

Cited by Other Article(s)

Li J, Kong WM. Diagnostic value of contrast-enhanced ultrasound in ovarian cancer: a meta-analysis. Acta Radiol 2025;66:461-469. [PMID: 40070024 DOI: 10.1177/02841851241297201] [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: 04/16/2025]

Ohno E, Kuzuya T, Kawabe N, Nakaoka K, Tanaka H, Nakano T, Funasaka K, Miyahara R, Hashimoto S, Hirooka Y. Current status of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms. DEN OPEN 2025;5:e413. [PMID: 39040523 PMCID: PMC11260769 DOI: 10.1002/deo2.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/02/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]

Endo K, Miwa H, Sugimori K, Shibasaki K, Yonei S, Ishino Y, Tsunoda S, Yoshimura H, Funaoka A, Tsuchiya H, Oishi R, Suzuki Y, Komiyama S, Kaneko T, Morimoto M, Numata K, Maeda S. Diagnostic Accuracy of Detective Flow Imaging Endoscopic Ultrasonography for Evaluating Blood Flow Within Mural Nodules of Intraductal Papillary Mucinous Neoplasms. Diagnostics (Basel) 2025;15:196. [PMID: 39857080 PMCID: PMC11765108 DOI: 10.3390/diagnostics15020196] [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: 12/10/2024] [Revised: 01/10/2025] [Accepted: 01/13/2025] [Indexed: 01/27/2025] Open

Abstract

Background/Objectives: Detective flow imaging (DFI) endoscopic ultrasonography (EUS) can identify the microvascular flow imaging of a mural nodule (MN) in an intraductal papillary mucinous neoplasm (IPMN) without the use of contrast agents. This retrospective study evaluated the diagnostic accuracy of DFI-EUS and its ability to evaluate the blood flow of MNs in IPMNs. Methods: Between April 2021 and September 2023, 68 patients with MNs in IPMNs observed on EUS images were retrospectively analyzed. Both DFI-EUS and contrast-enhanced EUS (CE-EUS) were performed during the same session. Three expert endosonographers blinded to the patients' clinical data assessed the MN images obtained with CE-EUS and DFI-EUS. First, DFI-EUS images were evaluated using a predefined scoring system; thereafter, CE-EUS images were evaluated. The diagnostic capability of DFI-EUS to detect MN blood flow was assessed with CE-EUS as the gold standard. Secondary outcomes included inter-reader agreement, the correlation between MN size and detection rates, and the association between DFI blood flow signal patterns and malignancy of MNs in surgically resected cases. Results: CE-EUS showed a contrast effect in the MN in 24 cases. Among these, DFI-EUS detected blood flow signals in 20 cases; false-positive results were not observed. DFI-EUS demonstrated a sensitivity of 83%, specificity of 100%, and accuracy of 93% for detecting MN blood flow. Inter-reader agreement was substantial (kappa values, 0.6-0.8). The subgroup analysis revealed that all MNs ≥ 10 mm had detectable blood flow on DFI-EUS, whereas MNs < 10 mm had reduced detection rates (75%; 12/16 cases). No significant correlation between the DFI blood flow signal patterns and MN malignancy of resected cases was observed. Conclusions: DFI-EUS demonstrated high diagnostic accuracy for detecting MN blood flow. Because of its simplicity and cost-effectiveness, DFI-EUS could be an alternative to CE-EUS for patients with MNs inside IPMNs.

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Affiliation(s)

Kazuki Endo Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Haruo Miwa Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Kazuya Sugimori Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Kozue Shibasaki Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Shoichiro Yonei Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Yugo Ishino Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Shotaro Tsunoda Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Hayato Yoshimura Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Akihiro Funaoka Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Hiromi Tsuchiya Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Ritsuko Oishi Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Yuichi Suzuki Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Satoshi Komiyama Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Takashi Kaneko Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Manabu Morimoto Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Kazushi Numata Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan; (K.E.); (K.S.); (K.S.); (S.Y.); (Y.I.); (S.T.); (H.Y.); (A.F.); (H.T.); (R.O.); (Y.S.); (S.K.); (T.K.); (M.M.); (K.N.)
Shin Maeda Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan;

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Rogowska J, Semeradt J, Durko Ł, Małecka-Wojciesko E. Diagnostics and Management of Pancreatic Cystic Lesions-New Techniques and Guidelines. J Clin Med 2024;13:4644. [PMID: 39200786 PMCID: PMC11355509 DOI: 10.3390/jcm13164644] [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: 07/08/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open

Yamashita Y, Kitano M. Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions. Clin Endosc 2024;57:164-174. [PMID: 38229442 PMCID: PMC10984748 DOI: 10.5946/ce.2023.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 01/18/2024] Open

Ohno E, Balduzzi A, Hijioka S, De Pastena M, Marchegiani G, Kato H, Takenaka M, Haba S, Salvia R. Association of high-risk stigmata and worrisome features with advanced neoplasia in intraductal papillary mucinous neoplasms (IPMN): A systematic review. Pancreatology 2024;24:48-61. [PMID: 38161091 DOI: 10.1016/j.pan.2023.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]

Abstract

BACKGROUND

This systematic review aimed to assess the diagnostic accuracy of the International Consensus Fukuoka Guidelines (ICG2017) in identifying high-risk lesions of Intraductal Papillary Mucinous Neoplasms (IPMNs).

METHODS

The ICG2017 revision committee conducted a comprehensive literature review to establish evidence-based statements on IPMNs. The review focused on articles examining the diagnostic value of imaging features (e.g., cyst or main pancreatic duct diameter), clinical symptoms associated with IPMN, and serum biomarkers. Five clinical questions regarding high-risk stigmata (HRS) and worrisome features (WF) in the ICG2017 guidelines were addressed.

RESULTS

A total of 210 articles were reviewed. The findings revealed a significant association between the presence of mural nodules ≥5 mm in diameter or solid components with contrast enhancement and the diagnosis of high-grade dysplasia or invasive carcinoma. Contrast-enhanced diagnostic tools, such as CT, MRI, or EUS, demonstrated the highest prediction rate and were recommended. Positive cytology was identified as an HRS, while symptoms like acute pancreatitis and cyst diameter growth ≥2.5 mm per year were considered WFs. The use of nomograms and multiple diagnostic factors was recommended for optimal IPMN management.

CONCLUSIONS

This systematic review provides evidence supporting the improved diagnostic accuracy of ICG2017 in identifying high-risk lesions of IPMN. The multidisciplinary incorporation of HRS and WF based on imaging findings and clinical symptoms is crucial. These findings should inform the revision of ICG2017, enhancing the evaluation and management of IPMN patients. By implementing these recommendations, clinicians can make more informed decisions, leading to better diagnosis and treatment outcomes for high-risk IPMN cases.

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Umar H, Mahnur H, Brooke G, Amitabh C. Management of Cystic Neoplasms of the Pancreas. GASTROINTESTINAL ONCOLOGY ‐ A CRITICAL MULTIDISCIPLINARY TEAM APPROACH 2E 2024:438-454. [DOI: 10.1002/9781119756422.ch22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]

Yamashita Y, Shimokawa T, Ashida R, Hirooka Y, Iwashita T, Kato H, Kin T, Masamune A, Miwa H, Ohno E, Shiomi H, Sofuni A, Takenaka M, Kitano M. Protocol for a Multi-Center Confirmatory Trial to Evaluate the Differential Diagnostic Performance of Contrast-Enhanced Ultrasonography Using Perflubutane in Patients with a Pancreatic Mass: A Multicenter Prospective Study. Diagnostics (Basel) 2024;14:130. [PMID: 38248007 PMCID: PMC10814130 DOI: 10.3390/diagnostics14020130] [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: 11/14/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open

Ohno E, Kuzuya T, Kawabe N, Nakaoka K, Tanaka H, Nakano T, Miyachi Y, Hashimoto S, Hirooka Y. Use of contrast-enhanced harmonic endoscopic ultrasonography for the diagnosis of pancreatic cystic lesions. J Med Ultrason (2001) 2023:10.1007/s10396-023-01376-x. [PMID: 37924442 DOI: 10.1007/s10396-023-01376-x] [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: 07/21/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023]

Oyama H, Hamada T, Nakai Y, Tanaka M, Endo G, Hakuta R, Ishida K, Ishigaki K, Kanai S, Kurihara K, Saito T, Sato T, Suzuki T, Suzuki Y, Takaoka S, Tange S, Tokito Y, Takahara N, Ushiku T, Fujishiro M. Clinical trajectory of intraductal papillary mucinous neoplasms progressing to pancreatic carcinomas during long-term surveillance: a prospective series of 100 carcinoma cases. J Gastroenterol 2023;58:1068-1080. [PMID: 37507590 PMCID: PMC10522754 DOI: 10.1007/s00535-023-02028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]

Abstract

BACKGROUND

Trajectories of serological and morphological signatures have not been documented in pancreatic carcinogenesis related to intraductal papillary mucinous neoplasms (IPMNs).

METHODS

Using a prospective cohort of 3437 IPMN patients, we identified 100 IPMN patients who developed pancreatic carcinomas during long-term surveillance. We examined serial changes of blood markers (carbohydrate antigen 19-9 [CA19-9], hemoglobin A1c [HbA1c], and pancreatic enzymes) and morphological features (worrisome features and high-risk stigmata) during the prediagnostic period of pancreatic carcinomas, overall and by carcinoma types (IPMN-derived vs. concomitant pancreatic carcinomas).

RESULTS

CA19-9 elevation was observed in 39 patients and was associated with a metastatic stage. Compared to IPMN-derived carcinomas, concomitant carcinomas were more likely to represent CA19-9 elevation (60% vs. 30%, respectively; P = 0.005). HbA1c levels elevated only in 3 patients. Pancreatic enzyme elevation was observed in 18 patients with no differences in frequencies between the carcinoma types. All patients with elevated levels of blood markers had positive findings on cross-sectional imaging. High-risk stigmata or worrisome features were observed in all patients but one with concomitant carcinoma. The most common types of worrisome features were the main pancreatic duct dilatation and CA19-9 elevation in IPMN-derived and concomitant carcinomas, respectively. Compared to IPMN-derived carcinomas, concomitant carcinomas were less likely to harbor high-risk stigmata (16% vs. 86%, respectively; P < 0.001).

CONCLUSIONS

The usefulness of currently available blood biomarkers was limited in early detection of pancreatic carcinomas related to IPMNs. Morphological alterations were well correlated with long-term risk of IPMN-derived carcinomas, but not with that of concomitant carcinomas.

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Affiliation(s)

Hiroki Oyama Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tsuyoshi Hamada Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
Yousuke Nakai Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo City, Tokyo, 113-8655, Japan.
Mariko Tanaka Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Go Endo Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Ryunosuke Hakuta Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Kota Ishida Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Kazunaga Ishigaki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Sachiko Kanai Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo City, Tokyo, 113-8655, Japan
Kohei Kurihara Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tomotaka Saito Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tatsuya Sato Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tatsunori Suzuki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Yukari Suzuki Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Shinya Takaoka Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Shuichi Tange Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Yurie Tokito Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Naminatsu Takahara Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Tetsuo Ushiku Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Mitsuhiro Fujishiro Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

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Fong ZV, Hernandez-Barco YG, Castillo CFD. A Clinical Guide to the Management of Intraductal Papillary Mucinous Neoplasms: the Need for a More Graded Approach in Clinical Decision-making. J Gastrointest Surg 2023;27:1988-1998. [PMID: 37495820 DOI: 10.1007/s11605-022-05536-1] [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: 07/02/2022] [Accepted: 10/30/2022] [Indexed: 07/28/2023]

Hisa T, Kudo A, Shimizu T, Nishiyama S, Yamada T, Osera S, Fukushima H, Tomori A. Ultrasonographic Features of Nonneoplastic Protrusions in Pancreatic Cysts by Contrast-Enhanced Endoscopic Ultrasound. Pancreas 2023;52:e328-e334. [PMID: 38015069 PMCID: PMC11913236 DOI: 10.1097/mpa.0000000000002261] [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: 05/06/2023] [Accepted: 09/08/2023] [Indexed: 11/29/2023]

Yamashita Y, Ashida R, Tamura T, Shimokawa T, Yamazaki H, Kawaji Y, Tamura T, Hatamaru K, Itonaga M, Kitano M. Novel Technique of Endoscopic Ultrasonography for the Differential Diagnosis of Gallbladder Lesions and Intraductal Papillary Mucinous Neoplasms: A Single-Center Prospective Study. Diagnostics (Basel) 2023;13:2132. [PMID: 37443527 DOI: 10.3390/diagnostics13132132] [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: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open

Adachi K, Tashiro T, Kato M, Ito T, Kato A, Takayama M, Kato S, Ono S, Yoshimine H, Koshino A, Nagao K, Kobayashi Y, Ebi M, Ogasawara N, Sasaki M, Kasugai K. A case report of contrast-enhanced harmonic ultrasonography for the diagnosis of an esophageal duplication cyst. DEN OPEN 2023;3:e218. [PMID: 36942054 PMCID: PMC10023831 DOI: 10.1002/deo2.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023]

Endoscopic ultrasonography: Enhancing diagnostic accuracy. Best Pract Res Clin Gastroenterol 2022;60-61:101808. [PMID: 36577529 DOI: 10.1016/j.bpg.2022.101808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]

Lee SW, Shim SR, Jeong SY, Kim SJ. Comparison of Preoperative Imaging Modalities for the Assessment of Malignant Potential of Pancreatic Cystic Lesions: A Network Meta-analysis. Clin Nucl Med 2022;47:849-855. [PMID: 35713890 DOI: 10.1097/rlu.0000000000004323] [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: 11/26/2022]

Abstract

PURPOSE

The aims of this study are to compare the performance of various preoperative imaging modalities for assessing the malignant potential of pancreatic cystic lesions (PCLs) through a network meta-analysis (NMA) and to clarify the role of 18 F-FDG PET in the management of patients with PCL.

METHODS

PubMed, EMBASE, and Cochrane Library were searched for the studies evaluating the performance of preoperative imaging modalities for identifying malignant PCLs. The NMA was performed for 4 representative categories of various imaging modalities in terms of diagnostic performance for differentiating malignant from benign PCL and intraductal papillary mucinous neoplasms only as a subgroup analysis. To calculate the probability of each imaging modality being the most effective diagnostic method, the surface under the cumulative ranking curve values were obtained.

RESULTS

A total of 1018 patients from 17 direct comparison studies using 2 or more preoperative imaging modalities were included for differentiating malignant from benign PCL. The positive predictive value (PPV) and accuracy of 18 F-FDG PET were significantly higher than that of CT (PPV: odds ratio [OR], 2.66; 95% credible interval [CrI], 1.21-6.17; accuracy: OR, 2.63; 95% CrI, 1.41-5.38) or MRI (PPV: OR, 2.50; 95% CrI, 1.09-6.26; accuracy: OR, 2.50; 95% CrI, 1.28-5.47) in all PCLs, as well as in the subgroup analysis for intraductal papillary mucinous neoplasm only. 18 F-FDG PET showed the highest surface under the cumulative ranking curve values in all diagnostic performance areas of sensitivity, specificity, PPV, negative predictive value, and accuracy, followed by MRI or CT.

CONCLUSIONS

The results from this NMA suggest that 18 F-FDG PET is the best preoperative imaging modality for differentiating malignant from benign PCLs and that it can be used for the preoperative evaluation of PCLs.

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Olar MP, Bolboacă SD, Pojoga C, Moșteanu O, Gheorghiu M, Seicean R, Rusu I, Sparchez Z, Al Hajjar N, Seicean A. Clinical Utility of the Contrast-Enhanced Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Cyst. Diagnostics (Basel) 2022;12:2209. [PMID: 36140610 PMCID: PMC9497576 DOI: 10.3390/diagnostics12092209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 12/04/2022] Open

Affiliation(s)

Miruna Patricia Olar Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Sorana D. Bolboacă Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania
Cristina Pojoga Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Sindicatelor Str, no. 7, 400029 Cluj-Napoca, Romania
Ofelia Moșteanu Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Marcel Gheorghiu Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Radu Seicean First Department of Surgery, Iuliu Hațieganu University of Medicine and Pharmacy, Clinicilor Str., no. 3-5, 400006 Cluj-Napoca, Romania
Ioana Rusu Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Zeno Sparchez Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Nadim Al Hajjar Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Third Department of Surgery, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania
Andrada Seicean Department of Gastroenterology, Iuliu Hațieganu University of Medicine and Pharmacy, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania Regional Institute of Gastroenterology and Hepatology, Croitorilor Str., no. 19-21, 400162 Cluj-Napoca, Romania

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Yamashita Y, Kawaji Y, Shimokawa T, Yamazaki H, Tamura T, Hatamaru K, Itonaga M, Ashida R, Kawai M, Kitano M. Usefulness of Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Diagnosis of Malignancy in Intraductal Papillary Mucinous Neoplasm. Diagnostics (Basel) 2022;12:diagnostics12092141. [PMID: 36140542 PMCID: PMC9497750 DOI: 10.3390/diagnostics12092141] [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: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 12/04/2022] Open

Diagnostic Dilemma of Biliopancreatic Contrast-Enhanced Harmonic Endoscopic Ultrasonography. Diagnostics (Basel) 2022;12:diagnostics12081983. [PMID: 36010332 PMCID: PMC9406750 DOI: 10.3390/diagnostics12081983] [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: 07/06/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022] Open

Kazami Y, Arita J, Nishioka Y, Kawaguchi Y, Ichida A, Ishizawa T, Akamatsu N, Kaneko J, Nakai Y, Koike K, Hasegawa K. Preoperative Predictive Features of Invasive Carcinoma Among Intraductal Papillary Mucinous Neoplasm of the Pancreas. Pancreas 2022;51:642-648. [PMID: 35835103 DOI: 10.1097/mpa.0000000000002078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]

Efficacy of Contrast-Enhanced Endoscopic Ultrasonography for the Diagnosis of Pancreatic Tumors. Diagnostics (Basel) 2022;12:diagnostics12061311. [PMID: 35741121 PMCID: PMC9222168 DOI: 10.3390/diagnostics12061311] [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: 04/26/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open

Salvia R, Burelli A, Perri G, Marchegiani G. State-of-the-art surgical treatment of IPMNs. Langenbecks Arch Surg 2021;406:2633-2642. [PMID: 34738168 PMCID: PMC8803623 DOI: 10.1007/s00423-021-02349-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]

Lisotti A, Napoleon B, Facciorusso A, Cominardi A, Crinò SF, Brighi N, Gincul R, Kitano M, Yamashita Y, Marchegiani G, Fusaroli P. Contrast-enhanced EUS for the characterization of mural nodules within pancreatic cystic neoplasms: systematic review and meta-analysis. Gastrointest Endosc 2021;94:881-889.e5. [PMID: 34217751 DOI: 10.1016/j.gie.2021.06.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]

Yamashita Y, Yoshikawa T, Yamazaki H, Kawaji Y, Tamura T, Hatamaru K, Itonaga M, Ashida R, Ida Y, Maekita T, Iguchi M, Kitano M. A Novel Endoscopic Ultrasonography Imaging Technique for Depicting Microcirculation in Pancreatobiliary Lesions without the Need for Contrast-Enhancement: A Prospective Exploratory Study. Diagnostics (Basel) 2021;11:diagnostics11112018. [PMID: 34829364 PMCID: PMC8621279 DOI: 10.3390/diagnostics11112018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open

Affiliation(s)

Yasunobu Yamashita Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.) Correspondence: ; Tel.: +(81)-73-447-2300; Fax: +(81)-73-445-3616
Takanori Yoshikawa Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama 641-8509, Japan;
Hirofumi Yamazaki Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Yuki Kawaji Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Takashi Tamura Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Keiichi Hatamaru Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Masahiro Itonaga Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Reiko Ashida Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Yoshiyuki Ida Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Takao Maekita Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Mikitaka Iguchi Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)
Masayuki Kitano Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (H.Y.); (Y.K.); (T.T.); (K.H.); (M.I.); (R.A.); (Y.I.); (T.M.); (M.I.); (M.K.)

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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]

Marchegiani G, Salvia R. Guidelines on Pancreatic Cystic Neoplasms: Major Inconsistencies With Available Evidence and Clinical Practice- Results From an International Survey. Gastroenterology 2021;160:2234-2238. [PMID: 33609506 DOI: 10.1053/j.gastro.2021.02.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 12/26/2022]

Kitano M, Yamashita Y, Kamata K, Ang TL, Imazu H, Ohno E, Hirooka Y, Fusaroli P, Seo DW, Napoléon B, Teoh AYB, Kim TH, Dietrich CF, Wang HP, Kudo M. The Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) Guidelines for Contrast-Enhanced Endoscopic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2021;47:1433-1447. [PMID: 33653627 DOI: 10.1016/j.ultrasmedbio.2021.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]

Sunnapwar A, Nagar A, Katre R, Khanna L, Sayana HP. Imaging of Ampullary and Periampullary Conditions. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1726663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open

Should Contrast-Enhanced Harmonic Endoscopic Ultrasound Be Incorporated into the International Consensus Guidelines to Determine the Appropriate Treatment of Intraductal Papillary Mucinous Neoplasm? J Clin Med 2021;10:jcm10091818. [PMID: 33921949 PMCID: PMC8122438 DOI: 10.3390/jcm10091818] [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: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open

Krishnan K, Bhutani MS, Aslanian HR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sethi A, Sullivan S, Trikudanathan G, Trindade AJ, Watson RR, Maple JT, Lichtenstein DR. Enhanced EUS imaging (with videos). Gastrointest Endosc 2021;93:323-333. [PMID: 33129492 DOI: 10.1016/j.gie.2020.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]

Affiliation(s)

Kumar Krishnan Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
Manoop S Bhutani Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Harry R Aslanian Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
Joshua Melson Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
Udayakumar Navaneethan Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
Rahul Pannala Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
Mansour A Parsi Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
Allison R Schulman Department of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
Amrita Sethi New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York, USA
Shelby Sullivan Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, Colorado, USA
Guru Trikudanathan Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
Arvind J Trindade Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
Rabindra R Watson Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
John T Maple Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
David R Lichtenstein Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA

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Predictive Features of Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Meta-Analysis. Cancers (Basel) 2020;12:cancers12092618. [PMID: 32937809 PMCID: PMC7563991 DOI: 10.3390/cancers12092618] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open

Abstract

Simple Summary

Currently, there are several guidelines that are widely used to establish the treatment strategy for branch duct type intraductal papillary mucinous neoplasms. Although there are some common grounds, there are discrepancies on which features they adopt, how much each feature is weighted, and how the features are combined. Furthermore, some of the features are based on lower level evidences or expert opinions. The aim of this meta-analysis was to investigate important clinical, radiological, and biochemical risk factors for malignancy and their impact as predictors. This study found symptom, size, cyst wall thickening, presence of mural nodule, change in main pancreatic duct caliber, lymphadenopathy, CA 19-9, and CEA as risk factors. Lymphadenopathy (odd ratio [OR]: 8.55), abrupt caliber change (OR: 7.41), and mural nodule (OR: 4.10) had the highest odd ratios. We expect the higher level evidences of this study to help shape better guidelines and reduce discrepancies among future guidelines.

Abstract

The current guidelines on branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) recommend various predictive features of malignancy as well as different treatment strategies. This study aimed to identify the risk factors for malignancy with higher level of evidence. A meta-analysis was performed on 40 literatures published between 2000 and 2019. These literatures included 6301 patients with pathologically proven IPMN. Malignancy was defined as high-grade dysplasia and invasive carcinoma. It was significantly associated with symptoms (odds ratio [OR] 1.35, confidence interval [CI] 1.01–1.79), size ≥ 3 cm (OR 1.90, CI 1.51–2.40), cystic wall thickening (OR 2.53, CI 1.50–4.27), mural nodule (OR 4.10, CI 3.38–4.97), main pancreatic duct dilatation (OR 2.98, CI 2.11–4.21), abrupt caliber change of the pancreatic duct (OR 7.41, CI 2.49–22.06), lymphadenopathy (OR 8.55, CI 3.25–22.51), elevated carbohydrate antigen 19-9 (OR 4.01, CI 2.55–6.28), and elevated carcinoembryonic antigen (OR 2.04, CI 1.60–2.61). Multilocular cysts and multiple cysts did not show a significant association with malignancy. This study examined the clinical, radiological, and biochemical features of BD-IPMN, often used as malignancy predictors according to the widely used guidelines. The results confirmed that all the features currently being used are valid.

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Tsumura A, Hirono S, Kawai M, Okada KI, Miyazawa M, Kitahata Y, Kobayashi R, Hayami S, Ueno M, Yanagisawa A, Yamaue H. Surgical indication for intraductal papillary mucinous neoplasm without mural nodule ≥5 mm. Surgery 2020;169:388-395. [PMID: 32859391 DOI: 10.1016/j.surg.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/13/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]

Abstract

BACKGROUND

In intraductal papillary mucinous neoplasm, a mural nodule ≥5 mm is an important predictor of malignancy. Surgical indication is less clear in cases of intraductal papillary mucinous neoplasm without mural nodule ≥5 mm. This is a retrospective study evaluating predictors of high-grade dysplasia or invasive intraductal papillary mucinous carcinoma for intraductal papillary mucinous neoplasm without mural nodule ≥5 mm.

METHODS

Among consecutive patients who underwent surgery for intraductal papillary mucinous neoplasm between 1999 and 2018, 174 had intraductal papillary mucinous neoplasm with mural nodule ≥5 mm (mural nodule[+] ≥5 mm group). The remaining 155 patients had intraductal papillary mucinous neoplasm but did not have mural nodule ≥5 mm: 24 patients with mural nodule <5 mm (mural nodule[+] <5 mm group) and 131 patients without mural nodule (mural nodule[-] group). We investigated predictors of high-grade dysplasia or invasive intraductal papillary mucinous neoplasm in cases of intraductal papillary mucinous neoplasm without mural nodule ≥5 mm.

RESULTS

The frequency of high-grade dysplasia invasive intraductal papillary mucinous neoplasm was significantly higher in the mural nodule(+) ≥5 mm group (87.4%) than in the mural nodule(+) <5 mm group (37.5%, P < .001) and mural nodule(-) group (45.0%, P < .001). However, frequency was not significantly different between mural nodule(+) <5 mm and mural nodule(-) groups (P = .494). Multivariate analysis showed three independent predictors of high-grade dysplasia invasive intraductal papillary mucinous carcinoma in intraductal papillary mucinous neoplasm without mural nodule ≥5 mm: branch cyst ≥40 mm (P = .038, odds ratio 3.704; 95% confidence interval, 1.075-12.821), positive cytology of pancreatic juice (P = .039, odds ratio 16.792; 95% confidence interval, 1.152-244.744), and carcinoembryonic antigen in pancreatic juice ≥30 mg/mL (P < .001, odds ratio 14.925; 95% confidence interval, 4.525-50.0).

CONCLUSION

For cases of intraductal papillary mucinous neoplasm without mural nodule ≥5 mm, large cysts, positive cytology of the pancreatic juice, and high levels of carcinoembryonic antigen in pancreatic juice may be useful to determine surgical indication, although further studies are needed to confirm these results.

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Ohno E, Hirooka Y, Kawashima H, Ishikawa T, Fujishiro M. Endoscopic ultrasonography for the evaluation of pancreatic cystic neoplasms. J Med Ultrason (2001) 2020;47:401-411. [PMID: 31605262 DOI: 10.1007/s10396-019-00980-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]

Mejuto-Fernandez R, Iglesias-Garcia J. Contrast Harmonic Endoscopic Ultrasound in Pancreatic Diseases. Clin Endosc 2020;54:309-313. [PMID: 32549524 PMCID: PMC8182232 DOI: 10.5946/ce.2020.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/09/2020] [Indexed: 11/14/2022] Open

Ge N, Brugge WR, Saxena P, Sahai A, Adler DG, Giovannini M, Pausawasdi N, Santo E, Mishra G, Tam W, Kida M, de la Mora-Levy JG, Sharma M, Umar M, Katanuma A, Lee L, Garg PK, Eloubeidi MA, Yu HK, Raijman I, Arturo Arias BL, Bhutani M, Carrara S, Rai P, Mukai S, Palazzo L, Dietrich CF, Nguyen NQ, El-Nady M, Poley JW, Guaraldi S, Kalaitzakis E, Sabbagh LC, Lariño-Noia J, Gress FG, Lee YT, Rana SS, Fusaroli P, Hocke M, Dhir V, Lakhtakia S, Ratanachu-ek T, Chalapathi Rao AS, Vilmann P, Okasha HH, Irisawa A, Ponnudurai R, Leong AT, Artifon E, Iglesias-Garcia J, Saftoiu A, Larghi A, Robles-Medranda C, Sun S. An international, multi-institution survey of the use of EUS in the diagnosis of pancreatic cystic lesions. Endosc Ultrasound 2019;8:418-427. [PMID: 31552915 PMCID: PMC6927137 DOI: 10.4103/eus.eus_61_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/04/2019] [Indexed: 02/05/2023] Open

Affiliation(s)

Nan Ge Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
William R. Brugge Department of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
Payal Saxena Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
Anand Sahai Center Hospitalier de l'Université de Montréal, Montreal, Canada
Douglas G. Adler Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
Marc Giovannini Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
Nonthalee Pausawasdi Siriraj Hospital, Mahidol University, Bangkok, Thailand
Erwin Santo Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
Girish Mishra Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
William Tam Lyell McEwin Hospital, Elizabeth Vale, Adelaide, Australia
Mitsuhiro Kida Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
Jose G. de la Mora-Levy National Cancer Institute, Mexico City, Mexico
Malay Sharma Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
Muhammad Umar Rawalpindi Medical College, Rawalpindi, Pakistan
Akio Katanuma Center for Gastroenterology, Teine-Kenjinkai Hospital, Sapporo, Japan
Linda Lee Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
Pramod Kumar Garg Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
Mohamad Ali Eloubeidi American University of Beirut Medical Center, Beirut, Lebanon
Ho Khek Yu National University of Singapore, Singapore
Isaac Raijman Digestive Associates of Houston, University of Texas, Houston, Texas, USA
Brenda Lucia Arturo Arias Surgical Clinical Gastroenterolgy, University of Caldas, Manizales, Colombia
Manoop Bhutani Anderson Cancer Center, University of Texas, Houston, Texas, USA
Silvia Carrara Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy
Praveer Rai Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Shuntaro Mukai Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Laurent Palazzo Trocadero Clinic, Paris, France
Christoph F. Dietrich Medical Department, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
Nam Q. Nguyen Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
Mohamed El-Nady Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Jan Werner Poley Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Simone Guaraldi Participants of the Nucleus of Endoscopy of the Brazilian Society of Digestive Endoscopy (SOBED), São Paulo, Brazil
Evangelos Kalaitzakis Division of Endoscopy, Gastro Unit, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
Luis Carlos Sabbagh Clinica Reina Sofia, Bogota, Colombia
Jose Lariño-Noia Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Frank G. Gress Columbia University Medical Center, New York, USA
Yuk-tong Lee Departments of Medicine & Therapeutics and Surgery, The Chinese University of Hong Kong, Hong Kong, China
Surinder S. Rana Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Pietro Fusaroli Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
Michael Hocke Department of Medical, Hospital Meiningen, Thuringia, Germany
Vinay Dhir Department of Gastroenterology and Endoscopy, S L Raheja Hospital, Mumbai, Maharashtra, India
Sundeep Lakhtakia Asian Institute of Gastroenterology, Hyderabad, Telangana, India
Thawee Ratanachu-ek Rajavithi Hospital, Bangkok, Thailand
A. S. Chalapathi Rao Bahrain Specialist Hospital, Manama, Kingdom of Bahrain
Peter Vilmann GastroUnit, Department of Surgery, Copenhagen University Hospital, Copenhagen, Denmark
Hussein Hassan Okasha Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
Atsushi Irisawa Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
Ryan Ponnudurai Prince Court Medical Center, Kuala Lumpur, Malaysia
Ang Tiing Leong Departments of Gastroenterology and Hepatology, Changi General Hospital, Singapore
Everson Artifon Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
Julio Iglesias-Garcia Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Adrian Saftoiu Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
Alberto Larghi Digestive Endoscopy Unit, Catholic University, Rome, Italy
Carlos Robles-Medranda Head of the Endoscopy Division, Ecuadorian Institute of Digestive Disease, Guayaquil, Ecuador
Siyu Sun Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China

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Pollini T, Andrianello S, Caravati A, Perri G, Malleo G, Paiella S, Marchegiani G, Salvia R. The management of intraductal papillary mucinous neoplasms of the pancreas. MINERVA CHIR 2019;74:414-421. [PMID: 31795628 DOI: 10.23736/s0026-4733.19.08145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]

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Lee ES, Kim JH, Yu MH, Choi SY, Kang HJ, Park HJ, Park YS, Byun JH, Shin SS, Lee CH. Diagnosis and Surveillance of Incidental Pancreatic Cystic Lesions: 2017 Consensus Recommendations of the Korean Society of Abdominal Radiology. Korean J Radiol 2019;20:542-557. [PMID: 30887737 PMCID: PMC6424832 DOI: 10.3348/kjr.2018.0640] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023] Open

Kitano M, Yoshida T, Itonaga M, Tamura T, Hatamaru K, Yamashita Y. Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer. J Gastroenterol 2019;54:19-32. [PMID: 30406288 PMCID: PMC6314985 DOI: 10.1007/s00535-018-1519-2] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/03/2018] [Indexed: 02/04/2023]

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Wang Y, Chai N, Feng J, Linghu E. A prospective study of endoscopic ultrasonography features, cyst fluid carcinoembryonic antigen, and fluid cytology for the differentiation of small pancreatic cystic neoplasms. Endosc Ultrasound 2018;7:335-342. [PMID: 28836521 PMCID: PMC6199906 DOI: 10.4103/eus.eus_40_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/11/2017] [Indexed: 12/18/2022] Open

Abstract

BACKGROUND AND OBJECTIVES

With improvements in imaging technologies, pancreatic cystic lesions (PCLs) have been increasingly identified in recent years. However, the imaging modalities used to differentiate the categories of pancreatic cysts remain limited, which may cause confusion when planning treatment. Due to progress in endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) technology, auxiliary diagnosis by the detection of cystic fluid has become a recent trend.

METHODS

From March 2015 to April 2016, 120 patients with PCLs were enrolled in this study. According to the results of EUS, cyst fluid carcinoembryonic antigen (CEA) analysis, and cystic fluid cytology, the patients were divided into two groups: a nonmucinous and a mucinous group. Of those, 61 patients who had undergone surgical resection were included in the analysis. The clinical features, biochemical and tumor markers of cyst fluid as well as the cytological test results of the patients were compared with histopathology results.

RESULTS

A cyst size of 4.0 cm was used as the boundary value; a cyst ≤4.0 cm was defined as a small PCL. 87 (72.5%) lesions were ≤4.0 cm, and 33 (27.5%) lesions were >4.0 cm. Regarding the analysis of CEA and carbohydrate antigens 19-9 (CA19-9), significant differences were found between the nonmucinous and mucinous groups (P < 0.05) according to nonparametric independent samples tests. The EUS, cystic fluid CEA, and cystic fluid cytology results were compared with the tissue pathology findings using McNemar's test (P < 0.05) and showed a sensitivity of 90% and a specificity of 84%.

CONCLUSION

A diagnostic combination of EUS, cyst fluid CEA, and cystic fluid cytology could be used to differentiate small pancreatic cystic neoplasms. Cystic fluid cytology analysis is helpful for planning treatment for pancreatic cystic tumors that pose a surgical risk.

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European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67:789-804. [PMID: 29574408 PMCID: PMC5890653 DOI: 10.1136/gutjnl-2018-316027] [Citation(s) in RCA: 868] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]

Marchegiani G, Andrianello S, Borin A, Dal Borgo C, Perri G, Pollini T, Romanò G, D'Onofrio M, Gabbrielli A, Scarpa A, Malleo G, Bassi C, Salvia R. Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas. Surgery 2018;163:1272-1279. [PMID: 29454468 DOI: 10.1016/j.surg.2018.01.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/19/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]

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Comparison between MRI with MR cholangiopancreatography and endoscopic ultrasonography for differentiating malignant from benign mucinous neoplasms of the pancreas. Eur Radiol 2017;28:179-187. [PMID: 28779397 DOI: 10.1007/s00330-017-4926-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 01/04/2023]