Is preoperative pancreatic juice cytology useful for determining therapeutic strategies for patients with intraductal papillary mucinous neoplasm of the pancreas?

BACKGROUND

We compared the results of preoperative pancreatic juice cytology (PJC) and final pathological diagnosis after resection in patients who underwent resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas to determine whether preoperative PJC can help determine therapeutic strategies.

METHODS

Of 1130 patients who underwent surgical resection IPMN at 11 Japanese tertiary institutions, the study included 852 patients who underwent preoperative PJC guided by endoscopic retrograde cholangiopancreatography (ERCP).

RESULTS

The accuracy of preoperative PJC for differentiation between cancerous and noncancerous lesions were 55% for IPMN overall; 59% for the branch duct type; 49% for the main pancreatic duct type; 53% for the mixed type, respectively. On classifying IPMN according to the diameters of the mural nodule (MN) and main pancreatic duct (MPD), the corresponding values for diagnostic performance were 40% for type 1 (MN ≥5 mm and MPD ≥ 10 mm); 46% for type 2 (MN ≥5 mm and MPD < 10 mm); 61% for type 3 (MN < 5 mm and MPD ≥ 10 mm); 72% for type 4 (MN < 5 mm and MPD < 10 mm), respectively.

CONCLUSIONS

PJC in IPMN is not a recommended examination because of its low overall sensitivity and no significant difference in diagnostic performance by type, location, or subclassification. Although the sensitivity is low, the positive predictive value is high, so we suggest that pancreatic juice cytology be performed only in cases where the patient is not sure about surgery.

Prediction of persistent form of atrial fibrillation using left atrial morphology on preprocedural computed tomography: application of radiomics

Background

Radiomics is a comprehensive analysis methodology of medical image and involves the extraction of numerous features from standard imaging. Its usefulness has been reported mainly in the field of cancer for diagnosis and prediction of prognosis. In the territory of cardiac imaging, several reports have investigated the utility of radiomics for classifying the risk of prognosis in coronary artery disease, and few practical applications have been reported for patients with atrial fibrillation (AF) who underwent catheter ablation (CA).

Purpose

The objective of this study was to evaluate the utility of radiomics analysis applying to the preprocedural cardiac computerized tomography (CT) in AF patients.

Methods

We analyzed 525 consecutive three-dimensional CT in patients with AF who underwent CA. After marking the region of interest on left atrium (LA) (including the root of pulmonary veins) semiautomatically, 107 radiomics feature values were obtained by Python program. We calculated the amount of representative statistics for each radiomics feature for prediction of persistent AF (PeAF) (Wald statistic in logistic regression analysis) and LA diameter (LAD) (coefficient correlation), respectively. To compare the distribution of the two statistics, the relative importance (calculated as the ratio of statistic to the maximum statistics among 107 radiomics features [%]) was calculated for each statistic. Further, we compared the area under the curve (AUC) in receiver operation characteristic (ROC) curve analysis for predicting PeAF between radiomics features (multivariate model) and LAD (single parameter).

Results

In 525 study patients (age 63±10 years old and male 80%), 253 (48%) were PeAF and remaining were paroxysmal AF (PAF). LAD was 43±6 mm and 38±6 mm in patients with PeAF and PAF, respectively. The relative importance of the two statistics (Wald statistic for PeAF and coefficient correlation for LAD) of 107 radiomics features are displayed in Figure 1, which shows similar distribution of two statistics. It means the close relationship between LA morphology and the form of PeAF in AF patients and the radiomics features possibly well explain the relationship. In Figure 2, the predictive capability for PeAF was compared between radiomics feature values and LAD, where the AUC was 0.85 (95% confidence interval [CI], 0.82–0.88) and 0.73 (95% CI, 0.69–0.78) for radiomics feature values and LAD, respectively (Delong test, P&lt;0.001).

Conclusion

We applied the radiomics features for the evaluation of LA morphology. The predictive capability for PeAF in the prediction model with the radiomics feature values was much better than that with LAD alone. Since radiomics feature analysis yields a huge number of numerical values representing the LA morphology in a reproducible manner, it would provide a new direction to construct a good prediction model using machine learning including artificial intelligence out of a routine cardiac CT scan.

Funding Acknowledgement

Type of funding sources: None.

[Dumbbell cervical neurinomas with subcutaneous extension: report of two cases]

Two cases of dumbbell cervical neurinomas with massive subcutaneous extension were reported. The first case was A 30-year-old woman who was admitted to our hospital because she had been aware of a left lateral cervical subcutaneous mass and was suffering from shoulder dullness. On admission, neurological examination revealed hypesthesia to touch and pain in the segmental area of C4, and hyperreflexia in the left biceps and patellar tendon reflexes. Plain X-ray showed enlargement of the left C3/4 intervertebral foramen. CT scan, post-myelogram CT and MRI demonstrated a dumbbell shaped tumor at the level of C3-4. Angiogram showed an anterior shift of the left vertebral artery (VA) and tumor stain. Temporary occlusion of the left VA by a balloon catheter was performed leaving no neurological deficits. The second case was a 36-year-old woman who had been aware of a left lateral cervical subcutaneous mass. She complained of shoulder pain and finger clumsiness. On admission, neurological examination revealed weakness of the left deltoid muscle, hypesthesia in the segmental area of C3-4 and exaggeration of all deep tendon reflexes in the left-side extremities. Plain X-ray showed enlargement of the C2/3, C3/4 and C4/5 intervertebral foramina. CT scan, post myelogram CT and MRI demonstrated a dumbbell shaped tumor at the level of C2-5. Angiogram showed an anteromedial shift of the left VA and tumor stain. Temporary occlusion test of the left VA by a balloon catheter was performed with negative results. In each case two-stage operations were undertaken with excellent results.(ABSTRACT TRUNCATED AT 250 WORDS)

[Successful treatment of a pretreated elderly case of small-cell lung carcinoma with continuous five-day intravenous infusion of cisplatin plus etoposide]

A 78-year-old man was admitted to our hospital with dyspnea in June 1988, and diagnosed as having small-cell lung carcinoma by cytological findings of pleural effusion. He was treated three times with CAV (cyclophosphamide, doxorubicin, vincristine) therapy and a partial response was achieved. In March 1989, he was again admitted complaining of right dull hypochondralgia accompanied by enlargement of primary tumor in the right lower lobe of the lung and metastases to mediastinal and intraabdominal lymph nodes. Because it was an aged and recurrent case, he was treated with continuous five-day infusion of etoposide, 30 mg/m2/day and CDDP, 18.5 mg/m2/day. After the second course, subjective symptoms clearly disappeared and swelling of mediastinal and intraabdominal lymph nodes was markedly reduced on computed tomography. No severe side effects except for moderate myelosuppression, alopecia and nausea were observed. This regimen appears useful in the treatment of small-cell lung carcinoma in elderly patients.