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Preoperative ultrasound combined with routine blood tests in predicting the malignant risk of pancreatic cystic neoplasms

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Cancer Biology & Medicine 2022年第10期19卷 1503-1516页

作者： Xiuchao Wang Junjin Wang Xi Wei Lihui Zhao Bo Ni Zekun Li Chuntao Gao Song Gao Tiansuo Zhao Jian Wang Weidong Ma Xiao Hu Jihui Hao Department of pancreatic Cancer Tianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China Department of Diagnostic and Therapeutic Ultrasonography Tianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China Department of Hepatobiliary and pancreatic Surgery The Affiliated Hospital of Qingdao UniversityQingdao 266000China

Objective:Accurate preoperative identification of benign or malignant pancreatic cystic neoplasms(PCN)may help clinicians make better intervention choices and will be essential for individualized ***:Preoperative ultrasound and laboratory examination findings,and demographic characteristics were collected from *** logistic regression was used to identify independent risk factors associated with malignant PCN,which were then included in the nomogram and validated with an external *** Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI)were calculated to evaluate the improvement in the predictive power of the new model with respect to that of a combined imaging and tumor marker prediction ***:Malignant PCN were found in 83(40.7%)and 33(38.7%)of the model and validation cohorts,*** analysis identified age,tumor location,imaging of tumor boundary,blood type,mean hemoglobin concentration,neutrophil-tolymphocyte ratio,carbohydrate antigen 19-9,and carcinoembryonic antigen as independent risk factors for malignant *** calibration curve indicated that the predictions based on the nomogram were in excellent agreement with the actual observations.A nomogram score cutoff of 192.5 classified patients as having low *** risk of malignant *** model achieved good C-statistics of 0.929(95%CI 0.890–0.968,P<0.05)and 0.951(95%CI 0.903–0.998,P<0.05)in predicting malignancy in the development and validation cohorts,***=0.268;IDI=0.271(P<0.001 for improvement).The DCA curve indicated that our model yielded greater clinical benefits than the comparator ***:The nomogram showed excellent performance in predicting malignant PCN and may help surgeons select patients for detailed examination and *** nomogram is freely available at https://***/DynNomapp/.

关键词： pancreatic cystic neoplasms malignancy prediction nomogram ultrasound blood routine

Online calculator for predicting the risk of malignancy in patients with pancreatic cystic neoplasms: A multicenter, retrospective study

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World Journal of Gastroenterology 2022年第37期28卷 5469-5482页

作者： Dong Jiang Zi-Xiang Chen Fu-Xiao Ma Yu-Yong Gong Tian Pu Jiang-Ming Chen Xue-Qian Liu Yi-Jun Zhao Kun Xie Hui Hou Cheng Wang Xiao-Ping Geng Fu-Bao Liu Department of General Surgery The First Affiliated Hospital of Anhui Medical UniversityHefei 230000Anhui ProvinceChina Department of General Surgery The Second Affiliated Hospital of Anhui Medical UniversityHefei 230000Anhui ProvinceChina Department of General Surgery The First Affiliated Hospital of University of Science and Technology of ChinaHefei 230000Anhui ProvinceChina

BACKGROUND Efficient and practical methods for predicting the risk of malignancy in patients with pancreatic cystic neoplasms(PCNs)are *** To establish a nomogram-based online calculator for predicting the risk of malignancy in patients with *** In this study,the clinicopathological data of target patients in three medical centers were *** independent sample t-test,Mann–Whitney U test or chi-squared test were used as appropriate for statistical *** univariable and multivariable logistic regression analysis,five independent factors were screened and incorporated to develop a calculator for predicting the risk of ***,the concordance index(C-index),calibration,area under the curve,decision curve analysis and clinical impact curves were used to evaluate the performance of the *** Enhanced mural nodules[odds ratio(OR):4.314;95%confidence interval(CI):1.618–11.503,P=0.003],tumor diameter≥40 mm(OR:3.514;95%CI:1.138–10.849,P=0.029),main pancreatic duct dilatation(OR:3.267;95%CI:1.230–8.678,P=0.018),preoperative neutrophil-to-lymphocyte ratio≥2.288(OR:2.702;95%CI:1.008–7.244,P=0.048],and preoperative serum CA19-9 concentration≥34 U/mL(OR:3.267;95%CI:1.274–13.007,P=0.018)were independent risk factors for a high risk of malignancy in patients with *** the training cohort,the nomogram achieved a C-index of 0.824 for predicting the risk of *** predictive ability of the model was then validated in an external cohort(C-index:0.893).Compared with the risk factors identified in the relevant guidelines,the current model showed better predictive performance and clinical *** The calculator demonstrates optimal predictive performance for identifying the risk of malignancy,potentially yielding a personalized method for patient selection and decision-making in clinical practice.

关键词： pancreatic cystic neoplasms Risk of malignancy Nomogram Model Prediction Calculator

Comparison of endoscopic ultrasound, computed tomography and magnetic resonance imaging in assessment of detailed structures of pancreatic cystic neoplasms

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World Journal of Gastroenterology 2017年第17期23卷 3184-3192页

作者： Chen Du Ning-Li Chai En-Qiang Linghu Hui-Kai Li Li-Hua Sun Lei Jiang Xiang-Dong Wang Ping Tang Jing Yang Department of Gastroenterology and Hepatology Chinese People’s Liberation Army General Hospital

AIM To evaluate the advantages of endoscopic ultrasound(EUS) in the assessment of detailed structures of pancreatic cystic neoplasms(PCNs) compared to computed tomography(CT) and magnetic resonance imaging(MRI).METHODS All patients with indeterminate PCNs underwent CT, MRI, and EUS. The detailed information, including size, number, the presence of a papilla/nodule, the presence of a septum, and the morphology of the pancreatic duct of PCNs were compared among the three imaging modalities. The size of each PCN was determined using the largest diameter measured. A cyst consisting of several small cysts was referred to as a motherdaughter cyst. Disagreement among the three imaging modalities regarding the total number of mother cysts resulted in the assumption that the correct number was the one in which the majority of imaging modalities *** A total of 52 females and 16 males were evaluated. The median size of the cysts was 42.5 mm by EUS, 42.0 mm by CT and 38.0 mm by MRI; there was no significant difference in size as assessed among the three imaging techniques. The diagnostic sensitivity and ability of EUS to classify PCNs were 98.5%(67/68) and 92.6%(63/68), respectively. These percentages were higher than those of CT(73.1%, P pancreatic duct using EUS was 100%, whereas using CT and MRI it was less than 10%.CONCLUSION EUS helps visualize

关键词： Endoscopic ultrasound Detailed structures Computed tomography Magnetic resonance imaging pancreatic cystic neoplasms

EUS for pancreatic cystic neoplasms: The roadmap to the future is much more than just a few shades of gray

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Asian Pacific Journal of Tropical Medicine 2016年第12期9卷 1193-1196页

作者： Tejas Kirtane Manoop S.Bhutani Department of Gastroenterology Hepatology and NutritionUniversity of Texas MD Anderson Cancer Center

pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or endoscopic therapy as well as avoiding unnecessary surgery in cysts with no malignant potential. Tumor markers such as KRAS and GNAS hold promise, but which molecular marker or a combination of markers is most useful and cost effective remains to be seen. Advanced imaging with confocal laser endomicroscopy can serve as an optical biopsy and play a part in the diagnostic algorithm. Microforceps aided biopsy of pancreatic cyst wall and tumor contents hold great promise as they allow direct tissue acquisition. Much progress has been made in the role of EUS guided evaluation of pancreatic cystic neoplasms over the last several years, and with the advances enumerated above, the future is more than just a few shades of grey. Future studies should include prospective multiarm trials of microforceps biopsy versus conventional EUS-FNA and use of biochemical and molecular markers, confocal laser endomicroscopy or a combination thereof to determine best approach to pancreatic cystic neoplasms. In Osler's words, ‘Medicine is a science of uncertainty and an art of probability'. Incorporation of advanced imaging and molecular markers into a new diagnostic algorithm with subsequent validation through retrospective and prospective studies has the potential to increase diagnostic accuracy and guide optimal management of patients and improve outcomes.

关键词： EUS-FNA Endoscopic ultrasound pancreatic cystic neoplasms Radiofrequency ablation nCLE Molecular markers

pancreatic cystic neoplasms:a comprehensive approach to diagnosis and management

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Oncology and Translational Medicine 2023年第6期9卷 269-280页

作者： Amir M.Parray Anoop Singh Vikram Chaudhari Avinash Supe Department of Surgical Gastroenterology and Minimal Access Surgery BLK Max Super Speciality HospitalNew DelhiIndia Gastrointestinal and Hepato-Pancreato-Biliary Service Department of Surgical OncologyTata Memorial CentreHomi Bhabha National InstituteMumbaiMaharashtraIndia Surgical Gastroenterology KEM HospitalMumbaiIndia

pancreatic cystic neoplasms present a complex diagnostic scenario encompassing low-and high-grade *** prevalence varies widely,notably increasing with age,reaching 75%in individuals older than 80 *** diagnosis is crucial,as errors occur in approximately one-third of resected cysts discovered *** imaging modalities such as computed tomography,magnetic resonance imaging,and endoscopic techniques are available to address this ***,risk stratification remains problematic,with guideline inconsistencies and diagnostic accuracy varying according to cyst *** review proposed a stepwisemanagement approach,considering patient factors,imaging results,and specific *** patient-centered model offers a structured framework for optimizing the care of individuals with pancreatic cystic neoplasms.

关键词： pancreatic cystic neoplasms cystic fluid analysis Serous cystic neoplasm Mucinous cystic neoplasm Intraductal papillary mucinous neoplasm cystic tumors

Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

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World Journal of Gastroenterology 2024年第10期30卷 1461-1465页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis 2^(nd) Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Pancreatobiliary intraductal papillary neoplasms(IPNs)represent precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and *** advances in diagnostic methods,identifying these premalignant lesions is still challenging for treatment *** imaging,biomarkers and molecular tests for genomic alterations can be used for diagnosis and *** intervention in combination with new chemotherapeutic agents is considered the optimal treatment for malignant *** balance between the risk of malignancy and any risk of resection guides management policy;therefore,treatment should be individualized based on a meticulous preoperative assessment of high-risk *** of the bile duct is more aggressive;thus,early diagnosis and surgery are *** conservative management of low-risk pancreatic branch-duct lesions is safe and effective.

关键词： Biliary tree diseases pancreatic cystic neoplasms Biliary tract neoplasms Extrahepatic cholangiocarcinoma pancreatic adenocarcinoma