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Contrast-enhanced ultrasound and contrast-enhanced computed tomography for differentiating mass-forming pancreatitis from pancreatic ductal adenocarcinoma:a meta-analysis

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Chinese Medical Journal 2023年第17期136卷 2028-2036页

作者： Jie Yang Jiayan Huang Yonggang Zhang Keyu Zeng Min Liao Zhenpeng Jiang Wuyongga Bao Qiang Lu Department of Ultrasound West China HospitalSichuan UniversityChengduSichuan 610041China Laboratory of Ultrasound Medicine West China HospitalSichuan UniversityChengduSichuan 610041China The Chinese Centre of Evidence-Based Medicine West China HospitalSichuan UniversityChengduSichuan 610041China

Background:Patients with mass-forming pancreatitis(MFP)or pancreatic ductal adenocarcinoma(PDAC)presented similar clinical symptoms,but required different treatment approaches and had different survival outcomes.This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound(CEUS)and contrast-enhanced computed tomography(CECT)in differentiating MFP from PDAC.Methods:A literature search was performed in the PubMed,EMBASE(Ovid),Cochrane Library(CENTRAL),China National Knowledge Infrastructure(CNKI),Weipu(VIP),and WanFang databases to identify original studies published from inception to August 20,2021.Studies reporting the diagnostic performances of CEUS and CECT for differentiating MFP from PDAC were included.The meta-analysis was performed with Stata 15.0 software.The outcomes included the pooled sensitivity,specificity,positive likelihood ratio(+LR),negative likelihood ratio(-LR),diagnostic odds ratio(DOR),and summary receiver operating characteristic(SROC)curves of CEUS and CECT.Meta-regression was conducted to investigate heterogeneity.Bayesian network meta-analysis was conducted to indirectly compare the overall diagnostic performance.Results:Twenty-six studies with 2115 pancreatic masses were included.The pooled sensitivity and specificity of CEUS for MFP were 82%(95%confidence interval[CI],73%-88%;I^(2)=0.00%)and 95%(95%CI,90%-97%;I^(2)=63.44%),respectively;the overall+LR,-LR,and DOR values were 15.12(95%CI,7.61-30.01),0.19(95%CI,0.13-0.29),and 78.91(95%CI,30.94-201.27),respectively;and the area under the SROC curve(AUC)was 0.90(95%CI,0.87-92).However,the overall sensitivity and specificity of CECT were 81%(95%CI,75-85%;I^(2)=66.37%)and 94%(95%CI,90-96%;I^(2)=74.87%);the overall+LR,-LR,and DOR values were 12.91(95%CI,7.86-21.20),0.21(95%CI,0.16-0.27),and 62.53(95%CI,34.45-113.51),respectively;and,the SROC AUC was 0.92(95%CI,0.90-0.94).The overall diagnostic accuracy of CEUS was comparable to that of CECT for the differential diagnosis of MFP and PDAC(relative DOR 1.26,95%CI[0.

关键词： Pancreatitis pancreatic neoplasms Ultrasonography Tomography,X-ray computed Meta-analysis

Solid pseudopapillary tumor of the pancreas: A systematic review of clinical, surgical and oncological characteristics of 1384 patients underwent pancreatic surgery

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HEPATOBILIARY & pancreatic DISEASES INTERNATIONAL 2024年第4期23卷 331-338页

作者： Mazzarella, Gennaro Muttillo, Edoardo Maria Coletta, Diego Picardi, Biagio Rossi, Stefano Monte, Simone Rossi Del Gomes, Vito Muttillo, Irnerio Angelo San Filippo Neri Hosp Div Gen & Emergency Surg I-00136 Rome Italy Sapienza Univ Rome Dept Surg Pietro Valdoni Viale Policlin 155 I-00161 Rome Italy Sapienza Univ Rome St Andrea Hosp Surg & Med Dept Translat Med I-00185 Rome Italy Sapienza Univ Rome Umberto Univ Hosp I Dept Surg Sci Rome Italy Ospedal Riuniti Marche Nord Dept Gen Surg Pesaro Italy San Filippo Neri Hosp Dept Pathol Rome Italy

Background: pancreatic solid pseudopapillary tumors (SPTs) are rare clinical entity, with low malignancy and still unclear pathogenesis. They account for less than 2% of exocrine pancreatic neoplasms. This study aimed to perform a systematic review of the main clinical, surgical and oncological characteristics of pancreatic SPTs. Data sources: MEDLINE/PubMed, Web of Science and Scopus databases were systematically searched for the main clinical, surgical and oncological characteristics of pancreatic SPTs up to April 2021, in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards. Primary endpoints were to analyze treatments and oncological outcomes. Results: A total of 823 studies were recorded, 86 studies underwent full-text reviews and 28 met inclusion criteria. Overall, 1384 patients underwent pancreatic surgery. Mean age was 30 years and 1181 patients (85.3%) were female. The most common clinical presentation was non-specific abdominal pain (52.6% of cases). Mean overall survival was 98.1%. Mean recurrence rate was 2.8%. Mean follow-up was 4.2 years. Conclusions: pancreatic SPTs are rare, and predominantly affect young women with unclear pathogenesis. Radical resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up. (c) 2023 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

关键词： Frantz's tumor Pancreas pancreatic neoplasms pancreatic surgery Solid pseudopapillary tumor PAPILLARY EPITHELIAL NEOPLASM CYSTIC TUMOR RISK-FACTORS EXPERIENCE MANAGEMENT ORIGIN TRANSLOCATION DIAGNOSIS FEATURES BEHAVIOR

Laparoscopic pancreaticoduodenectomy with portal or superior mesenteric vein resection and reconstruction for pancreatic cancer:A single-center experience

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Hepatobiliary & pancreatic Diseases International 2023年第2期22卷 147-153页

作者： Ming-Jian Ma He Cheng Yu-Sheng Chen Xian-Jun Yu Chen Liu Department of pancreatic Surgery Fudan University Shanghai Cancer CenterShanghai 200032China Department of Oncology Shanghai Medical CollegeFudan UniversityShanghai 200032China Shanghai pancreatic Cancer Institute Shanghai 200032China pancreatic Cancer Institute Fudan UniversityShanghai 200032China

Background: Open pancreaticoduodenectomy(OPD) with portal or superior mesenteric vein resection and reconstruction has been applied in pancreatic cancer patients with tumor infiltration or adherence. However, it is controversial whether laparoscopic pancreaticoduodenectomy(LPD) with major vascular resection and reconstruction is feasible. This study aimed to evaluate the safety and feasibility of LPD with major vascular resection compared with OPD with major vascular resection. Methods: We reviewed data for all pancreatic cancer patients undergoing LPD or OPD with vascular resection at Department of pancreatic Surgery, Fudan University Shanghai Cancer Center, between February 2018 and May 2022. We compared the preoperative, intraoperative, and postoperative clinicopathological data of the two groups to conduct a comprehensive evaluation of LPD with major vascular resection. Results: A total of 63 patients underwent pancreaticoduodenectomy(PD) with portal or superior mesenteric vein resection and reconstruction, including 25 LPDs and 38 OPDs. The LPD group had less intraoperative blood loss(200 vs. 400 m L, P pancreatic fistula, delayed gastric emptying and abdominal infection between the two groups. No postpancreatectomy hemorrhage nor bile leakage occurred during perioperative period. There was no significant difference in R0 resection rate and number of lymph nodes harvested between the two groups. Patency of reconstructed vessels in the two groups were 96.0% and 92.1%, respectively( P = 0.927). Conclusions: LPD with portal or superior mesenteric vein resection and reconstruction was safe, feasible and oncologically acceptable for selected pat

关键词： Laparoscopy pancreaticoduodenectomy Whipple procedure Mesenteric veins Portal vein pancreatic neoplasms

Exosomal miR-485-3p derived from pancreatic ductal epithelial cells inhibits pancreatic cancer metastasis through targeting PAK1

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Chinese Medical Journal 2022年第19期135卷 2326-2337页

作者： Mingzhe Li Jiaxin Zhou Zhengkui Zhang Jisong Li Feng Wang Ling Ma Xiaodong Tian Zebin Mao Yinmo Yang Department of General Surgery Peking University First HospitalBejing 100034China Department of Urology Sir Run Run Shaw HospitalZhejang UniversityHangzhouZhejiang 310016China Department of Gastrointestinal Surgery Sichuan Academy of Medical Sciences&Sichuan Provincial People's HospitalChengduSichuan 610072China Department of Surgical Oncology Peking University Ninth School of Clinical Medicine(Bejing Shijitan HospitalCapital Medical University)Bejing 100038China Department of Medical Biochemistry and Molecular Biology Peking University Health Science CenterBeijing 100191China.

Background:Cell competition is an important feature in pancreatic cancer(PC)progression,but the underlying mechanism remains elusive.This study aims to explore the role of exosomes derived from normal pancreatic ductal epithelial cells involved in PC progression.Methods:PC cells and pancreatic stellate cells(PSCs)were treated with exosomes isolated from pancreatic ductal epithelial cells.Cell proliferation was assessed by CCK8 assays.Cell migration and invasion were assessed by Transwell assays.PC and matched adjacent non-tumor tissue specimens were obtained from 46 patients pathologically diagnosed with PC at Peking University First Hospital from 2013 to 2017.Tissue miR-485-3p and p21-activated kinase-1(PAK1)expression was examined by real-time polymerase chain reaction(RT-PCR),and the relationship of the two was analyzed using Pearman’s product-moment correlation.The clinical significance of miR-485-3p was analyzed using the Chi-square test,Wilcoxon rank-sum test,and Fisher exact probability,respectively.The binding of miR-485-3p to PAK15’-untranslated region(5’-UTR)was examined by luciferase assay.PC cells were xenografted into nude mice as a PC metastasis model.Results:Exosomes from pancreatic ductal epithelial cells suppressed PC cell migration and invasion as well as the secretion and migration of PSCs.MiR-485-3p was enriched in the exosomes of pancreatic ductal epithelial cells but deficient in those of PC cells and PSCs,in accordance with the lower level in PSCs and PC cells than that in pancreatic ductal cells.And the mature miR-485-3p could be delivered into these cells by the exosomes secreted by normal pancreatic duct cells,to inhibit PC cell migration and invasion.Clinical data analysis showed that miR-485-3p was significantly decreased in PC tissues(P<0.05)and was negatively associated with lymphovascular invasion(P=0.044).As a direct target of miR-485-3p,PAK1 was found to exert an inhibitory effect on PC cells,and there was a significantly negative correlation between the expression levels of miR-4

关键词： pancreatic neoplasms Cell competition Exosomes miR-485-3p p21-activated kinase-1

Application of Unenhanced Computed Tomography Texture Analysis to Differentiate pancreatic Adenosquamous Carcinoma from pancreatic Ductal Adenocarcinoma

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Current Medical Science 2022年第1期42卷 217-225页

作者： Shuai REN Hui-juan TANG Rui ZHAO Shao-feng DUAN Rong CHEN Zhong-qiu WANG Department of Radiology Jiangsu Province Hospital of Chinese MedicineAffiliated Hospital of Nanjing University of Chinese MedicineNanjing 210029China Department of Diagnostic Radiology and Nuclear Medicine School of MedicineUniversity of MarylandBaltimoreMD 21201USA Department of Oncology Jiangsu Province Hospital of Chinese MedicineAffiliated Hospital of Nanjing University of Chinese MedicineNanjing 210029China Department of Clinical and Molecular Sciences Marche Polytechnic UniversityAncona 60126Italy GE Healthcare Shanghai 201203China

Objective:The objective of this study was to investigate the application of unenhanced computed tomography(CT)texture analysis in differentiating pancreatic adenosquamous carcinoma(PASC)from pancreatic ductal adenocarcinoma(PDAC).Methods:Preoperative CT images of 112 patients(31 with PASC,81 with PDAC)were retrospectively reviewed.A total of 396 texture parameters were extracted from AnalysisKit software for further texture analysis.Texture features were selected for the differentiation of PASC and PDAC by the Mann-Whitney U test,univariate logistic regression analysis,and the minimum redundancy maximum relevance algorithm.Furthermore,receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic performance of the texture feature-based model by the random forest(RF)method.Finally,the robustness and reproducibility of the predictive model were assessed by the 10-times leave-group-out cross-validation(LGOCV)method.

关键词： platelet doubling computed tomography pancreatic neoplasms adenocarcinoma adenosquamous carcinoma texture analysis

Value of contrast-enhanced ultrasound combined with percutaneous ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions

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Chinese Medical Journal 2022年第4期135卷 426-432页

作者： Yang Gui Menghua Dai Zhilan Meng Xiaoyan Chang Li Tan Jing Zhang Xueqi Chen Tongtong Zhou Qing Zhang Mengsu Xiao Ke Lyu Yuxin Jiang Department of Ultrasound State Key Laboratory of Complex Severe and Rare DiseasesPecking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeDongcheng DistrictBeijing 100730China Department of Surgery State Key Laboratory of Complex Severe and Rare DiseasesPecking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeDongcheng DistrictBeijing 100730China Department of Pathology State Key Laboratory of Complex Severe and Rare DiseasesPecking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeDongcheng DistrictBeijing 100730China

Background:Contrast-enhanced ultrasound(CEUS)can detect lesions hidden in inflammatory regions and find necrosis or areas of severe fibrosis within the lesion.This retrospective study aimed to compare the diagnostic accuracy of solid pancreatic lesions using percutaneous ultrasound(US)-guided fine-needle aspiration(FNA)with or without CEUS assessment.Methods:Clinical,imaging,and pathologic data of 181 patients from January 2014 to December 2018 in Pecking Union Medical College Hospital,with solid pancreatic masses who underwent percutaneous US-FNA and ThinPrep cytologic test were retrospectively evaluated.Patients were divided into CEUS and US groups according to whether CEUS was performed before the biopsy.According to FNA cytology diagnoses,we combined non-diagnostic,neoplastic,and negative cases into a negative category.The positive category included malignant,suspicious,and atypical cases.The final diagnosis was confirmed by pathology or clinical and radiological follow-up for at least 12 months.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of US-FNA were evaluated between the two groups.Results:This study enrolled 107 male and 74 female patients(average age:60 years).There were 58 cases in the US group and 123 cases in the CEUS group.No statistically significant differences in age,gender,or lesion size were found between the two groups.The diagnostic accuracy of the CEUS group was 95.1%(117/123),which was higher than the 86.2%(50/58)observed in the US group(P=0.036).The sensitivity,specificity,PPV,and NPV of the CEUS group were increased by 7.5%,16.7%,3.4%,and 18.8%,respectively,compared with the US group.However,the differences of the two groups were not statistically significant.Conclusions:Compared with the conventional US,the use of CEUS could improve the biopsy accuracy and avoid the need for a repeat biopsy,especially for some complicated FNA cases.

关键词： Biopsy Contrast-enhanced ultrasound Cytology Fine-needle aspiration pancreatic lesion pancreatic neoplasms Percutaneous ultrasound

Inhibition of focal adhesion kinase enhances antitumor response of radiation therapy in pancreatic cancer through CD8+ T cells

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Cancer Biology & Medicine 2021年第1期18卷 206-214页

作者： Arsen Osipov Alex B.Blair Juliane Liberto Jianxin Wang Keyu Li Brian Herbst Yao Xu Shiqi Li Nan Niu Rufiaat Rashid Ding Ding Yanan Liu Zaiqi Wang Christopher L.Wolfgang Richard A.Burkhart Daniel Laheru Lei Zheng The Sydney Kimmel Comprehensive Cancer Center Johns Hopkins University School of MedicineBaltimore 21287MDUSA The pancreatic Cancer Precision Medicine Center of Excellence Program Johns Hopkins University School of MedicineBaltimore 21287MDUSA Department of Oncology Johns Hopkins University School of MedicineBaltimore 21287MDUSA Department of Surgery Johns Hopkins University School of MedicineBaltimore 21287MDUSA Inx Med Shanghai Shanghai 201202China

Objective:pancreatic ductal adenocarcinoma(PDAC)is a deadly malignancy,due in large part to its resistance to conventional therapies,including radiotherapy(RT).Despite RT exerting a modest antitumor response,it has also been shown to promote an immunosuppressive tumor microenvironment.Previous studies demonstrated that focal adhesion kinase inhibitors(FAKi)in clinical development inhibit the infiltration of suppressive myeloid cells and T regulatory(T regs)cells,and subsequently enhance effector T cell infiltration.FAK inhibitors in clinical development have not been investigated in combination with RT in preclinical murine models or clinical studies.Thus,we investigated the impact of FAK inhibition on RT,its potential as an RT sensitizer and immunomodulator in a murine model of PDAC.Methods:We used a syngeneic orthotopic murine model to study the effect of FAKi on hypofractionated RT.Results:In this study we showed that IN10018,a small molecular FAKi,enhanced antitumor response to RT.Antitumor activity of the combination of FAKi and RT is T cell dependent.FAKi in combination with RT enhanced CD8+T cell infiltration significantly in comparison to the radiation or FAKi treatment alone(P<0.05).FAKi in combination with radiation inhibited the infiltration of granulocytes but enhanced the infiltration of macrophages and T regs in comparison with the radiation or FAKi treatment alone(P<0.01).Conclusions:These results support the clinical development of FAKi as a radiosensitizer for PDAC and combining FAKi with RT to prime the tumor microenvironment of PDAC for immunotherapy.

关键词： Focal adhesion protein-tyrosine kinases radiotherapy pancreatic neoplasms immunomodulation

Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasoundguided fine needle aspiration

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Hepatobiliary & pancreatic Diseases International 2017年第4期16卷 418-423页

作者： Dong Kee Jang Sang Hyub Lee Jun Kyu Lee Woo Hyun Paik Kwang Hyun Chung Ban Seok Lee Jun Hyuk Son Jae Woo Lee Ji Kon Ryu Yong-Tae Kim Kyoung-Bun Lee Department of Internal Medicine Dongguk University Ilsan Medical CenterGoyang-siGyeonggi-doKorea Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of MedicineSeoulKorea Department of Internal Medicine Inje University Ilsan Paik HospitalGoyang-siGyeonggi-doKorea Department of Pathology Seoul National University College of MedicineSeoulKorea

BACKGROUND:Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) has become a crucial diagnostic technique for pancreatic malignancies.The specimen obtained by EUS-FNA can be prepared for either cytological or histological examinations.This study was to compare diagnostic performance of cytological and histological preparations using EUSFNA in the same lesions when pancreatic malignancies were suspected.METHODS:One hundred and eighteen patients who underwent EUS-FNA for suspected pancreatic malignancies were consecutively enrolled.All procedures were conducted by a single echoendoscopist under the same conditions.Four adequate preparations were obtained by 22-gauge needles with 20 to-and-fro movements for each pass.The 4 preparations included 2 cytological and 2 histological specimens.The pathologic reviews of all specimens were conducted independently by a single experienced cytopathologist.Sensitivity,specificity,and accuracy of the 2 preparations were compared.RESULTS:The enrolled patients consisted of 62 males(52.5%),with the mean age of 64.6±10.5 years.Surgery was performed in 23(19.5%) patients.One hundred and sixteen(98.3%) lesions were classified as malignant,while 2(1.7%) were benign.Sensitivity of cytology and histology were 87.9% and 81.9%,respectively,with no significant difference(P=0.190).Accuracy was also not significantly different.Cytological preparation was more sensitive when the size of lesion was pancreatic malignancies.However,cytological preparation might be more sensitive for pancreatic lesions <3 cm.

关键词： endoscopic ultrasound-guided fine needle aspiration pancreatic neoplasms cytology pathology histology

Diagnostic yield of EUS-FNA of small(≤15 mm) solid pancreatic lesions using a 25-gauge needle

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Hepatobiliary & pancreatic Diseases International 2018年第1期17卷 70-74页

作者： Stefano Francesco Crinò Maria Cristina Conti Bellocchi Laura Bernardoni Erminia Manfrin Alice Parisi Antonio Amodio Nicolò De Pretis Luca Frulloni Armando Gabbrielli Gastroenterology and Digestive Endoscopy Unit The Pancreas Institute University of Verona G.B. Rossi University Hospital Department of Pathology University of Verona G.B. Rossi University Hospital

Background: Early detection of small solid pancreatic lesions is increasingly common. To date, few and contradictory data have been published about the relationship between lesion size and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) diagnostic yield. The aim of this study was to assess the relation between the size of solid pancreatic lesions and the diagnostic yield of EUS-FNA using a 25-gauge needle in a center without available rapid on-site evaluation.Methods: In the retrospective cohort study, we selected patients who underwent EUS-FNA for solid pancreatic lesions with a 25-gauge needle from October 2014 to October 2015. Patients were divided into three groups(≤15 mm, 16–25 mm and >25 mm), and the outcomes were compared.Results: We analyzed 163 patients. Overall adequacy, sensitivity, specificity and accuracy were 85.2%,81.8%, 93.7%, and 80.4%, respectively. When stratified by size, the sensitivity and accuracy correlated with size(P = 0.016 and P = 0.042, respectively). Multivariate analysis showed that lesion size was the only independent factor(P = 0.019, OR = 4.76) affecting accuracy. The role of size as an independent factor affecting accuracy was confirmed in a separate multivariate analysis, where size was included in the model as a covariate(P = 0.018, OR = 1.08).Conclusion: Our study demonstrates that, in the absence of rapid on-site evaluation, mass size affects the accuracy of EUS-FNA of solid pancreatic lesions.

关键词： Endoscopic ultrasound Endoscopic ultrasound-guided fine needle aspiration pancreatic cancer Benign pancreatic tumors pancreatic neoplasms