A pilot study of radiologic measures of abdominal adiposity: weighty contributors to early pancreatic carcinogenesis worth evaluating?

Abstract

Objective:Intra-abdominal fat is a risk factor for pancreatic cancer (PC), but little is known about its contribution to PC precursors known as intraductal papillary mucinous neoplasms (IPMNs). Our goal was to evaluate quantitative radiologic measures of abdominal/visceral obesity as possible diagnostic markers of IPMN severity/pathology.Methods:In a cohort of 34 surgically-resected, pathologically-confirmed IPMNs (17 benign; 17 malignant) with preoperative abdominal computed tomography (CT) images, we calculated body mass index (BMI) and four radiologic measures of obesity: total abdominal fat (TAF) area, visceral fat area (VFA), subcutaneous fat area (SFA), and visceral to subcutaneous fat ratio (V/S). Measures were compared between groups using Wilcoxon two-sample exact tests and other metrics.Results:Mean BMI for individuals with malignant IPMNs (28.9 kg/m2) was higher than mean BMI for those with benign IPMNs (25.8 kg/m2) (P=0.045). Mean VFA was higher for patients with malignant IPMNs (199.3 cm2) compared to benign IPMNs (120.4 cm2),P=0.092. V/S was significantly higher (P=0.013) for patients with malignant versus benign IPMNs (1.25vs. 0.69 cm2), especially among females. The accuracy, sensitivity, specificity, and positive and negative predictive value of V/S in predicting malignant IPMN pathology were 74%, 71%, 76%, 75%, and 72%, respectively. Conclusions:Preliminary findings suggest measures of visceral fat from routine medical images may help predict IPMN pathology, acting as potential noninvasive diagnostic adjuncts for management and targets for intervention that may be more biologically-relevant than BMI. Further investigation of gender-specific associations in larger, prospective IPMN cohorts is warranted to validate and expand upon these observations.

Comparison of Radiomic Features in a Diverse Cohort of Patients With Pancreatic Ductal Adenocarcinomas

“…Whereas standard "semantic" radiologic features are typically subjectively and qualitatively measured, computer algorithmgenerated radiomic features such as tumor signal intensity, texture, shape, and volume have many advantages (15)(16)(17)(18)(19)(20)(21): they represent quantitative, objective measures; reflect tumor heterogeneity and subregional habitats; and are reproducible, stable, and strongly linked to clinical outcomes and underlying molecular data. Radiomic evaluations of pancreas CT scans have been conducted by our team (22)(23)(24) and others (15,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38), but to date none of these studies have focused on evaluating radiomic features present in pancreatic tumors from AA compared to other ethnic populations. Furthermore, we are unaware of published investigations that specifically compare racial and ethnic differences in radiomic features of different types of non-pancreas tumors.…”

A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms

“…Surgery is recommended for all suitable patients with suspected PCNs 9 , 10 . However, it is important to consider that pancreatic surgery is risky, and the possibility of major postsurgical complications (as well as of long-term impairment of pancreatic function) is non-negligible 11 , 12 . The risk of over-treatment (unnecessary pancreatectomy) should be balanced carefully with the risk of under-treatment (missing the opportunity to cure a potentially curable malignant or premalignant lesion) 4 .…”