Epidemiology, clinical features and diagnostic work-up of cystic neoplasms of the pancreas: Interim analysis of the prospective PANCY survey

Pezzilli, Raffaele; Buscarini, Elisabetta; Pollini, Tommaso; Bonamini, Deborah; Marchegiani, Giovanni; Crippa, Stefano; Belfiori, Giulio; Sperti, Cosimo; Moletta, Lucia; Pozza, G; Nucci, Germana de; Manes, G.; Mandelli, Enzo Domenico; Casadei, Riccardo; Ricci, Claudio; Alicante, Saverio; Vattiato, C.; Carrara, Sandro; Leo, Milena Di; Fabbri, Carlo; Giovanelli, S.; Barresi, Luca; Tacelli, Matteo; Mirante, V.G.; Conigliaro, Rita; Antonini, Filippo; Macarri, Giampiero; Frulloni, Luca; Marchi, Giulia De; Sassatelli, Romano; Cecinato, Paolo; Blanco, Giovanna Del Vecchio; Galli, Andrea; Pezzullo, Angelo Maria; Fantin, Alberto; Graffeo, M; Frego, Mauro; Stillittano, D.; Monica, Fabio; Germanà, B.; Capurso, Gabriele; Quartini, Mariano; Veneroni, Luigi; Cannizzaro, Renato; Falconi, Massimo

doi:10.1016/j.dld.2020.02.003

Cited by 23 publications

(21 citation statements)

References 22 publications

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“…PCLs are a heterogeneous family of lesions; some show benign behavior and others have unequivocal malignant potential and thus are considered a precursor of pancreatic cancer. The increased use of cross-sectional imaging, CT and MRI, has increased the reporting of incidental PCLs by up to 45%[ 2 ]. A key element of optimal clinical management of PCLs is identification of the small minority of cysts with early invasive cancer or high-grade dysplasia, and possibly the prediction of patients who will develop them in the future.…”

Section: Discussionmentioning

confidence: 99%

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Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

Bertani¹,

Pezzilli²,

Pigò³

et al. 2021

WJGE

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BACKGROUND Pancreatic cystic lesions (PCLs) are considered a precursor of pancreatic cancer. Needle-based confocal endomicroscopy (nCLE) is an imaging technique that enables visualization of the mucosal layer to a micron resolution. Its application has demonstrated promising results in the distinction of PCLs. This study evaluated the utility of nCLE in patients with indeterminate PCLs undergoing endoscopic ultrasound fine-needle aspiration (EUS-FNA) to distinguish mucinous from non-mucinous lesions. AIM To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous lesions. METHODS Patients who required EUS-FNA between 2015 and 2017 were enrolled prospectively. During EUS-FNA, confocal imaging, analyses of the tumor markers carcinoembryonic antigen and amylase, and cytologic examination were conducted. All patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance imaging. nCLE videos were independently reviewed by 6 observers to reach a final diagnosis (mucinous vs non-mucinous) based on criteria derived from previous studies; if there was disagreement > 20%, a final diagnosis was discussed after consensus re-evaluation. The sensitivity, specificity, and accuracy of nCLE were calculated. Adverse events were recorded. RESULTS Fifty-nine patients were included in this study. Final diagnoses were derived from surgery in 10 patients, cytology in 13, and imaging and multidisciplinary team review in 36. Three patients were excluded from final diagnosis due to problems with nCLE acquisition. Fifty-six patients were included in the final analysis. The sensitivity, specificity, and accuracy of nCLE were 80% [95% confidence interval (CI): 65-90], 100% (95%CI: 72-100), and 84% (95%CI: 72-93), respectively. Post-procedure acute pancreatitis occurred in 5%. CONCLUSION EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.

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Section: Discussionmentioning

confidence: 99%

“…Pancreatic cystic lesions (PCLs) are considered a precursor of pancreatic cancer, as some have malignant potential and therefore should be evaluated carefully. However, other PCLs exhibit benign behavior with no surveillance required[ 2 - 4 ].…”

Section: Introductionmentioning

confidence: 99%

Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

Bertani¹,

Pezzilli²,

Pigò³

et al. 2021

WJGE

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“…From a practical point of view, the premalignant lesions frequently come in the form of an incidental pancreatic cyst detected on cross-sectional imaging usually done for another medical indication in otherwise asymptomatic persons. 4 The prevalence of an incidentally detected cyst varies with geographic region (3 times higher in the United States compared to Asian countries), with the population studied (higher in the elderly population), and with the imaging modality used (higher with use of MRI compared to CT). 5 Incidental pancreatic cysts are estimated to occur on 3%-20% of all abdominal imaging scans.…”

Section: Premalignant Conditions Of the Pancreasmentioning

confidence: 99%

Clinical Management of Pancreatic Premalignant Lesions

Søreide

Marchegiani

2022

Gastroenterology

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“…Of note, the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and the Italian Association for the Study of the Pancreas (AISP), are currently involved in a survey to prospectively validate their guidelines, which foresees surgery in the presence of an enhancing solid component within the cyst or main duct > 10 mm in asymptomatic patients [63]; preliminary data are encouraging in producing a reliable real-life diagnostic workup and management of PCNs [64].…”

Section: State-of-the-art Managementmentioning

confidence: 99%

“…Although they can be found in any IPMN subtype, GNAS mutations are more frequently observed in the intestinal subtype [77,78]. Interestingly, GNAS has also been shown to harbor tumor-suppressor gene abilities in other tumors [79,80], suggesting that the output of GNAS mutations is highly contextual in cancers [63,64].…”

Section: Genetics and Molecular Pathwaysmentioning

confidence: 99%

Intraductal Pancreatic Mucinous Neoplasms: A Tumor-Biology Based Approach for Risk Stratification

Nasca

Chiaravalli

Piro

et al. 2020

IJMS

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Pancreatic ductal adenocarcinoma is one of the most lethal human cancers. Its precursor lesions include pancreatic intra-epithelial neoplasia, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm (IPMN). IPMNs usually present as an incidental finding at imaging in 2.6% of the population and, according to the degree of dysplasia, they are classified as low- or high-grade lesions. Since the risk of malignant transformation is not accurately predictable, the management of these lesions is based on morphological and clinical parameters, such as presence of mural nodule, main pancreatic duct dilation, presence of symptoms, or high-grade dysplasia. Although the main genetic alterations associated to IPMNs have been elucidated, they are still not helpful for disease risk stratification. The growing body of genomic and epigenomic studies along with the more recent development of organotypic cultures provide the opportunity to improve our understanding of the malignant transformation process, which will likely deliver biomarkers to help discriminate between low- and high-risk lesions. Recent insights on the topic are herein summarized.

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Epidemiology, clinical features and diagnostic work-up of cystic neoplasms of the pancreas: Interim analysis of the prospective PANCY survey

Cited by 23 publications

References 22 publications

Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

Clinical Management of Pancreatic Premalignant Lesions

Intraductal Pancreatic Mucinous Neoplasms: A Tumor-Biology Based Approach for Risk Stratification

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