Multislice CT with single–phase technique in patients with suspected pancreatic cancer

Imbriaco, Massimo; Smeraldo, D.; Liuzzi, Raffaele; F, Carrillo; Cacace, Gianluigi; Vecchione, Donatella; Diglio, Antonio; Salvatore, Marco

doi:10.1007/s11547-006-0017-4

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…The timing of scanning was either fixed (mostly old studies) or bolus triggering. Pancreatic (late arterial, early portal) and portal (late portal) phases were performed in almost all studies, except in four studies [19, 22, 23, 44]. In ten studies execution of the CT was not described in sufficient detail due to missing information on type of scanner, the type/amount/concentration of iv contrast, and the different phases with scan delay [18, 20, 22, 25, 31, 34, 35, 37, 43, 44].…”

Section: Resultsmentioning

confidence: 99%

“…Liver metastases;5. Distant lymph nodes larger than 1 cm¶ Vascular invasion according to Loyer grade 1 Grade A: fat plane visible between tumour and vessel;Grade B: normal pancreatic tissue between tumour and vessel;Grade C: tumour adjacent to vessel with a contour convex towards the vessel;Grade D: tumour adjacent to vessel with a contour concave towards the vessel,Grade E: circumferential involvement of vessel;Grade F: thrombosis or occlusion of vessel.NOYESYESImbriaco [23]Not available2 experienced radiologists independentlyCriteria for unresectability:1. Peripancreatic vascular invasion (defined as infiltration of the coeliac trunk, hepatic artery, superior mesenteric artery or portal vein, and superior mesenteric vein) ¶;2.…”

Section: Resultsmentioning

confidence: 99%

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Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Somers

Bipat

2017

Eur Radiol

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ObjectiveTo obtain a summary positive predictive value (sPPV) of contrast-enhanced CT in determining resectability.MethodsThe MEDLINE and EMBASE databases from JAN2005 to DEC2015 were searched and checked for inclusion criteria. Data on study design, patient characteristics, imaging techniques, image evaluation, reference standard, time interval between CT and reference standard, and data on resectability/unresectablity were extracted by two reviewers. We used a fixed-effects or random-effects approach to obtain sPPV for resectability. Several subgroups were defined: 1) bolus-triggering versus fixed-timing; 2) pancreatic and portal phases versus portal phase alone; 3) all criteria (liver metastases/lymphnode involvement/local advanced/vascular invasion) versus only vascular invasion as criteria for unresectability.ResultsTwenty-nine articles were included (2171 patients). Most studies were performed in multicentre settings, initiated by the department of radiology and retrospectively performed. The I2-value was 68%, indicating heterogeneity of data. The sPPV was 81% (95%CI: 75-86%). False positives were mostly liver, peritoneal, or lymphnode metastases. Bolus-triggering had a slightly higher sPPV compared to fixed-timing, 87% (95%CI: 81-91%) versus 78% (95%CI: 66-86%) (p = 0.077). No differences were observed in other subgroups.ConclusionsThis meta-analysis showed a sPPV of 81% for predicting resectability by CT, meaning that 19% of patients falsely undergo surgical exploration.Key points• Predicting resectability of pancreatic cancer by CT is 81% (95%CI: 75-86%).• The percentage of patients falsely undergoing surgical exploration is 19%.• The false positives are liver metastases, peritoneal metastases, or lymph node metastases Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4708-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Somers

Bipat

2017

Eur Radiol

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“…This rare entity should be included in the differential diagnosis of atypical glandular epithelial cells in a pancreatic cyst fluid, particularly when abundant thick mucin is not present in the background. Although the diagnosis of pancreatic cystic lesions remains a challenging task for cytopathologists, it is reasonable to believe that the use of a combined approach of cytology, advanced imaging techniques such as high resolution pancreatic protocol CT, MRI, and EUS‐FNA, along with molecular markers will facilitate clinical risk stratification, leading to less patient morbidity and a cost‐effective practice.…”

Section: Discussionmentioning

confidence: 99%

“…The patient was referred to our institution for further management. A pancreatic protocol CT [13][14][15][16] was performed and revealed a 2.5 cm cystic lesion in the neck of the pancreas, radiographically suggestive of an IPMN. The EUS showed a 2.9 3 2.2 cm septated cyst ( Fig.…”

Section: Case Reportmentioning

confidence: 99%

Intraductal tubulopapillary neoplasm of the pancreas on fine needle aspiration: Case Report with Differential Diagnosis

Guan

Gurda

Lennon

et al. 2012

Diagnostic Cytopathology

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Intraductal tubulopapillary neoplasm (ITPN) is a rare primary pancreatic neoplasm accounting for less than 1% of all pancreatic exocrine neoplasms and 3% of intraductal neoplasms of the pancreas. Data on this entity are still limited. Here, we report a case of ITPN with cytopathologic and histopathologic findings. A 41-year-old woman with a 2.2 cm cyst in the head of the pancreas for five years was referred to our institution. The endoscopic ultrasound-guided fine-needle aspiration produced cytospins were moderately cellular with a few fragments of markedly atypical epithelium. The neoplastic cells displayed high-grade nuclear atypia with enlarged, eccentric nuclei, anisonucleosis and prominent nucleoli, irregular nuclear membranes, high nucleus to cytoplasmic (N/C) ratios, and a moderate amount of cytoplasm with no intracytoplasmic mucin. Histologically, the lesion was found to be an ITPN with focal high-grade dysplasia. No invasive carcinoma was identified. The neoplastic cells exhibited luminal immunolabeling for MUC-1, but were negative for MUC-2, trypsin, chymotrypsin, and P53. Approximately 5% of the neoplastic cells showed Ki-67 immunoreactivity. ITPN of pancreas may be a source of markedly atypical epithelial cells in pancreatic cystic aspiration. Clinical and radiographic findings, molecular mutational analysis, in combination with cytological features are essential to differentiate it from other disease entities.

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“…endoluminal ultrasonography (EUS) and magnetic resonance imaging (MRI) in staging of rectal cancer, positron emission tomography (PET) in staging of small cell lung cancer, MRI in determining disease staging in patients with M. Crohn, and computed tomography (CT) in grading disease severity in peripheral arterial occlusive disease. Ongoing developments and improvements in techniques such as CT, MRI, and PET (‐CT) have led to the widespread use of these techniques and more developments are ahead 1–6. To determine the role of these techniques, their value should be carefully evaluated, including by means of systematic reviews and meta‐analyses.…”

Section: Introductionmentioning

confidence: 99%

Multivariate fixed- and random-effects models for summarizing ordinal data in meta-analysis of diagnostic staging studies

Bipat

Zwinderman

2010

Res. Synth. Method

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For many diseases (e.g. rectal cancer and the Crohn disease), more than two stages exist and as treatment mostly depends on disease stages, correctly determining this by a diagnostic test is very important. To determine their role in clinical practice, the value of these tests should be carefully evaluated, and summarizing results in meta-analysis should also be done appropriately. A multinomial model for meta-analyzing data with more than two categories has previously been developed; these data were considered as nominal categories. However, there is an ordinal character within staging data. In this study we extended this multinomial model to three ordinal models (models for the logits of adjacent-categories, for continuation-ratio logits and for proportional odds logits) to summarize the ordinal character of staging data. Both fixed- and random-effects approaches were developed and compared. The principles of the multinomial model as well as three ordinal models are shown by fitting these models using the data on staging of rectal cancer by endoluminal ultrasonography and magnetic resonance imaging. The proportions of patients correctly staged, understaged, and overstaged per stage are obtained by these models. Because of the increased interest in meta-analyses for evidence-based guidelines, these models can be helpful in summarizing staging data. Copyright © 2010 John Wiley & Sons, Ltd.

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Multislice CT with single–phase technique in patients with suspected pancreatic cancer

Abstract: MSCT with a single-phase technique is an accurate and reproducible method for diagnosis and evaluation of disease resectability in patients with suspected PC, ensuring optimal tumour-to-pancreas contrast and maximal opacification of the main peripancreatic arterial and venous structures.

Cited by 6 publications

References 18 publications

Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Intraductal tubulopapillary neoplasm of the pancreas on fine needle aspiration: Case Report with Differential Diagnosis

Multivariate fixed- and random-effects models for summarizing ordinal data in meta-analysis of diagnostic staging studies

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