Pancreatic Cystic Lesions: A Focused Review on Cyst Clinicopathological Features and Advanced Diagnostics

Chen, Wei; Ahmed, Nehaal; Krishna, Somashekar G.

doi:10.3390/diagnostics13010065

Cited by 10 publications

(10 citation statements)

References 122 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, there is an urgent need for highly accurate diagnostic tools that can effectively stratify the risk of branch-duct IPMNs. These tools should aim to prevent unnecessary surgical resections while also minimizing the risk of overlooking lesions with high-grade dysplasia or cancer [ 8 , 14 , 15 ].…”

Section: Diagnosis Of Mucinous Lesionsmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms

Krishna,

Abdelbaki,

Hart

et al. 2024

Cancers

View full text Add to dashboard Cite

Pancreatic cancer is on track to become the second leading cause of cancer-related deaths by 2030, yet there is a lack of accurate diagnostic tests for early detection. Intraductal papillary mucinous neoplasms (IPMNs) are precursors to pancreatic cancer and are increasingly being detected. Despite the development and refinement of multiple guidelines, diagnosing high-grade dysplasia or cancer in IPMNs using clinical, radiologic, endosonographic, and cyst fluid features still falls short in terms of accuracy, leading to both under- and overtreatment. EUS-guided needle-based confocal laser endomicroscopy (nCLE) is a novel technology that allows real-time optical biopsies of pancreatic cystic lesions. Emerging data has demonstrated that EUS-nCLE can diagnose and risk stratify IPMNs more accurately than conventional diagnostic tools. Implementing EUS-nCLE in clinical practice can potentially improve early diagnosis of pancreatic cancer, reduce unnecessary surgeries of IPMNs with low-grade dysplasia, and advance the field of digital pathomics. In this review, we summarize the current evidence that supports using EUS-nCLE as a diagnostic imaging biomarker for diagnosing IPMNs and for risk stratifying their degree of neoplasia. Moreover, we will present emerging data on the role of adding artificial intelligence (AI) algorithms to nCLE and integrating novel fluid biomarkers into nCLE.

show abstract

Section: Diagnosis Of Mucinous Lesionsmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms

Krishna,

Abdelbaki,

Hart

et al. 2024

Cancers

View full text Add to dashboard Cite

show abstract

“…Currently, clinical assessment and radiological investigations (computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), as well as endoscopic ultrasonography (EUS) with fluid analysis (fluid cytology, carcinoembryonic antigen (CEA) level, and biopsy of the cystic wall)) are used in the standard diagnostic process in patients with PCTs [ 11 , 12 , 13 ]. The differentiation of benign, premalignant, and malignant PCTs is important because of the difference in their treatment.…”

Section: Introductionmentioning

confidence: 99%

“…EUS-guided needle-based confocal laser-scanning endomicroscopy (CLE) is useful for the visualization and assessment of the pancreatic cyst epithelial wall [ 11 ]. This investigation, coupled with intravascularly injected fluorescein dye, shows the vascular PCT pattern revealing distinct epithelial features [ 12 ]. Needle-based CLE used with EUS-based fine-needle aspiration and/or biopsy might improve diagnostic accuracy in order to reduce unnecessary surgery and patient observation [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Needle-based CLE used with EUS-based fine-needle aspiration and/or biopsy might improve diagnostic accuracy in order to reduce unnecessary surgery and patient observation [ 11 ]. A multidisciplinary approach with a combination of analysis of medical history and clinical presentation, as well as the above-mentioned investigations of cross-sectional radiological imaging (CT, MRI, and MRCP), EUS with cyst fluid cytology, cyst fluid analysis, and cyst wall biopsy with CLE and molecular profiling, is used in differential diagnostics and risk stratification of PCTs [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pancreatic Cystic Tumors: A Single-Center Observational Study

et al. 2023

View full text Add to dashboard Cite

Background and Objectives: The aim of the study was to analyze the prevalence and characteristics of pancreatic cystic tumors (PCTs). Material and methods: A retrospective analysis of the medical records of 124 patients, 102 (69%) women and 46 (31%) men, who had undergone surgery for pancreatic cystic tumors in 2014–2018. Among 148 pancreatic cysts, 24 (16%) were non-neoplasmatic and 124 (84%) were neoplasmatic. The neoplasmatic cysts (n=124) were included in our analysis. There were five main types of PCTs: IPMN (intraductal papillary mucinous neoplasm) (n = 45), MCN (mucinous cystic neoplasm) (n = 30), SCN (serous cystic neoplasm) (n = 28), SPN (solid pseudopapillary neoplasm) (n = 8), and CPEN (cystic pancreatic endocrine neoplasm) (n = 8), as well as mixed-type tumors (n = 5). Results: A statistically significant dependency between PCT type and age was proven (p= 0.0001): IPMNs were observed in the older group of patients with an average age of 66.12 (40–79) years while SPNs were noted in the youngest group of patients with an average age of 36.22 (22–55) years. A statistically significant association between PCT type and gender (p = 0.0001) was found: IPMNs occurred among 24 (53.33%) men and 21 (46.6%) women. In the MCN and SPN groups, all patients were female (100%). Among the SCN group, the majority were women (27 (96.43%)), and there was only 1 (3.57%) man. A statistically significant dependency between PCT type and size was proven (p = 0.0007). The mean size of IPMNs was the smallest 2.95 (0.6–10 cm) and the mean size of MCNs was the largest 6.78 (1.5–19 cm). A statistically significant dependency between PCT type and tumor location was proven (p = 0.000238). The most frequent location of IPMN was the pancreatic head: 27 (60%). MCN was most frequently located in the pancreatic tail (18 (60%)). Most (10/28) SCNs were found in the pancreatic tail (10 (35.71%)). CPENs were most frequently located in the pancreatic tail (three (37.5%)) and pancreatic body and tail (three (37.5%)). SPNs were located commonly in the pancreatic head (five (62.5%)). The type of surgery depended on the tumor location. The most frequent surgery for IPMNs was pancreatoduodenectomy (44.4%), while for MCNs and SCNs, it was distal pancreatectomy (81%). The postoperative morbidity and mortality were 34.68% and 1.61%, respectively. Postoperative pancreatic fistula (POPF) was the most frequent (29%) complication. Conclusions: IPMN was the most frequent resected PCT in our material. A statistically significant association between the type of cyst and location within the pancreas, size, local lymph node involvement, and patient’s age and sex was proved. POPF was the most frequent postoperative complication. In patients with PCTs, due to substantial postoperative morbidity, adequate patient selection, considering both the surgical risk as well as the long-term risk of malignant transformation, is very important during qualification for surgery.

show abstract

“…Subtyping will impact the clinical decision on the surgical management and non-surgical surveillance, as SCN and pseudocysts have a low cancer risk, for which costly surveillance could be avoided. Abdominal ultrasound, computed tomography, magnetic resonance imaging, and endoscopic ultrasound (EUS) are utilized to evaluate PCLs [ 5 ]. However, accurate preoperative diagnosis of subtypes of PCLs poses practical challenges to clinicians.…”

Section: Introductionmentioning

confidence: 99%

Deep-Learning-Enabled Computer-Aided Diagnosis in the Classification of Pancreatic Cystic Lesions on Confocal Laser Endomicroscopy

et al. 2023

View full text Add to dashboard Cite

Accurate classification of pancreatic cystic lesions (PCLs) is important to facilitate proper treatment and to improve patient outcomes. We utilized the convolutional neural network (CNN) of VGG19 to develop a computer-aided diagnosis (CAD) system in the classification of subtypes of PCLs in endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (nCLE). From a retrospectively collected 22,424 nCLE video frames (50 videos) as the training/validation set and 11,047 nCLE video frames (18 videos) as the test set, we developed and compared the diagnostic performance of three CNNs with distinct methods of designating the region of interest. The diagnostic accuracy for subtypes of PCLs by CNNs with manual, maximal rectangular, and U-Net algorithm-designated ROIs was 100%, 38.9%, and 66.7% on a per-video basis and 88.99%, 73.94%, and 76.12% on a per-frame basis, respectively. Our per-frame analysis suggested differential levels of diagnostic accuracy among the five subtypes of PCLs, where non-mucinous PCLs (serous cystic neoplasm: 93.11%, cystic neuroendocrine tumor: 84.31%, and pseudocyst: 98%) had higher diagnostic accuracy than mucinous PCLs (intraductal papillary mucinous neoplasm: 84.43% and mucinous cystic neoplasm: 86.1%). Our CNN demonstrated superior specificity compared to the state-of-the-art for the classification of mucinous PCLs (IPMN and MCN), with high specificity (94.3% and 92.8%, respectively) but low sensitivity (46% and 45.2%, respectively). This suggests the complimentary role of CNN-enabled CAD systems, especially for clinically suspected mucinous PCLs.

show abstract

Pancreatic Cystic Lesions: A Focused Review on Cyst Clinicopathological Features and Advanced Diagnostics

Cited by 10 publications

References 122 publications

Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms

Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms

Pancreatic Cystic Tumors: A Single-Center Observational Study

Deep-Learning-Enabled Computer-Aided Diagnosis in the Classification of Pancreatic Cystic Lesions on Confocal Laser Endomicroscopy

Contact Info

Product

Resources

About