Significance of pancreatic calcification on preoperative computed tomography of intraductal papillary mucinous neoplasms

Abstract

Background and Aim Chronic pancreatitis is a risk factor for pancreatic cancer. Pancreatic calcification is a characteristic of chronic pancreatitis; however, its significance for intraductal papillary mucinous neoplasm (IPMN) oncogenesis remains unknown. Therefore, we investigated the relationship between pancreatic calcification and invasive IPMN. Methods This study included 157 patients who underwent resection for IPMN between April 2001 and October 2016 (intraductal papillary mucinous adenoma, n = 76; noninvasive intraductal papillary mucinous carcinoma [IPMC], n = 32; and invasive IPMC, n = 49). We divided the subjects on the basis of the presence/absence of pancreatic calcification on preoperative computed tomography (CT). The factors associated with pancreatic calcification were investigated in univariate analyses. Then, multivariate logistic regression analyses of the relationship between pancreatic calcification and invasive IPMC (after adjusting for clinical or imaging characteristics) were conducted. Results Preoperative CT revealed pancreatic calcification in 17.2% (27/157) of the resected IPMN. In the univariate analyses, jaundice, high serum carbohydrate antigen 19‐9 levels, and invasive IPMC were significantly associated with pancreatic calcification (4/27 [14.8%] vs 4/130 [3.1%], 0.01; 12/27 [44.4%] vs 31/130 [23.8%], 0.03; and 15/27 [55.6%] vs 34/130 [26.2%], 0.001, respectively). Pancreatic calcification was significantly associated with invasive IPMC (multivariate odds ratio = 2.88, 95% confidence interval [95% CI] = 1.15–7.21, 0.03, adjusted for clinical characteristics; odds ratio = 5.50, 95% CI = 1.98–15.3, 0.001, adjusted for imaging characteristics). Conclusions Pancreatic calcification on CT is associated with invasive IPMC. Pancreatic calcification might be a predictor of invasive IPMC.

Clinical Significance of Pancreatic Calcifications: A 15-Year Single Center Observational Study

“…Previous studies have also reported that the presence of coarse calci cations is associated with high risk for malignancy. [27] Not much is known about PC and malignancy in other non-CP diseases, and some of our results were somewhat contradictory. In MCN, multilocular macrocystic lesions and lesions with calci cations in the wall had a higher risk of malignancy.…”

“…Calci cation around the pancreatic lesions was de ned as calci cation pushed aside by the lesion and not assessed as intralesional calci cation. [12] (3) Distribution of calci cations -If the calci cations were observed in any particular part of the parenchyma of pancreas such as the uncinate process, head, body, or tail of the pancreas, then it was considered to have segmental distribution while in patients with diffuse distribution the calci cations were located throughout the entire parenchyma of pancreas. [7] (4) Morphology of calci cation -Eggshell calci cations was de ned as linear calcium deposits in the wall or septae.…”

“…A central calci ed scar consisted of calci ed septations radiating outwards with a sunburst or stellate appearance called as stellate central calci cations. [6,8,12] Pancreatic cystic lesions were de ned as those exhibiting a round or oval shape with a recognizable wall, and attenuation similar to that of water with no enhancement after the administration of contrast medium, and the presence of enhancing solid components in less than 50% of the lesion. A solid lesion was de ned as a discrete mass of soft-tissue attenuation with the enhancing solid portion involving more than 90% of the lesion.…”

Clinical significance of pancreatic calcifications: a 15-year single-center observational study

“…Intralesional calcification was defined as calcification within the lesion, including wall of the cyst, septa, and mural nodules. Calcification around the pancreatic lesions was defined as calcification pushed aside by the lesion and not assessed as intralesional calcification [ 12 ]. (3) Distribution of calcifications—If the calcifications were observed in any particular part of the parenchyma of pancreas, such as the uncinate process, head, body, or tail of the pancreas, then it was considered to have segmental distribution while in patients with diffuse distribution the calcifications were located throughout the entire parenchyma of pancreas [ 7 ].…”

“…“Cyst wall” indicates calcification that was found beside the cyst, and “septum” indicates calcification that was present in the cyst bulkhead. A central calcified scar consisted of calcified septations radiating outwards with a sunburst or stellate appearance called as stellate central calcifications [ 6 , 8 , 12 ].…”