Abstract
Objectives. To propose an multidetector computed tomography-based tool for quantitative differentiation between pancreatic neuroendocrine tumour (PNET) and solid pseudopapillary neoplasm (SPN) in clinical practice. Methods. The retrospective study included 76 patients from January 2014 to March 2018. The final cohort of sixty-two patients was divided into two groups: PNET and SPN. Two radiologists independently analyzed MDCT data. We constructed two multivariable prognostic models for differential diagnosis between hypervascular PNETs and SPN, nonhypervascular PNETs and SPN via binary logistic regression. We used the receiver operating characteristic (ROC) curves to evaluate the prognostic value of any quantitative characteristics and to determine optimal cut- off values for differential diagnosis. Results. Thirty patients with PNET comprised the first group. Thirty-two patients with SPN comprised the second group. For the first prognostic model selecting a cut-off value of 34% yielded the maximum sensitivity and specificity of 96.7% and 93.8%, respectively. Values larger than the cut-off value correlated with PNET. For the second prognostic model, selecting a cut-off value of 50% yielded the maximum sensitivity and specificity of 100% and 100%. Values larger than the cut-off value correlated with PNET. Conclusion. We developed two diagnostic models for differential diagnosis between hypervascular, nonhypervascular PNETs and SPN. The models allow for increased confidence in the diagnosis. Finally, we created an on-line calculator for easy routine use http://pancreas-calculator.com).
Highlights
According to the 40-year long American SEER study (Surveillance, Epidemiology and End Results), adenocarcinoma NOS is the most frequent histological type of pancreatic tumour (69.27%) [1]
The final cohort of sixty-two patients was divided into two groups: pancreatic neuroendocrine tumour (PNET) and solid pseudopapillary neoplasm (SPN)
We used the receiver operating characteristic (ROC) curves to evaluate the prognostic value of any quantitative characteristics and to determine optimal cut- off values for differential diagnosis
Summary
According to the 40-year long American SEER study (Surveillance, Epidemiology and End Results), adenocarcinoma NOS (not otherwise specified) is the most frequent histological type of pancreatic tumour (69.27%) [1]. Ductal adenocarcinoma (10.27%) was the second one, nonfunctioning pancreatic neuroendocrine tumour (PNET) ranks was the 3rd (4.49%). SPN is a rare pancreatic tumour with low malignant potential predominantly affecting young women [2]. Nonfunctioning PNETs are more common than their hormonally active counterpart. They do not produce syndromes of hormonal excess. Instead, they become symptomatic by invading surrounding tissue and seeding metastases [3–5]. Most PNETs are indolent, but have malignant potential [3–5]. Evolution of a well-differentiated (G1–G2) PNET into a high-grade tumour (G3) or even a poorly differentiated pancreatic neuroendocrine cancer (PNEC) is possible, albeit rare [6, 7]. Published studies indicate that the PNETs are malignant in 40–90% of cases [6, 7]
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