Diagnosis Of Pancreatic Diseases Research Articles

Automated Classification of Abdominal Ultrasound lmages of the Pancreas Based on the Spectral Representation of the Border’s Contours

The purpose of the research is to develop a methodology for classifying complexly structured halftone images based on a multimodal approach using methods of morphological analysis, spectral analysis and neural network modeling.Methods. А method for classifying the contours of the boundaries of segments of a complexly structured image is described. Тhe method is based on the fact that in chronic diseases of the pancreas, there is a violation of the integrity of the contour of its border and its waviness increases due to retractions and bulges caused by an alterative inflammatory process. Тhe method includes the stages of normalization of ultrasound images and image segmentation with the selection of the contour of the object of interest. Тo classify the contour of a segment boundary, it is proposed to use Fourier analysis and neural network technologies. Тhe method is illustrated using the example of classifying the contour of the border of the pancreas on its transcutaneous acoustic image.Results. Еxperimental studies of the proposed methods and means for classifying medical risk were carried out on diagnostic tasks according to the following classes: "chronic pancreatitis" – "without pathology". For experimental studies, video sequences of ultrasound images of the pancreas provided by an endoscopist were used. Тhe purpose of the experimental studies was to analyze the classification quality indicators of image classifiers with class segments "Chronic pancreatitis" and "Without pathology". Тhe training sample of video images (frames of video sequences) included 200 examples, one hundred from each class. Тhe quality indicator "Sensitivity" of classification for two classes is 85,7%, the indicator "Specificity" is 87,1%.Тhe use of the contour analysis method in classifiers of ultrasound images of the pancreas opens up new opportunities for accessible and objective diagnosis of pancreatic diseases, expanding the capabilities of intelligent clinical decision support systems.

Technologies of Bioimpedance Spectroscopy in Decision Support Systems for the Diagnosis of Socially Significant Diseases

The purpose of the research is to develop methods for the synthesis of hybrid classifiers to assess the risk of socially significant diseases using bioimpedance analysis.Methods. We developed a descriptor approach using impedance spectroscopy results, generating four amplitudephase-frequency responses from four quasi-orthogonal leads. They create the feature spaces necessary for our hybrid classifier in the diagnosis of pancreatic diseases, the autonomous intelligent agents of which are built on various paradigms: probabilistic neural networks, fuzzy logical inference, fully connected feedforward neural networks. We also presented a device structure for creating an informative feature space.Results. Experimental studies of the proposed methods and means of classifying medical rice were carried out on diagnostic tasks according to the classes "acute destructive pancreatitis" – "no acute destructive pancreatitis" and differential diagnosis tasks according to the classes "prostate cancer" ‒ "chronic pancreatitis". They showed that incorporating multi-frequency sensing into neural network-based classifiers allows the development of clinical decision support systems for disease diagnosis that are comparable in performance to existing clinical diagnostic methods. The results were confirmed in groups of male and female patients at different stages of cancer aged 25 to 80 years using a variety of diagnostic methods, including history, physical examination, assessment of comorbidities, laboratory tests, ultrasound, laparoscopy, intraoperative exploration and computed tomography.Conclusion. The use of bioimpedance spectroscopy and hybrid classifier models opens up new opportunities for accessible and objective diagnosis of pancreatic diseases, expanding the capabilities of intelligent medical decision support systems.

Label-free assessment of pathological changes in pancreatic intraepithelial neoplasia by biomedical multiphoton microscopy.

Pancreatic intraepithelial neoplasia (PanIN) is the most common precursor lesion that has the potential to progress to invasive pancreatic cancer, and early and rapid detection may offer patients a chance for treatment before the development of invasive carcinoma. Therefore, the identification of PanIN holds significant clinical importance. In this study, we first used multiphoton microscopy (MPM) combining two-photon excitation fluorescence and second-harmonic generation imaging to label-free detect PanIN and attempted to differentiate between normal pancreatic ducts and different grades of PanIN. Then, we also developed an automatic image processing strategy to extract eight morphological features of collagen fibers from MPM images to quantify the changes in collagen fibers surrounding the ducts. Experimental results demonstrate that the combination of MPM and quantitative information can accurately identify normal pancreatic ducts and different grades of PanIN. This study may contribute to the rapid diagnosis of pancreatic diseases and may lay the foundation for further clinical application of MPM.

Micelle-based fluorogenic sensing of trypsin: a sensitive method in pancreatic disease diagnosis.

Protamine-mediated micellar aggregates, featuring an AIE-based fluorescent sensor, facilitate efficient detection of trypsin activity. This method enables the detection of trypsin at exceptionally low concentrations (0.01-0.1 μg mL-1) in urine, demonstrating its potential for early clinical diagnosis of trypsin-related pancreatic diseases.

Percutaneous Magnetic Resonance Imaging-Guided Coaxial Cutting Needle Biopsy of Pancreatic Lesions: Diagnostic Accuracy and Safety.

To appraise the diagnostic performance of magnetic resonance imaging-guided percutaneous coaxial cutting needle biopsy of pancreatic lesions using a 0.4-T open magnetic resonance imaging scanner with optical tracking navigation. This retrospective study included 158 patients who underwent magnetic resonance imaging-guided pancreatic lesion biopsy procedures from May 2019 to December 2020. Two to four specimens were collected from each patient. Pathological diagnosis and clinical follow-ups were conducted to establish the final diagnosis. The procedures were evaluated for sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and complications. The Cardiovascular and Interventional Radiological Society of Europe guidelines were used to classify complications. Biopsy pathology revealed 139 pancreatic tumor malignancies and 19 benign pancreatic lesions. Finally, 151 patients were diagnosed with pancreatic malignancy and 7 with benign disease confirmed by surgery, re-biopsy, and clinical follow-up. The sensitivity, specificity, positive and negative predictive value, and accuracy for diagnosis of pancreatic diseases were 92.1%, 100%, 100%, 36.8%, and 92.4%, respectively. The biopsy accuracy was significantly related to the size (≤ 2cm, 76.2%; 2-4cm, 94.0%; > 4cm, 96.2%, P = .02) and not the lesion's location (head of pancreas, 90.7%; neck of pancreas, 88.9%; body of pancreas, 94.3%; tail of pancreas, 96.7%, P = .73). Minor complications included two patients experiencing mild abdominal pain and two with a minor occurrence of hemorrhage. Percutaneous magnetic resonance imaging-guided pancreatic lesion biopsy combined with optical navigation has high diagnostic accuracy and is safe for clinical practice. Level of Evidence Level 4, Case-series.

Radiomics and artificial intelligence in the differential diagnosis of tumor and non-tumor diseases of the pancreas. Review

This work provides a comprehensive overview of the recent advancements in the field of radiomic diagnostics and artificial intelligence (AI) in the diagnosis of pancreatic diseases. The integration of radiochemical analysis and AI has allowed for more accurate and precise diagnoses of pancreatic diseases, including pancreatic cancer. The review highlights the different stages of radiomic analysis, such as data collection, preprocessing, tumour segmentation, data detection and extraction, modeling, statistical processing, and data validation, which are essential for the accurate diagnosis of pancreatic diseases. Furthermore, the review evaluates the possibilities of using AI and artificial neural networks in surgical and oncological pancreatology. The features and advantages of using radiochemical analysis and AI in the diagnosis and prognosis of pancreatic cancer are also described. These advancements have the potential to improve patient outcomes, as early and accurate diagnosis can lead to earlier treatment and better chances of recovery. However, the limitations associated with the use of radiometry and AI in pancreatology are also noted, such as the lack of standardization and the potential for false positives or false negatives. Nevertheless, this work highlights the potential benefits of incorporating radiochemical analysis and AI in the diagnosis and treatment of pancreatic diseases, which can ultimately lead to better patient care and outcomes.

Technical comparison of continuous versus intermittent perfusion computed tomography computed tomography scans of the human pancreas.

Pancreatic perfusion computed tomography (CT) imaging is increasingly used for neoplastic grading, predicting prognosis, and evaluating the response to therapy. To optimize the clinical pancreatic CT perfusion imaging methods, we evaluated 2 different CT scanning protocols concerning pancreas perfusion parameters. A retrospective study was conducted on 40 patients who underwent whole pancreas CT perfusion scanning in The First Affiliated Hospital of Zhengzhou University. Of these 40 patients, 20 patients in group A underwent continuous perfusion scanning, while 20 patients in group B underwent intermittent perfusion scanning. For group A, continuous axial scanning was performed 25 times, and the total scan time was 50 s. For group B, arterial phase helical perfusion scanning was performed 8 times, and then venous phase helical perfusion scanning was performed 15 times, with a total scan time of 64.6 to 70.0 s. A comprehensive list of perfusion parameters between different parts of the pancreas and the 2 groups were compared. The effective radiation dose for the 2 scanning methods was analyzed. The parameter of the mean slope of increase (MSI) at different pancreatic parts in group A differed (P=0.028). The pancreas head had the lowest value, and the tail had the highest (about a 20% difference). In group A compared to group B, the blood volume of the pancreatic head was smaller (15.256±2.925 vs. 16.953±3.602), the positive enhanced integral was smaller (0.307±0.050 vs. 0.344±0.060) and the permeability surface was larger (34.205±9. 612 vs. 24.377±8.413); the blood volume of the pancreatic neck was smaller (13.940±2.691 vs. 17.173±3.918), the positive enhanced integral was smaller (0.304±0.088 vs. 0.361±0.051) and the permeability surface was larger (34.898±11.592 vs. 25. 794±8.149); the blood volume of the pancreatic body was smaller (16.142±4.006 vs. 18.401±2.513), the positive enhanced integral was smaller (0.305±0.093 vs. 0.342±0.048) and the permeability surface was larger (28.861±10.448 vs. 22.158±6. 017); the blood volume of the pancreatic tail was smaller (16.446±3.709 vs. 17.374±3.781), the positive enhanced integral was smaller (0.304±0.057 vs. 0.350±0.073) and the permeability surface was larger (27.823±8.228 vs. 21.509±7.768) (P<0.05). The effective radiation dose in the intermittent scan mode was slightly lower at 16.657±2.259 mSv than in the continuous scan mode (17.973±3.698 mSv). Different CT scanning intervals had a significant influence on whole pancreas blood volume, permeability surface, and positive enhanced integral. These demonstrate the high sensitivity of intermittent perfusion scanning for identifying perfusion abnormalities. Therefore, for the diagnosis of pancreatic diseases, intermittent pancreatic CT perfusion may be more advantageous.

Study of analytical error in lipase assay.

Lipase and amylase are the most frequently used biomarker for the diagnosis of pancreatic diseases, especially acute pancreatitis. Lipase has better diagnostic accuracy in comparison to amylase for the analysis of acute pancreatitis. However, lipase assay in random access analyzer is sometimes difficult to perform as it is exposed to different types of samples or reagents which may act as interference. In our laboratory, we found the raised values (>500 IU/L) of lipase with normal amylase in some samples. However, the immediate rerun of these samples for lipase only showed normal (<80 IU/L) lipase level. To root out this fallacy, we performed reagent and sample carryover studies. The cause of the falsely raised value of lipase was revealed by reagent carryover studies. All samples which assayed triglyceride (TGL) followed by lipase immediately after it showed elevated (>500 IU/L) lipase value. This is due to the interference of microbial lipase used in TGL reagents. This was corrected by separating the analysis of lipase and TGL into two different instruments. If interference testing is not done, the laboratories are prone to have an analytical error in reporting and hence lead to diagnostic error. Hence, after analyzer installation, interference testing should be included in the validation protocol.

Ulcerated, tender nodules of the lower extremities

CaseA 63-year-old woman presented with 1 week of worsening lower extremity lesions that started as multiple red pustules and evolved into subcutaneous nodules with overlying ulceration. On exam, there were many 0.5- to 2-cm dark pink and purple papulonodules with central hemorrhagic crust and erosions (Fig 1) and 2 tender, several-centimeter ulcerations with violaceous, rolled borders and necrotic bases. The lesions were debrided on admission due to concern for infection. She had 2 weeks of diarrhea secondary to her chronic pancreatitis but denied acute pancreatitis symptoms including epigastric pain, fever, or nausea. Punch biopsy demonstrated lobular panniculitis, “ghost cells,” calcification, and neutrophil-rich infiltrate (Fig 2).Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)Question 1: What is the most likely diagnosis?A.Pyoderma gangrenosumB.Pancreatic panniculitisC.Alpha-1 antitrypsin deficiency panniculitisD.Nodular vasculitisE.Factitial dermatitisAnswer:A.Pyoderma gangrenosum – Incorrect. Histopathology would demonstrate dense neutrophilic inflammation and the presence of ghost cells, and saponification would not be seen.1Maverakis E. Ma C. Shinkai K. et al.Diagnostic criteria of ulcerative pyoderma gangrenosum: a Delphi Consensus of International Experts.JAMA Dermatol. 2018; 154: 461Crossref PubMed Scopus (203) Google ScholarB.Pancreatic panniculitis – Correct. Pancreatic panniculitis presents clinically with lesions to the lower extremities that are tender, erythematous, red-brown in color, nodular, ulcerated, and potentially with an oily drainage.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar In 40% of cases, cutaneous findings precede the diagnosis of pancreatic disease by 1 to 7 months.3Chee C. Panniculitis in a patient presenting with a pancreatic tumor and polyarthritis: a case report.J Med Case Rep. 2009; 3: 7331Crossref PubMed Scopus (13) Google Scholar,4Poelman S.M. Nguyen K. Pancreatic panniculitis associated with acinar cell pancreatic carcinoma.J Cutan Med Surg. 2008; 12: 38-42Crossref PubMed Scopus (22) Google Scholar Along with these clinical features in the setting of pancreatic disease, an incisional biopsy can help confirm the diagnosis. A deep incisional biopsy is necessary to ensure adequate tissue sampling that includes subcutaneous fat. The main feature on histology is mostly lobular panniculitis without vasculitis. “Ghost cells” are also pathognomonic for panniculitis and result from coagulative necrosis of adipocytes due to pancreatic enzymes. Within “ghost cells,” saponification can be seen as fine basophilic granular material due to dystrophic calcification.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google ScholarC.Alpha-1 antitrypsin deficiency panniculitis – Incorrect. Histopathology is absent of skip areas, making this diagnosis less likely.D.Nodular vasculitis – Incorrect. Although this pathology also demonstrates erythematous, tender, ulcerated nodules of the lower extremities, its histopathology would reveal a mixed inflammatory infiltrate and would not demonstrate “ghost cells.”5Mascaró Jr., J.M. Baselga E. Erythema induratum of bazin.Dermatol Clin. 2008; 26: 439-445https://doi.org/10.1016/j.det.2008.05.007Abstract Full Text Full Text PDF PubMed Scopus (70) Google ScholarE.Factitial dermatitis – Incorrect. Although some of our patient’s clinical symptoms can be self-induced, the histopathology is more specific for pancreatic panniculitis.Question 2: Pancreatic panniculitis is a cutaneous presentation that occurs in 2% to 3% of patients with pancreatic disease. Which of these etiologies is not associated with pancreatic panniculitis?A.MalignancyB.InfectionC.TraumaD.MetabolicE.ChemicalAnswer:A.Malignancy – Incorrect. Pancreatic panniculitis can be associated with pancreatic acinar carcinoma, can be associated with islet cell carcinoma, and even have nonpancreatic associations such as intrahepatic cholangiocarcinoma.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar The use of imaging, tumor markers, and biopsies should be utilized to rule out malignancy as the etiology of pancreatic panniculitis.B.Infection – Incorrect. Certain infections may result in acute pancreatitis which can progress to pancreatic panniculitis. For example, viral infections of mumps, coxsackievirus, hepatitis B, cytomegalovirus, varicella-zoster, herpes simplex, and HIV; bacterial infections of Mycoplasma, Legionella, Leptospira, and Salmonella; fungal infections of Aspergillus; or parasitic infections of Toxoplasma, Cryptosporidium, and Ascaris all can cause pancreatitis.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar, 7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar, 8Parenti D.M. Steinberg W. Kang P. Infectious causes of acute pancreatitis.Pancreas. 1996; 13: 356-371https://doi.org/10.1097/00006676-199611000-00005Crossref PubMed Scopus (206) Google Scholar The clinical presentation of ulcerated nodules could mimic infection in the skin, and the presence of neutrophils on histopathology also can make this a concern, but the presence of ghost cells and calcification supports pancreatic panniculitis.C.Trauma – Incorrect. Pancreatic panniculitis can arise from traumatic pancreatitis or status after endoscopic retrograde cholangiopancreatography (ERCP).2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarD.Metabolic – Correct. Metabolic processes such as exocrine pancreatic insufficiency have not been associated with pancreatic panniculitis.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarE.Chemical – Incorrect. Pancreatic panniculitis can arise in pancreatitis secondary to sulindac intake.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarQuestion 3: What is the most effective treatment recommendation for pancreatic panniculitis?A.Wide local excisionB.Lower pancreatic enzymesC.SupportiveD.Immune supportE.Topical steroidsAnswer:A.Wide local excision – Incorrect. This has not been shown to treat pancreatic panniculitis since it does not address the root cause of the pathology. However, punch biopsies can be used to help in the diagnosis of pancreatic panniculitis as seen in our patient.B.Lower pancreatic enzymes – Correct. A goal of pancreatic panniculitis treatment is to decrease pancreatic enzyme levels.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar High pancreatic enzyme levels indicate continued fat saponification and progression of cutaneous lesions. Our patient had asymptomatic acute pancreatitis, so obtaining an ERCP was made to search for an underlying cause. ERCP identified a portion of the pancreatic duct that appeared extrinsically compressed to a tight stricture by a pancreatic cyst along with dilation of the main pancreatic duct within the body of the pancreas. There was a significant downtrend in lipase and amylase levels after ERCP. It is also important to note that elevated amylase, lipase, and aspartate aminotransferase/alanine aminotransferase are not diagnostic of pancreatic panniculitis as these abnormalities are not always observed in patients.C.Supportive – Incorrect. Supportive measures, such as analgesics, can help the patient tolerate the tender, ulcerated lesions seen in pancreatic panniculitis. However, pancreatic panniculitis will not resolve without an intervention that will decrease pancreatic enzyme levels.D.Immune support – Incorrect. Increased immunosuppressive medications in patients with pancreatic panniculitis status after transplant have been shown to rapidly normalize pancreatic enzyme levels.9Beveridge M. Pei S. Tsoukas M.M. Pancreatic panniculitis in a pancreas-kidney transplant patient resolved after immunosuppression increase: case report and review of literature.JAAD Case Rep. 2015; 1: 101-105Abstract Full Text Full Text PDF PubMed Scopus (5) Google ScholarE.Topical steroids – Incorrect. May provide symptomatic relief, but they have shown to be ineffective in treatment of pancreatic panniculitis.6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar CaseA 63-year-old woman presented with 1 week of worsening lower extremity lesions that started as multiple red pustules and evolved into subcutaneous nodules with overlying ulceration. On exam, there were many 0.5- to 2-cm dark pink and purple papulonodules with central hemorrhagic crust and erosions (Fig 1) and 2 tender, several-centimeter ulcerations with violaceous, rolled borders and necrotic bases. The lesions were debrided on admission due to concern for infection. She had 2 weeks of diarrhea secondary to her chronic pancreatitis but denied acute pancreatitis symptoms including epigastric pain, fever, or nausea. Punch biopsy demonstrated lobular panniculitis, “ghost cells,” calcification, and neutrophil-rich infiltrate (Fig 2).Question 1: What is the most likely diagnosis?A.Pyoderma gangrenosumB.Pancreatic panniculitisC.Alpha-1 antitrypsin deficiency panniculitisD.Nodular vasculitisE.Factitial dermatitisAnswer:A.Pyoderma gangrenosum – Incorrect. Histopathology would demonstrate dense neutrophilic inflammation and the presence of ghost cells, and saponification would not be seen.1Maverakis E. Ma C. Shinkai K. et al.Diagnostic criteria of ulcerative pyoderma gangrenosum: a Delphi Consensus of International Experts.JAMA Dermatol. 2018; 154: 461Crossref PubMed Scopus (203) Google ScholarB.Pancreatic panniculitis – Correct. Pancreatic panniculitis presents clinically with lesions to the lower extremities that are tender, erythematous, red-brown in color, nodular, ulcerated, and potentially with an oily drainage.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar In 40% of cases, cutaneous findings precede the diagnosis of pancreatic disease by 1 to 7 months.3Chee C. Panniculitis in a patient presenting with a pancreatic tumor and polyarthritis: a case report.J Med Case Rep. 2009; 3: 7331Crossref PubMed Scopus (13) Google Scholar,4Poelman S.M. Nguyen K. Pancreatic panniculitis associated with acinar cell pancreatic carcinoma.J Cutan Med Surg. 2008; 12: 38-42Crossref PubMed Scopus (22) Google Scholar Along with these clinical features in the setting of pancreatic disease, an incisional biopsy can help confirm the diagnosis. A deep incisional biopsy is necessary to ensure adequate tissue sampling that includes subcutaneous fat. The main feature on histology is mostly lobular panniculitis without vasculitis. “Ghost cells” are also pathognomonic for panniculitis and result from coagulative necrosis of adipocytes due to pancreatic enzymes. Within “ghost cells,” saponification can be seen as fine basophilic granular material due to dystrophic calcification.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google ScholarC.Alpha-1 antitrypsin deficiency panniculitis – Incorrect. Histopathology is absent of skip areas, making this diagnosis less likely.D.Nodular vasculitis – Incorrect. Although this pathology also demonstrates erythematous, tender, ulcerated nodules of the lower extremities, its histopathology would reveal a mixed inflammatory infiltrate and would not demonstrate “ghost cells.”5Mascaró Jr., J.M. Baselga E. Erythema induratum of bazin.Dermatol Clin. 2008; 26: 439-445https://doi.org/10.1016/j.det.2008.05.007Abstract Full Text Full Text PDF PubMed Scopus (70) Google ScholarE.Factitial dermatitis – Incorrect. Although some of our patient’s clinical symptoms can be self-induced, the histopathology is more specific for pancreatic panniculitis.Question 2: Pancreatic panniculitis is a cutaneous presentation that occurs in 2% to 3% of patients with pancreatic disease. Which of these etiologies is not associated with pancreatic panniculitis?A.MalignancyB.InfectionC.TraumaD.MetabolicE.ChemicalAnswer:A.Malignancy – Incorrect. Pancreatic panniculitis can be associated with pancreatic acinar carcinoma, can be associated with islet cell carcinoma, and even have nonpancreatic associations such as intrahepatic cholangiocarcinoma.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar The use of imaging, tumor markers, and biopsies should be utilized to rule out malignancy as the etiology of pancreatic panniculitis.B.Infection – Incorrect. Certain infections may result in acute pancreatitis which can progress to pancreatic panniculitis. For example, viral infections of mumps, coxsackievirus, hepatitis B, cytomegalovirus, varicella-zoster, herpes simplex, and HIV; bacterial infections of Mycoplasma, Legionella, Leptospira, and Salmonella; fungal infections of Aspergillus; or parasitic infections of Toxoplasma, Cryptosporidium, and Ascaris all can cause pancreatitis.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar, 7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar, 8Parenti D.M. Steinberg W. Kang P. Infectious causes of acute pancreatitis.Pancreas. 1996; 13: 356-371https://doi.org/10.1097/00006676-199611000-00005Crossref PubMed Scopus (206) Google Scholar The clinical presentation of ulcerated nodules could mimic infection in the skin, and the presence of neutrophils on histopathology also can make this a concern, but the presence of ghost cells and calcification supports pancreatic panniculitis.C.Trauma – Incorrect. Pancreatic panniculitis can arise from traumatic pancreatitis or status after endoscopic retrograde cholangiopancreatography (ERCP).2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarD.Metabolic – Correct. Metabolic processes such as exocrine pancreatic insufficiency have not been associated with pancreatic panniculitis.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarE.Chemical – Incorrect. Pancreatic panniculitis can arise in pancreatitis secondary to sulindac intake.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarQuestion 3: What is the most effective treatment recommendation for pancreatic panniculitis?A.Wide local excisionB.Lower pancreatic enzymesC.SupportiveD.Immune supportE.Topical steroidsAnswer:A.Wide local excision – Incorrect. This has not been shown to treat pancreatic panniculitis since it does not address the root cause of the pathology. However, punch biopsies can be used to help in the diagnosis of pancreatic panniculitis as seen in our patient.B.Lower pancreatic enzymes – Correct. A goal of pancreatic panniculitis treatment is to decrease pancreatic enzyme levels.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar High pancreatic enzyme levels indicate continued fat saponification and progression of cutaneous lesions. Our patient had asymptomatic acute pancreatitis, so obtaining an ERCP was made to search for an underlying cause. ERCP identified a portion of the pancreatic duct that appeared extrinsically compressed to a tight stricture by a pancreatic cyst along with dilation of the main pancreatic duct within the body of the pancreas. There was a significant downtrend in lipase and amylase levels after ERCP. It is also important to note that elevated amylase, lipase, and aspartate aminotransferase/alanine aminotransferase are not diagnostic of pancreatic panniculitis as these abnormalities are not always observed in patients.C.Supportive – Incorrect. Supportive measures, such as analgesics, can help the patient tolerate the tender, ulcerated lesions seen in pancreatic panniculitis. However, pancreatic panniculitis will not resolve without an intervention that will decrease pancreatic enzyme levels.D.Immune support – Incorrect. Increased immunosuppressive medications in patients with pancreatic panniculitis status after transplant have been shown to rapidly normalize pancreatic enzyme levels.9Beveridge M. Pei S. Tsoukas M.M. Pancreatic panniculitis in a pancreas-kidney transplant patient resolved after immunosuppression increase: case report and review of literature.JAAD Case Rep. 2015; 1: 101-105Abstract Full Text Full Text PDF PubMed Scopus (5) Google ScholarE.Topical steroids – Incorrect. May provide symptomatic relief, but they have shown to be ineffective in treatment of pancreatic panniculitis.6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar A 63-year-old woman presented with 1 week of worsening lower extremity lesions that started as multiple red pustules and evolved into subcutaneous nodules with overlying ulceration. On exam, there were many 0.5- to 2-cm dark pink and purple papulonodules with central hemorrhagic crust and erosions (Fig 1) and 2 tender, several-centimeter ulcerations with violaceous, rolled borders and necrotic bases. The lesions were debrided on admission due to concern for infection. She had 2 weeks of diarrhea secondary to her chronic pancreatitis but denied acute pancreatitis symptoms including epigastric pain, fever, or nausea. Punch biopsy demonstrated lobular panniculitis, “ghost cells,” calcification, and neutrophil-rich infiltrate (Fig 2). Question 1: What is the most likely diagnosis?A.Pyoderma gangrenosumB.Pancreatic panniculitisC.Alpha-1 antitrypsin deficiency panniculitisD.Nodular vasculitisE.Factitial dermatitis Answer:A.Pyoderma gangrenosum – Incorrect. Histopathology would demonstrate dense neutrophilic inflammation and the presence of ghost cells, and saponification would not be seen.1Maverakis E. Ma C. Shinkai K. et al.Diagnostic criteria of ulcerative pyoderma gangrenosum: a Delphi Consensus of International Experts.JAMA Dermatol. 2018; 154: 461Crossref PubMed Scopus (203) Google ScholarB.Pancreatic panniculitis – Correct. Pancreatic panniculitis presents clinically with lesions to the lower extremities that are tender, erythematous, red-brown in color, nodular, ulcerated, and potentially with an oily drainage.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar In 40% of cases, cutaneous findings precede the diagnosis of pancreatic disease by 1 to 7 months.3Chee C. Panniculitis in a patient presenting with a pancreatic tumor and polyarthritis: a case report.J Med Case Rep. 2009; 3: 7331Crossref PubMed Scopus (13) Google Scholar,4Poelman S.M. Nguyen K. Pancreatic panniculitis associated with acinar cell pancreatic carcinoma.J Cutan Med Surg. 2008; 12: 38-42Crossref PubMed Scopus (22) Google Scholar Along with these clinical features in the setting of pancreatic disease, an incisional biopsy can help confirm the diagnosis. A deep incisional biopsy is necessary to ensure adequate tissue sampling that includes subcutaneous fat. The main feature on histology is mostly lobular panniculitis without vasculitis. “Ghost cells” are also pathognomonic for panniculitis and result from coagulative necrosis of adipocytes due to pancreatic enzymes. Within “ghost cells,” saponification can be seen as fine basophilic granular material due to dystrophic calcification.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google ScholarC.Alpha-1 antitrypsin deficiency panniculitis – Incorrect. Histopathology is absent of skip areas, making this diagnosis less likely.D.Nodular vasculitis – Incorrect. Although this pathology also demonstrates erythematous, tender, ulcerated nodules of the lower extremities, its histopathology would reveal a mixed inflammatory infiltrate and would not demonstrate “ghost cells.”5Mascaró Jr., J.M. Baselga E. Erythema induratum of bazin.Dermatol Clin. 2008; 26: 439-445https://doi.org/10.1016/j.det.2008.05.007Abstract Full Text Full Text PDF PubMed Scopus (70) Google ScholarE.Factitial dermatitis – Incorrect. Although some of our patient’s clinical symptoms can be self-induced, the histopathology is more specific for pancreatic panniculitis. Question 2: Pancreatic panniculitis is a cutaneous presentation that occurs in 2% to 3% of patients with pancreatic disease. Which of these etiologies is not associated with pancreatic panniculitis?A.MalignancyB.InfectionC.TraumaD.MetabolicE.Chemical Answer:A.Malignancy – Incorrect. Pancreatic panniculitis can be associated with pancreatic acinar carcinoma, can be associated with islet cell carcinoma, and even have nonpancreatic associations such as intrahepatic cholangiocarcinoma.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar The use of imaging, tumor markers, and biopsies should be utilized to rule out malignancy as the etiology of pancreatic panniculitis.B.Infection – Incorrect. Certain infections may result in acute pancreatitis which can progress to pancreatic panniculitis. For example, viral infections of mumps, coxsackievirus, hepatitis B, cytomegalovirus, varicella-zoster, herpes simplex, and HIV; bacterial infections of Mycoplasma, Legionella, Leptospira, and Salmonella; fungal infections of Aspergillus; or parasitic infections of Toxoplasma, Cryptosporidium, and Ascaris all can cause pancreatitis.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar, 7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar, 8Parenti D.M. Steinberg W. Kang P. Infectious causes of acute pancreatitis.Pancreas. 1996; 13: 356-371https://doi.org/10.1097/00006676-199611000-00005Crossref PubMed Scopus (206) Google Scholar The clinical presentation of ulcerated nodules could mimic infection in the skin, and the presence of neutrophils on histopathology also can make this a concern, but the presence of ghost cells and calcification supports pancreatic panniculitis.C.Trauma – Incorrect. Pancreatic panniculitis can arise from traumatic pancreatitis or status after endoscopic retrograde cholangiopancreatography (ERCP).2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarD.Metabolic – Correct. Metabolic processes such as exocrine pancreatic insufficiency have not been associated with pancreatic panniculitis.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google ScholarE.Chemical – Incorrect. Pancreatic panniculitis can arise in pancreatitis secondary to sulindac intake.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar,7Sibrack L.A. Gouterman I.H. Cutaneous manifestations of pancreatic diseases.Cutis. 1978; 21: 763-768PubMed Google Scholar Question 3: What is the most effective treatment recommendation for pancreatic panniculitis?A.Wide local excisionB.Lower pancreatic enzymesC.SupportiveD.Immune supportE.Topical steroids Answer:A.Wide local excision – Incorrect. This has not been shown to treat pancreatic panniculitis since it does not address the root cause of the pathology. However, punch biopsies can be used to help in the diagnosis of pancreatic panniculitis as seen in our patient.B.Lower pancreatic enzymes – Correct. A goal of pancreatic panniculitis treatment is to decrease pancreatic enzyme levels.2García-Romero D. Vanaclocha F. Pancreatic panniculitis.Dermatol Clin. 2008; 26: 465-470Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar High pancreatic enzyme levels indicate continued fat saponification and progression of cutaneous lesions. Our patient had asymptomatic acute pancreatitis, so obtaining an ERCP was made to search for an underlying cause. ERCP identified a portion of the pancreatic duct that appeared extrinsically compressed to a tight stricture by a pancreatic cyst along with dilation of the main pancreatic duct within the body of the pancreas. There was a significant downtrend in lipase and amylase levels after ERCP. It is also important to note that elevated amylase, lipase, and aspartate aminotransferase/alanine aminotransferase are not diagnostic of pancreatic panniculitis as these abnormalities are not always observed in patients.C.Supportive – Incorrect. Supportive measures, such as analgesics, can help the patient tolerate the tender, ulcerated lesions seen in pancreatic panniculitis. However, pancreatic panniculitis will not resolve without an intervention that will decrease pancreatic enzyme levels.D.Immune support – Incorrect. Increased immunosuppressive medications in patients with pancreatic panniculitis status after transplant have been shown to rapidly normalize pancreatic enzyme levels.9Beveridge M. Pei S. Tsoukas M.M. Pancreatic panniculitis in a pancreas-kidney transplant patient resolved after immunosuppression increase: case report and review of literature.JAAD Case Rep. 2015; 1: 101-105Abstract Full Text Full Text PDF PubMed Scopus (5) Google ScholarE.Topical steroids – Incorrect. May provide symptomatic relief, but they have shown to be ineffective in treatment of pancreatic panniculitis.6Dahl P.R. Su W.P. Cullimore K.C. Dicken C.H. Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (153) Google Scholar None disclosed.

Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions

BackgroundsPercutaneous ultrasound (US) and endoscopic ultrasound (EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases. Studies comparing the diagnostic performance of US- and EUS-guided pancreatic biopsies are lacking. This study aimed to evaluate and compare the diagnostic yields of US- and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies. MethodsOf the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center, 275 underwent EUS-guided fine needle aspiration (EUS-FNA), and 799 underwent US-guided core needle biopsy (US-CNB/FNA). The outcomes were inconclusive pathological biopsy, diagnostic accuracy and the need for repeat biopsy. All of the included factors and diagnostic performances of both US-CNB/FNA and EUS-FNA were compared, and the independent predictors for the study outcomes were identified. ResultsThe diagnostic accuracy was 89.8% for EUS-FNA and 95.2% for US-CNB/FNA (P = 0.001). Biopsy under EUS guidance [odds ratio (OR) = 1.808, 95% confidence interval (CI): 1.083-3.019; P = 0.024], lesion size < 2 cm (OR = 2.069, 95% CI: 1.145-3.737; P = 0.016), hypoechoic appearance (OR = 0.274, 95% CI: 0.097-0.775; P = 0.015) and non-pancreatic ductal adenocarcinoma carcinoma (PDAC) diagnosis (OR = 2.637, 95% CI: 1.563-4.449; P < 0.001) were identified as factors associated with inconclusive pathological biopsy. Hypoechoic appearance (OR = 0.236, 95% CI: 0.064-0.869; P = 0.030), lesions in the uncinate process of the pancreas (OR = 3.506, 95% CI: 1.831-6.713; P < 0.001) and non-PDAC diagnosis (OR = 2.622, 95% CI: 1.278-5.377; P = 0.009) were independent predictors for repeat biopsy. Biopsy under EUS guidance (OR = 2.024, 95% CI: 1.195-3.429; P = 0.009), lesions in the uncinate process of the pancreas (OR = 1.776, 95% CI: 1.014-3.108; P = 0.044) and hypoechoic appearance (OR = 0.127, 95% CI: 0.047-0.347; P < 0.001) were associated with diagnostic accuracy. ConclusionsIn conclusion, both percutaneous US- and EUS-guided biopsies of solid pancreatic lesions are safe and effective; though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA. A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.

[Pancreas multidisciplinary team optimizes the diagnosis and treatment of pancreas-related diseases and improves the prognosis of pancreatic cancer patients].

Objectives: To evaluate the role of pancreas multidisciplinary team(MDT) clinic in the diagnosis of pancreatic diseases,patient compliance with MDT advice,and the impact of MDT on the postoperative survival of patients with pancreatic cancer. Methods: The study included 927 patients(554 males,373 females,aged (58.1±13.3)years (range: 15 to 89 years)) that had visited the pancreas MDT clinic of Zhongshan Hospital from May 2015 to December 2021,and 677 patients(396 males, 281 females, aged (63.6±8.9)years(range: 32 to 95 years)) who underwent radical surgery and with pathologically confirmed pancreatic adenocarcinoma from January 2012 to December 2020,of whom 79 patients had attended the pancreas MDT. The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate. The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model. Survival rates were compared using χ2 test. Results: Among the 927 patients that had visited the MDT clinic,233 patients(25.1%) were referred due to undetermined diagnosis. A direct diagnosis was made in 109 cases (46.8%,109/233) by the MDT clinic, of which 98 were consistent with the final diagnosis,resulting in an accuracy of 89.9%(98/109). The direct diagnosis rate in the recent years(36.6%(41/112),from June 2019 to December 2021) decreased compared to that in the previous years(56.2%(68/121),from May 2015 to May 2019),yet the accuracy in the recent years(90.2%,37/41) was basically the same as before (89.7%,61/68). The rate of compliance of the entire cohort was 71.5%(663/927), with the compliance rate in the recent two and a half years(81.4%,338/415) remarkably higher than that in the previous four years(63.4%,325/512). Patients with pancreatic cancer that attended the MDT exhibited a trend toward longer median postoperative survival than patients that did not attend the MDT,but the difference was not statistically significant(35.2 months vs.30.2 months,P>0.05). The 1-year and 3-year survival rates of patients that attended the MDT were significanly higher than patients that did not attend the MDT(88.6% vs. 78.4%,P<0.05;32.9% vs. 21.9%,P<0.05,respectively),but the 5-year survival rate was not statistically different(7.6% vs. 4.8%,P>0.05). Conclusions: The pancreas MDT clinic is an accurate and convenient way to diagnose intractable pancreatic diseases,and in the recent years the patients' compliance rate with MDT advice has increased. Pancreatic cancer patients that have attended the MDT have higher 1-year and 3-year postoperative survival rates,but the long-term survival benefits of MDT still needs to be proved by clinical studies on a larger scale.

Evaluation of Ultrasound-Based Point Shear Wave Elastography for Differential Diagnosis of Pancreatic Diseases.

Introduction: A variety of imaging techniques exists for the diagnosis of pancreatic disorders. None of the broadly applied diagnostic methods utilizes elasticity as an indicator of tissue damage. A well-known fact is that both chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDA) are associated with the development of prominent fibrosis (increased tissue stiffness). Purpose: To prospectively assess the accuracy of point shear wave elastography (pSWE) in differentiating between benign and malignant pancreatic diseases, establish a cut-off value for the diagnosis of PDA, and evaluate the influence of certain variables on the obtained results. Materials and methods: The present study included 78 patients who were admitted at the Department of Gastroenterology at the university hospital “Kaspela” between December 2017 and August 2021 for diagnosis and/or treatment of pancreatic disorders. Based on the clinical criteria, diagnostic imaging, and histological findings, patients were divided into the CP and PDA group. The ultrasound based pSWE technique was applied and shear wave velocity (SWV) was measured. The depth of region of interest (ROI) and successful measurement rate were also recorded. Results: The mean ± SD SWV values established through pSWE were 1.75 ± 0.34 m/s and 2.93 ± 0.91 m/s for the CP and PDA, respectively. With a cut-off value of 2.09 m/s, we calculated the sensitivity (Se), specificity (Sp), and accuracy for differentiating between CP and PDA of 89.47%, 91.20%, and 88.60%, respectively. Of the examined variables, BMI and depth of ROI in the CP group and sex in the PDA group showed a statistically significant influence on the obtained results. Conclusions: pSWE may be utilized as a differential diagnostic modality in patients with suspected CP or PDA.

Characteristics and Clinical Course of Diabetes of the Exocrine Pancreas: A Nationwide Population-Based Cohort Study.

The natural course of diabetes of the exocrine pancreas (DEP) is not well established. We aimed to compare the risk of insulin initiation, diabetic complications, and mortality between DEP and type 2 diabetes. Using the Korean National Health Insurance Service-Health Screening Cohort between 2012 and 2017, we divided patients with diabetes into those with diabetes without prior pancreatic disease (indicated type 2 diabetes, n = 153,894) and diabetes with a prior diagnosis of pancreatic disease (indicated DEP, n = 3,629). ICD-10 codes and pharmacy prescription information were used to define type 2 diabetes, DEP, and acute and chronic diabetes complications. Kaplan-Meier curves were produced to compare insulin use over time between groups. We created logistic regression models for odds of progression to diabetic complications and mortality. DEP was associated with a higher risk of insulin use than type 2 diabetes (adjusted hazard ratio 1.38 at 5 years [95% CI 1.30-1.47], P < 0.0001). Individuals with DEP showed higher risks of hypoglycemia (odds ratio 1.85 [1.54-2.21], P < 0.0001), diabetic neuropathy (1.38 [1.28-1.49], P < 0.0001), nephropathy (1.38 [1.27-1.50], P < 0.0001), retinopathy (1.10 [1.01-1.20], P = 0.0347), coronary heart disease (1.59 [1.48-1.70], P < 0.0001), cerebrovascular disease (1.38 [1.28-1.49], P < 0.0001), and peripheral arterial disease (1.34 [1.25-1.44], P < 0.0001). All-cause mortality was higher in those with DEP (1.74 [1.57-1.93], P < 0.0001) than in those with type 2 diabetes. DEP is more likely to require insulin therapy than type 2 diabetes. Hypoglycemia, micro- and macrovascular complications, and all-cause mortality events are higher in DEP compared with type 2 diabetes.

Deletion of pancreas-specific miR-216a reduces beta-cell mass and inhibits pancreatic cancer progression in mice

SummarymiRNAs have crucial functions in many biological processes and are candidate biomarkers of disease. Here, we show that miR-216a is a conserved, pancreas-specific miRNA with important roles in pancreatic islet and acinar cells. Deletion of miR-216a in mice leads to a reduction in islet size, β-cell mass, and insulin levels. Single-cell RNA sequencing reveals a subpopulation of β-cells with upregulated acinar cell markers under a high-fat diet. miR-216a is induced by TGF-β signaling, and inhibition of miR-216a increases apoptosis and decreases cell proliferation in pancreatic cells. Deletion of miR-216a in the pancreatic cancer-prone mouse line KrasG12D;Ptf1aCreER reduces the propensity of pancreatic cancer precursor lesions. Notably, circulating miR-216a levels are elevated in both mice and humans with pancreatic cancer. Collectively, our study gives insights into how β-cell mass and acinar cell growth are modulated by a pancreas-specific miRNA and also suggests miR-216a as a potential biomarker for diagnosis of pancreatic diseases.

Design of 99mTc-labeled zinc-chelating imaging probe for SPECT imaging of the pancreas

Early and sensitive diagnosis of pancreatic diseases is a contemporary clinical challenge. Zinc level in pancreatic tissue and its secretion in pancreatic juice has long been considered a surrogate marker of pancreatic function. The objective of this study was to design a Zn-chelating imaging probe (ZCIP) which could be labeled with 99mTc radionuclide for imaging of pancreas using single photon emission tomography (SPECT). We synthesized ZCIP as a bifunctional chelate consisting of diethylene triamine pentaacetic acid for 99mTc-chelation at one end and bispicolylethylamine for Zn-complexation at the other end. ZCIP was labeled with 99mTc by standard Sn2+-based reduction method. The 99mTc-labeled ZCIP was studied in normal mice (0.3 mCi) for SPECT imaging. We found that ZCIP consistently labeled with 99mTc radionuclide with over 95% efficiency. Addition of ZCIP altered the spectrum of standard dithizone-Zn complex, indicating its ability to chelate Zn. SPECT data demonstrated the ability of 99mTc-ZCIP to image pancreas with high sensitivity in a non-invasive manner; liver and spleen were the other major organs of 99mTc-ZCIP uptake. Based on these results, we conclude that 99mTc-ZCIP presents as a novel radiotracer for pancreas imaging for diagnosis of diseases such as pancreatitis.

Diagnostic Performance of EUS-Guided Sampling in Indeterminate Radiological Diagnosis of Pancreatic Disease and Intra-Abdominal Lymphadenopathy.

Background: Endoscopic ultrasound (EUS)-guided sampling has been widely used for pathologic diagnosis of pancreatic lesions and intra-abdominal lymphadenopathy. However, its effectiveness for diagnostic decision making in indeterminate radiological diagnosis has not been well determined. Materials and Methods: From March 2012 to October 2015, 98 consecutive patients who underwent EUS-guided FNA for solid intra-abdominal lesions were retrospectively analyzed (100 procedures). The purpose of EUS-guided sampling was classified as (1) confirmation of a high-confidence radiological diagnosis (High-confidence group) or (2) decision making in the differential diagnostic dilemma for indeterminate radiological diagnosis (Indeterminate group). The accuracies of EUS-guided sampling according to the purpose were analyzed and then compared. Results: Of the 100 procedures, 22 procedures (22%) came under the Indeterminate group, whereas 78 came under the High-confidence group. The accuracies did not differ between the Indeterminate and the High-confidence groups (86.4% vs. 88.5%, p = 1.000). Clinical conditions that required EUS-guided sampling for indeterminate radiological diagnosis were (1) pancreatic cancer vs. benign disease (n = 8; e.g., pancreatic cancer vs. mass-forming pancreatitis), (2) recurrence of previous/pre-existing cancer vs. benign disease (n = 5; e.g., recurrent gastric cancer vs. reactive lymph node), (3) pathologic differentiation of presumed malignancy (n = 6; e.g., lymphadenopathies in the previous history of esophageal cancer and colon cancer), or (4) miscellaneous (n = 3; e.g., tuberculous lymphadenopathy vs. other condition). Conclusions: EUS-guided sampling demonstrated an accuracy of 86.4% in the clinical setting of indeterminate radiological diagnosis, which was not different from that of the confirmation of high-confidence diagnosis.

Rational design and development of a novel and highly specific near-infrared fluorogenic substrate for sensing and imaging of human pancreatic lipase in living systems

• A novel activatable near-infrared (NIR) fluorogenic substrate ( DDAO-ol ) for human pancreatic lipase (hPL) was devised. • DDAO-ol is found with the best combination of stability, specificity, sensitivity and reactivity towards hPL. • DDAO-ol offers a practical tool for high-throughput screening and characterizing hPL inhibitors. • DDAO-ol offers a powerful visualization tool for in situ sensing and imaging of PL in living cells, tissues and organs. Human pancreatic lipase (hPL), a crucial digestive enzyme responsible for the digestion of dietary lipids in humans, has been validated as a key target for treating obesity and as a potential biomarker for diagnosis of pancreatic diseases. This study aims to devise a novel and highly specific near-infrared (NIR) fluorogenic substrate for sensing and imaging of human pancreatic lipase (hPL) in biological systems. To achieve this aim, the oleate esters of various NIR fluorophores are rationally designed on the basis of the enzymatic properties and the preferred substrates of hPL. Following virtual screening and experimental validation, DDAO-ol is found with the best combination of stability, specificity, sensitivity and reactivity towards hPL. Under physiological conditions, DDAO-ol can be rapidly hydrolyzed by hPL to release the fluorophore DDAO , which emits strong NIR fluorescence signal around 660 nm. DDAO-ol offers a novel and practical tool to construct the assay for high-throughput screening and characterizing hPL inhibitors, which strongly facilitates the discovery of novel anti-obesity agents targeting hPL. Meanwhile, DDAO-ol is also a powerful visualization tool for sensing and imaging of mammalian pancreatic lipase (PL) in living systems (including living cells, tissues and organs) with low cytotoxicity and high imaging resolution. Collectively, this study reports a novel and highly specific NIR fluorogenic substrate for hPL, which offers a practical and reliable tool for deciphering the biological functions of hPL and the relevance of this key digestive enzyme to diseases.

Fluorescence "Turn-On" Enzyme-Responsive Supra-Amphiphile Fabricated by Host-Guest Recognition between γ-Cyclodextrin and a Tetraphenylethylene-Sodium Glycyrrhetinate Conjugate.

A novel fluorescence "turn-on" enzyme-responsive supra-amphiphile is developed based on the host-guest recognition between γ-cyclodextrin (γ-CD) and an amphiphilic tetraphenylethene-sodium glycyrrhetinate conjugate (TPE-SGA). The covalent amphiphile TPE-SGA displayed strong fluorescence in aqueous solution owing to the aggregation-induced emission. Upon addition of γ-CD, the fluorescence of TPE-SGA was effectively turned off due to the host-guest recognition with γ-CD prohibiting the aggregation of TPE-SGA in aqueous solution. The as-formed nonfluorescent supra-amphiphile (TPE-SGA/γ-CD) inherited the α-amylase-responsive property of γ-CD. In the presence of α-amylase, the fluorescence of the supra-amphiphile was gradually turned on owing to the hydrolysis of γ-CD, and the fluorescence intensity linearly correlated to the activity of α-amylase. This study enriches the field of supra-amphiphile on the basis of cyclodextrin-based host-guest chemistry and provides a novel strategy to construct fluorescence turn-on functioned self-assemblies. It is anticipated that the fluorescence turn-on supra-amphiphile has potential applications in biological analysis and diagnosis of pancreatic diseases.

Sonographic Evaluation of the Pancreas in Type 1 Diabetes Mellitus: A Case-control Study.

Background:Pancreas is a vital insulin-producing gland, and it is subjected to various disorders which produce alteration in the morphology and function. Ultrasound (US) of the pancreas is sensitive for evaluating the gland and provides the accurate diagnosis of pancreatic diseases. The aim of this study is to determine whether there were alterations in pancreatic size and echogenicity in type 1 diabetes mellitus (DM).Methods:A total of 100 patients with Type-1 DM (insulin dependent) were examined using the ultrasonography. They were compared to 22 healthy controls. Measurements of the pancreas were performed on type 1 diabetic patients and controls.Results:Pancreatic diameters of the head, body, and tail of the pancreas were reduced in Type 1 DM versus controls (1.78 vs. 1.80 cm, 95% confidence interval [CI]: −0.147 −0.099, P = 0.699 for the head of the pancreas; and 1.093 vs. 1.13 cm: 95% CI: −2.97–1.196, P = 0.484 for the body of the pancreas; 1.12 vs. 1.46 cm, 95% CI: −0.491–0.194, P < 0.001 for the tail of the pancreas). The echogenicity of the pancreas in patients with Type 1 DM increased significantly as the duration of the disease increased (P = 0.015).Conclusion:Individuals with Type 1 DM have reduced pancreatic size in comparison with controls. Patients with Type 1 DM have increased echogenicity of the pancreas as the duration of the disease increased.

A non-peptide probe for detecting chymotrypsin activity based on protection-deprotection strategy in living systems.

Chymotrypsin (CHT) plays a vital role in the metabolism of organisms and affects cell proliferation and apoptosis. Abnormal levels of CHT will lead to a variety of diseases, such as inflammatory arthritis, diabetes, pharyngitis, indigestion, and pancreatic cancer. Therefore, it is significant to design an effective method for the detection of CHT in living systems. Here, we synthesized a specific deep-red non-peptide probe DT by effectively combining isophorone and p-hydroxybenzaldehyde for the detection of CHT using 3-phenylpropionate chloride as the recognition group based on a protection-deprotection strategy. The DT probe exhibited an emission range of 525-700 nm and showed excellent photostability, high sensitivity (LOD = 0.071 U mL-1), and selectivity for CHT detection. The cellular experiments demonstrated that DT could sensitively recognize CHT activity in three cell lines and the content of CHT was much higher in P815 cells than in MCF-7 and 3T3 cells. Also, DT was successfully used to visualize the endogenous CHT in zebrafish. Notably, the DT probe provided an intuitive way to visualize endogenous CHT in mouse pancreas for the first time, demonstrating the potential for application in the future clinical diagnosis of pancreatic diseases. Therefore, the small-molecule probe DT is expected to be a useful molecular tool for CHT-related disease diagnosis and drug discovery.