Evaluation Of Pancreatic Tumors Research Articles

OPPORTUNITIES IN DIAGNOSTICS OF PANCREATIC METASTATIC TUMORS BY CYTOLOGICAL METHOD

Our study includes results of 152 pancreatic fine needle aspirations of solid and cystic tumors, from 149 patients of the N.N. Petrov Cancer Research Center for the 3-year period (2016 - 2018). Representative cell material for morphological studies was obtained in 97.4% of cases. The results of cytological examination of 111 patients with pancreatic tumors were compared with histological data. The effectiveness of cytological examination was 96.1%, sensitivity - 95.6%, specificity -100%. Metastatic lesions were presented in 9% (9 patients). In 9 diagnostically proven cases, the cytological result was correct 8 times. Cytological examination with immunocytochemistry is a valid and accurate diagnostic procedure for the evaluation of pancreatic tumors including metastatic lesions.

Imaging of Malignant and Benign Tumors of the Pancreas

Pancreatic cross-sectional imaging has been widely used to diagnose and stage pancreatic neoplasms. The most commonly used techniques include multidetector CT, MRI, and endoscopic ultrasonography. Hybrid imaging including positron emission tomography combined with CT has a limited role. Dedicated imaging applications of these modalities for the evaluation of pancreatic neoplasms and their accuracies for different neoplasms are summarized in this review. Critical and differential imaging findings of the most common neoplasms of the pancreas, including adenocarcinoma, neuroendocrine tumors, cystic neoplasms, lymphoma, and metastases, emphasizing the most accurate imaging techniques are also discussed. Additionally, the most common mimics of the pancreatic neoplasms and their imaging findings are reviewed. This review contains 32 references, 13 figures, and 5 tables. Key words: adenocarcinoma, CT, EUS, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, MRI, neuroendocrine tumors, PET-CT, serous cystadenoma

Imaging of Malignant and Benign Tumors of the Pancreas

Pancreatic cross-sectional imaging has been widely used to diagnose and stage pancreatic neoplasms. The most commonly used techniques include multidetector CT, MRI, and endoscopic ultrasonography. Hybrid imaging including positron emission tomography combined with CT has a limited role. Dedicated imaging applications of these modalities for the evaluation of pancreatic neoplasms and their accuracies for different neoplasms are summarized in this review. Critical and differential imaging findings of the most common neoplasms of the pancreas, including adenocarcinoma, neuroendocrine tumors, cystic neoplasms, lymphoma, and metastases, emphasizing the most accurate imaging techniques are also discussed. Additionally, the most common mimics of the pancreatic neoplasms and their imaging findings are reviewed. This review contains 32 references, 13 figures, and 5 tables. Key words: adenocarcinoma, CT, EUS, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, MRI, neuroendocrine tumors, PET-CT, serous cystadenoma

Imaging of Malignant and Benign Tumors of the Pancreas

Pancreatic cross-sectional imaging has been widely used to diagnose and stage pancreatic neoplasms. The most commonly used techniques include multidetector CT, MRI, and endoscopic ultrasonography. Hybrid imaging including positron emission tomography combined with CT has a limited role. Dedicated imaging applications of these modalities for the evaluation of pancreatic neoplasms and their accuracies for different neoplasms are summarized in this review. Critical and differential imaging findings of the most common neoplasms of the pancreas, including adenocarcinoma, neuroendocrine tumors, cystic neoplasms, lymphoma, and metastases, emphasizing the most accurate imaging techniques are also discussed. Additionally, the most common mimics of the pancreatic neoplasms and their imaging findings are reviewed. This review contains 32 references, 13 figures, and 5 tables. Key words: adenocarcinoma, CT, EUS, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, MRI, neuroendocrine tumors, PET-CT, serous cystadenoma

Role of MDCT Scan in the Evaluation of Pancreatic Mass with Histopathological Correlation

Diagonstic imaging plays a critical role in evaluation of the adenocarcinoma of the pancreas- the 4th leading cause of death for the cancer globally. The purpose of this study was to determine the role of multidetector computed tomography (MDCT) in evaluation of pancreatic tumors. The prospective and study was carried out in Dhaka, Bangladesh during the period of July, 2013 to December 2014. Amongst 47 publish with suspected pancreatic lesion (having positive CT scan findings). Patients underwent histopathology of their lesions, the report of which was used as gold standard for comparing the role of CT scan in evaluating such lesions. Pancreatic disease was found to be more prevalent in males. The commonest age group was 56-65 years. On the average malignant lesions were more common in elder age group than the benign ones. Head of the pancreas was the commonest site for malignant pancreatic mass. Main pancreatic duct (MPD) dilatation was found to be a harbinger for malignant condition of pancreas. 72.3% patients showed MPD dilatation most of which proved to be malignant. Some 45% patients showed common bile duct (CBD) dilatation all of which presented clinically with jaundice. Out of 47 patients 33 (60.3%) were diagnosed to have malignant lesions while 14 (39.7%) had benign lesions. Finding of the study suggest that CT scan may be a useful tool for assessing and changing of Parcrease mass lesions.

Priming the pancreatic cancer tumor microenvironment for checkpoint-inhibitor immunotherapy

Single agent immunotherapy is effective against several cancers, but has failed against poorly immunogenic cancers, including pancreatic cancer. Evaluation of pancreatic tumors following treatment with an experimental vaccine (Lutz et al. Cancer Immunology Research 2014) suggests that vaccination primes the tumor microenvironment (TME) for checkpoint-inhibitor immunotherapy, and supports a new platform for evaluating checkpoint-inhibitors in poorly immunogenic cancers.

Contrast-enhanced ultrasound of pancreatic tumours.

Indication/purpose: To review contrast‐enhanced ultrasound features of the most common pancreatic tumours. Methods: Contrast‐enhanced ultrasound (CEUS) can provide distinctive features of pancreatic tumours that are reported in the present paper, providing radiologic‐pathological correlations and clarifying the main differential diagnosis. Conclusion: Contrast‐enhanced ultrasound plays a well‐established role in the evaluation of pancreatic tumours. When possible, CEUS should be always performed after the initial US diagnosis, in order to improve the accuracy of the first line examination.

Role of multi-detector computed tomography in the evaluation of pancreatic tumors

The purpose of this study was to determine the role of multidetector computed tomography (MDCT) in evaluation and prediction of pancreatic tumors resectability. The study included 20 patients who had pancreatic masses, 16 males and 4 females, and their age range was 30–70 years with a mean age of 58.0 years. All the patients underwent non-contrast and contrast enhanced Multi-slice CT using a 16-slice machine. The gold standard for diagnosis was histopathology and operative data. Adenocarcinoma as reported by pathological studies was found in 8 patients, cyst adenocarcinoma in one patient, infiltrative adenocarcinoma in 2 patients, intraductal papillary mucinous tumor in 2 patients, mucinous cyst adenocarcinoma in one patient, pancreatic pseudo cyst in 2 patients and mucinous cystadenoma in 4 patients. According to MDCT criteria 6 patients were considered suitable for tumor resection and 14 patients were considered inoperable with unresectable tumor, one out of the 6 operable patients was unresectable during operation due to the invasion of the superior mesenteric vein with infiltration of the mesenteric root. Contrast-enhanced multiphase pancreatic imaging by multislice computerized tomography (MSCT) with its postprocessing techniques represents the image of choice for diagnosis and predicting pancreatic masses and resectability.

Findet die molekulare Diagnostik Einzug in die Pankreaspathologie?

Genetic alterations of solid and cystic tumors of the pancreas have been increasingly more characterized over the last few years. Pancreatic ductal adenocarcinoma (PDAC) carries numerous point mutations and, to a lesser extent, deletions and amplifications of genes that are associated with at least 13 tumor relevant signalling pathways and processes. Besides the four common driver mutations in the KRAS, p53, CDKN2a and SMAD4 genes there are a number of low frequency driver mutations. The classification of PDAC subtypes has benefited from recent analyses of transcriptional profiles that revealed a classical KRAS driven and a KRAS independent quasi-mesenchymal subtype. The analyses of mRNA and miRNA expression profiles of fine needle aspirates serve as a basis for reliable preoperative diagnosis of pancreatic masses.The four most common cystic pancreatic tumors bear tumor-specific genetic alterations, such as GNAS mutations in intraductal papillary mucinous neoplasms, β-catenin mutations in solid pseudopapillary neoplasms and VHL mutations or loss of heterozygosity in serous cystadenoma. Recovery of DNA from aspirates of cyst fluids enables an improved preoperative management of cystic pancreatic tumors by mutational analysis. In addition to the analysis of DNA there are promising approaches in distinguishing benign and premalignant/malignant cystic tumors by evaluating miRNA profiles.In recent years much progress has been made in molecular genetic characterization and preoperative evaluation of pancreatic tumors. Hopefully these results will contribute to prognostic and therapeutic stratification of PDAC and to a reliable preoperative diagnostics of benign cystic pancreatic tumors in the future.

The many roles of endoscopic ultrasound in the evaluation of pancreatic neoplasms: Getting to know its strengths and limitations

The many roles of endoscopic ultrasound in the evaluation of pancreatic neoplasms: Getting to know its strengths and limitations

Current status on the diagnosis and evaluation of pancreatic tumor in Asia with particular emphasis on the role of endoscopic ultrasound

In Asia, the incidence of pancreatic cancer in some countries has been increasing. Owing to most cases being diagnosed late, prognosis for pancreatic cancer remains dismal. It is clear that the future for pancreatic cancer lies in early detection. While the possible presence of pancreatic masses is often first raised by non-invasive abdominal imaging, such as computerized tomography and magnetic resonance imaging, smaller lesions and locoregional lymph node metastases are often not detectable by these means. Endoscopic ultrasonography (EUS) offers a higher sensitivity (93-100%) for detection of small potentially curable pancreatic masses than other existing imaging modalities. It is also recommended for the evaluation of portal vein confluence, portal vein, celiac axis, and superior mesentric artery origin, and exclusion of resectability. Due to the closer proximity of EUS to the target structure, and lower rate of needle tract seeding, EUS-guided fine-needle aspiration of pancreatic mass is considered the most suitable tissue acquisition technique. Lastly, EUS also enables the performance of endoscopic interventions. Its performance can be further enhanced with newer techniques, including contrast-enhanced ultrasound and elastrography. It is anticipated that in the near future, molecular technologies may make it possible to detect microscopic amounts of cancer in tissue or blood, predict relapse and survival after therapy, as well as determine optimal therapy.

DOG1 (Clone K9) is Seldom Expressed and Not Useful in the Evaluation of Pancreatic Neoplasms

DOG1, a transmembrane calcium-regulated chloride channel protein, is a sensitive and specific marker for gastrointestinal stromal tumors compared with other spindle cell and epithelioid neoplasms. Overexpression has also been described in a variety of both benign and malignant epithelial neoplasms. Recently, DOG1 immunoreactivity has been reported in pancreatic solid pseudopapillary tumors (SPT), suggesting a role as a marker for SPT. Utilizing immunohistochemistry, we evaluated DOG1 expression in pancreatic neoplasms to determine the prevalence of staining and establish diagnostic utility. Multiple tissue microarrays (TMA) were created from cores of formalin-fixed paraffin-embedded blocks containing pancreatic adenocarcinomas (n=112), neuroendocrine tumors (n=99), serous cystadenomas (n=28), and SPT (n=14) as well as normal pancreas (n=12). Immunoreactivity for DOG1 (clone K9) was assessed for intensity (1 to 3+), percentage of tumor positivity and location. Of the 99 cases of neuroendocrine tumors, only 2 (2%) were focally positive. Patchy staining was identified in 8 cases (7%) of adenocarcinoma of 1 to 2+ intensity, involving 15% to 80% of the tumor cells and primarily seen in a membranous and luminal distribution. In contrast to a previous report, no DOG1 positivity was observed in SPT, evaluated by both TMA and full sections. The TMAs of serous cystadenomas and normal pancreas were negative for DOG1. Rarely, pancreatic islets displayed granular, cytoplasmic staining. DOG1 antibody clone K9 is not a useful marker for SPT or other primary pancreatic neoplasms. Additional studies may be helpful to evaluate differences between clones of DOG1.

Pancreatic Neoplasia: A Practical Cross-sectional Imaging Primer for the Nonradiologist

The purpose of this article is to provide a practical review of basic pancreatic imaging protocols and key cross-sectional imaging findings of the more common pancreatic neoplasms. We performed a literature search and reviewed numerous cases archived in the radiology department of a large university hospital to find examples which illustrate the key cross-sectional imaging findings of pancreatic neoplasms. We reviewed the literature and provided several practical examples of common cross-sectional imaging findings in patients with pancreatic neoplasms. Cross-sectional imaging plays a pivotal role in the evaluation of pancreatic neoplasms and allows proper triage of patients for conservative, medical or surgical management due to its ability to reliably detect and characterize pancreatic lesions, determine involvement of local structures, and assess metastatic disease. Familiarity with the key imaging findings will allow the clinician to better implement imaging data into daily practice.

Magnetic resonance imaging in the detection of pancreatic neoplasms

Recently, with the rapid scanning time and improved image quality, outstanding advances in magnetic resonance (MR) methods have resulted in an increase in the use of MRI for patients with a variety of pancreatic neoplasms. MR multi-imaging protocol, which includes MR cross-sectional imaging, MR cholangiopancreatography and dynamic contrast-enhanced MR angiography, integrates the advantages of various special imaging techniques. The non-invasive all-in-one MR multi-imaging techniques may provide the comprehensive information needed for the preoperative diagnosis and evaluation of pancreatic neoplasms. Pancreatic neoplasms include primary tumors and pancreatic metastases. Primary tumors of the pancreas may be mainly classified as ductal adenocarcinomas, cystic tumors and islet cell tumors (ICT). Pancreatic adenocarcinomas can be diagnosed in a MRI study depending on direct evidence or both direct and indirect evidence. The combined MRI features of a focal pancreatic mass, pancreatic duct dilatation and parenchymal atrophy are highly suggestive of a ductal adenocarcinoma. Most cystic neoplasms of the pancreas are either microcystic adenomas or mucinous cystic neoplasms. Intraductal papillary mucinous tumors are the uncommon low-grade malignancy of the pancreatic duct. ICT are rare neoplasms arising from neuroendocrine cells in the pancreas or the periampullary region. ICT are classified as functioning and non-functioning. The most frequent tumors to metastasize to the pancreas are cancers of the breast, lung, kidney and melanoma. The majority of metastases present as large solitary masses with well-defined margins.

Assessment of Pancreatic Neoplasms: Review of Biopsy Techniques

Pancreatic cancer is the 4th leading cause of cancer death annually. Recent technological advances in imaging have led to non-uniformity in the evaluation of pancreatic neoplasms. The following article describes the history behind various biopsy techniques and the rationale for obtaining a biopsy of a pancreatic neoplasm and discusses the benefits and disadvantages of the various pancreatic biopsy techniques, including fine needle aspiration biopsy, Tru-cut needle biopsy, endoscopic brushings/cytology, and endoscopic ultrasound guided biopsies. A treatment algorithm for pancreatic neoplasms is then presented.

Pancreatic head cancer: accuracy of CT in determination of resectability

Pancreatic cancer is a devastating disease whose early detection remains difficult. There is no 100% reliable imaging test to diagnose and stage pancreatic cancer. We assessed the surgical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival rates of patients who had pancreatic head cancer. Eighty-nine patients who had pancreatic head cancer were investigated with spiral CT. Based on the preoperative CT results, we assigned patients to one of three CT groups based on resectability. A correlation between classification of CT resectability and intraoperative finding was found in 83% of patients. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of spiral CT in identifying predictive unresectability were 79%, 82%, 91%, 62%, and 81%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosis of vascular invasion were 94%, 84.2%, 94%, 84%, and 91.3%, respectively. The use of CT in the evaluation of pancreatic tumors provides valuable preoperative assessment of surgical resectability and should be performed for clinical examination. Classifying patients by tumor resectability on CT helps to estimate more precisely the tumor stage and to prognosticate survival rates of these patients.

Multidetector row helical CT of the pancreas: value of three-dimensional images, two-dimensional reformations, and contrast-enhanced multiphasic imaging.

Multidetector row helical computed tomography (MD-CT) scanning is performed for the evaluation of pancreatic tumors. Three-phase contrast study is performed using 2.5-mm collimation, and the images are reconstructed at 1.25-mm intervals. CT angiography and pancreatic duct images using two- or three-dimensional techniques are reconstructed from the volumetric data. MD-CT can perform multiphasic scanning rapidly with an optimal temporal window. CT angiography obtained with MD-CT can delineate peripancreatic vasculature with high spatial resolution and sufficient vascular enhancement. Pancreatic duct images can provide important information in assessing pancreatic disease. MD-CT has the potential to improve detection and preoperative assessment of pancreatic tumors.

Evaluation of pancreatic tumors with positron emission tomography and F-18 fluorodeoxyglucose: comparison with CT and US.

To assess the clinical value of positron emission tomography (PET) with fluorine-18-labeled fluorodeoxyglucose (FDG) for identification of pancreatic carcinoma. Forty-six patients suspected of having a pancreatic neoplasm and who were to undergo surgery prospectively underwent FDG PET, computed tomography (CT), and transabdominal ultrasound (US). Endoscopic US was performed in 40 patients. Images were independently interpreted and compared with the histopathologic findings at surgery (41 patients) or with clinical follow-up findings (five patients). In 33 of 35 patients, foci of pancreatic carcinomas (10-100 mm in diameter) were identified as an increase in FDG uptake, whereas CT, transabdominal US, and endoscopic US depicted the foci in 31, 31, and 28, cases, respectively. Among 11 benign lesions, nine showed no increased FDG uptake (specificity = 82%). Specificities of the other modalities were lower. False-positive findings were obtained in a case of chronic active pancreatitis and in a serous cystadenoma. FDG PET, which provides "biochemical" information, is accurate in identifying pancreatic carcinoma and may be a method of choice when imaging equivocal masses detected with other "anatomic" imaging studies.

Pancreatic neoplasms: how useful is evaluation with US?

The usefulness of ultrasonography (US) in the evaluation of pancreatic neoplasms was assessed in 51 patients. Indications for US included jaundice (n = 19), pain (n = 16), weight loss and anorexia (n = 4), clinically palpable mass (n = 3), bleeding in the upper gastrointestinal tract (n = 1), and gastric outlet obstruction (n = 1). Three patients were investigated because of a previous abnormal US examination; in four the mass was an incidental observation. Sonograms were interpreted without knowledge of results from other procedures. Pancreatic masses were detected in 50 patients. Biliary and pancreatic duct obstructions were seen in 29 and 27 patients, respectively. Liver metastases were identified in 16 patients and missed in three that were not detected with either US or computed tomography. Vascular involvement was predicted in 12 patients and missed in four, while lymphadenopathy was seen in 16 and missed in five. Thirty-one cases of unresectable disease were correctly predicted with US. Resectability was not as accurately determined; only seven of 19 "resectable" lesions were successfully removed. US is an effective tool in the detection and preoperative evaluation of pancreatic malignancy.