Skip to main content

Differentiation of aggressive from non-aggressive pancreatic solid pseudopapillary neoplasms using computed tomography

Abdominal Radiology volume 44, pages 2448–2458 (2019)Cite this article

Abstract

Purposes

Microscopic aggressive behaviors may be related with the prognosis of solid pseudopapillary neoplasms (SPNs). In this study, we investigate computed tomography (CT) features and differential diagnosis of aggressive and non-aggressive SPNs in pancreas.

Materials and methods

122 patients with pathologically proven SPNs in pancreas were included. Patients’ age, tumor site, texture, shape, margins, exophytic growth, capsule, calcification, hemorrhage, pancreatic duct dilatation or pancreatic parenchyma atrophy, peripancreatic infiltration or metastases, vascular encasement, and enhancement pattern were assessed. The diagnostic accuracy was analyzed by using the receiver operating characteristic curve (ROC).

Results

There were 30 aggressive SPNs and 92 non-aggressive SPNs. Aggressive SPNs showed significantly higher frequencies of an ill-defined margin, patient age > 40.5 years, and tumor size < 42.1 mm, but lower frequencies of complete capsule, hemorrhage compared with non-aggressive SPNs (p < 0.05). Lack of complete capsule and age > 40.5 years were independent risk factors of aggressive SPNs (odd ratio 7.08 and 3.1, respectively). When we applied the two predictors in the logistic regression model, the area under the curve (AUC) was 0.77 with sensitivity of 86.7% and specificity of 55.4%.

Conclusion

Size less than 42.1 mm, lack of complete capsule, ill-defined, and absent bleeding are useful CT imaging features for predicating aggressive SPNs. Patient age > 40.5 years and lack of complete capsule showed acceptable diagnostic performance for discriminating aggressive from non-aggressive SPNs.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Bosman FT, Carneiro F, Hruban RH, Theise ND, Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system. International Agency for Research on Cancer.

  2. Law JK, Ahmed A, Singh VK, Akshintala VS, Olson MT, Raman SP, Ali SZ, Fishman EK, Kamel I, Canto MI, Dal Molin M, Moran RA, Khashab MA, Ahuja N, Goggins M, Hruban RH, Wolfgang CL, Lennon AM (2014) A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas 43 (3):331-337. https://doi.org/10.1097/mpa.0000000000000061

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yoon WJ, Lee JK, Lee KH, Ryu JK, Kim YT, Yoon YB (2008) Cystic neoplasms of the exocrine pancreas: an update of a nationwide survey in Korea. Pancreas 37 (3):254-258. https://doi.org/10.1097/MPA.0b013e3181676ba4

    Article  PubMed  Google Scholar 

  4. Lubezky N, Papoulas M, Lessing Y, Gitstein G, Brazowski E, Nachmany I, Lahat G, Goykhman Y, Ben-Yehuda A, Nakache R, Klausner JM (2017) Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 43 (6):1056-1060. https://doi.org/10.1016/j.ejso.2017.02.001

    Article  CAS  Google Scholar 

  5. Pancreatic Surgery of Chinese Academic Society of Young Surgeons (2018) The current status of diagnosis and treatment of pancreatic cystic neoplasm in China: a report of 2 251 cases. Zhonghua wai ke za zhi [Chinese journal of surgery] 56 (1):24-29. https://doi.org/10.3760/cma.j.issn.0529-5815.2018.01.007

    Article  Google Scholar 

  6. Papavramidis T, Papavramidis S (2005) Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. Journal of the American College of Surgeons 200 (6):965-972. https://doi.org/10.1016/j.jamcollsurg.2005.02.011

    Article  PubMed  Google Scholar 

  7. Jutric Z, Rozenfeld Y, Grendar J, et al. (2017) Analysis of 340 Patients with Solid Pseudopapillary Tumors of the Pancreas: a Closer Look at Patients with Metastatic Disease. Annals of surgical oncology 24(7):2015–2022. https://doi.org/10.1245/s10434-017-5772-z

    Article  PubMed  Google Scholar 

  8. Gao H, Gao Y, Yin L, Wang G, Wei J, Jiang K, Miao Y (2018) Risk Factors of the Recurrences of Pancreatic Solid Pseudopapillary Tumors: A Systematic Review and Meta-analysis. Journal of Cancer 9 (11):1905-1914. https://doi.org/10.7150/jca.24491

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gerry JM, Poultsides GA (2017) Surgical Management of Pancreatic Cysts: A Shifting Paradigm Toward Selective Resection. Digestive diseases and sciences 62 (7):1816-1826. https://doi.org/10.1007/s10620-017-4570-6

    Article  PubMed  Google Scholar 

  10. Wang X, Chen YH, Tan CL, Zhang H, Xiong JJ, Chen HY, Ke NW, Liu XB (2018) Enucleation of pancreatic solid pseudopapillary neoplasm: Short-term and long-term outcomes from a 7-year large single-center experience. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 44 (5):644-650. https://doi.org/10.1016/j.ejso.2018.01.085

    Article  Google Scholar 

  11. Zhang C, Liu F, Chang H, Li H, Zhou X, Lu J, Qin C, Sun Y, Sun H, Lin J (2015) Less Aggressive Surgical Procedure for Treatment of Solid Pseudopapillary Tumor: Limited Experience from a Single Institute. PloS one 10 (11):e0143452. https://doi.org/10.1371/journal.pone.0143452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Stewart CL, Meguid C, Chapman B, Schulick R, Edil BH (2016) Evolving Trends Towards Minimally Invasive Surgery for Solid-Pseudopapillary Neoplasms. Annals of surgical oncology 23 (13):4165-4168. https://doi.org/10.1245/s10434-016-5491-x

    Article  PubMed  Google Scholar 

  13. Ercelep O, Ozdemir N, Turan N, Topcu TO, Uysal M, Tanriverdi O, Demirci U, Taskoylu BY, Urakci Z, Duran AO, Aksoy A, Menekse S, Ozcelik M, Gumus M (2018) Retrospective evaluation of patients diagnosed solid pseudopapillary neoplasms of the pancreas. Current problems in cancer. https://doi.org/10.1016/j.currproblcancer.2018.06.014

  14. Kim CW, Han DJ, Kim J, Kim YH, Park JB, Kim SC (2011) Solid pseudopapillary tumor of the pancreas: can malignancy be predicted? Surgery 149 (5):625-634. https://doi.org/10.1016/j.surg.2010.11.005

    Article  PubMed  Google Scholar 

  15. Sacco Casamassima MG, Gause CD, Goldstein SD, Abdullah F, Meoded A, Lukish JR, Wolfgang CL, Cameron J, Hackam DJ, Hruban RH, Colombani PM (2016) Pancreatic surgery for tumors in children and adolescents. Pediatric surgery international 32 (8):779-788. https://doi.org/10.1007/s00383-016-3925-y

    Article  PubMed  Google Scholar 

  16. Lee JH, Yu JS, Kim H, Kim JK, Kim TH, Kim KW, Park MS, Kim JH, Kim YB, Park C (2008) Solid pseudopapillary carcinoma of the pancreas: differentiation from benign solid pseudopapillary tumour using CT and MRI. Clin Radiol 63 (9):1006-1014. https://doi.org/10.1016/j.crad.2008.04.007

    Article  CAS  PubMed  Google Scholar 

  17. Park MJ, Lee JH, Kim JK, Kim YC, Park MS, Yu JS, Kim YB, Lee D (2014) Multidetector CT imaging features of solid pseudopapillary tumours of the pancreas in male patients: distinctive imaging features with female patients. The British journal of radiology 87 (1035):20130513. https://doi.org/10.1259/bjr.20130513

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Marchegiani G, Andrianello S, Massignani M, Malleo G, Maggino L, Paiella S, Ferrone CR, Luchini C, Scarpa A, Capelli P, Mino-Kenudson M, Lillemoe KD, Bassi C, Castillo CF, Salvia R (2016) Solid pseudopapillary tumors of the pancreas: Specific pathological features predict the likelihood of postoperative recurrence. Journal of surgical oncology 114 (5):597-601. https://doi.org/10.1002/jso.24380

    Article  PubMed  Google Scholar 

  19. Li DL, Li HS, Xu YK, Wang QS, Chen RY, Zhou F (2018) Solid pseudopapillary tumor of the pancreas: clinical features and imaging findings. Clinical imaging 48:113-121. https://doi.org/10.1016/j.clinimag.2017.10.006

    Article  PubMed  Google Scholar 

  20. Wang P, Wei J, Wu J, Xu W, Chen Q, Gao W, Jiang K, Miao Y (2018) Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases. Pancreatology : official journal of the International Association of Pancreatology (IAP) [et al] 18 (4):415-419. https://doi.org/10.1016/j.pan.2017.12.012

  21. Fu XB, Hao ZQ, He JY, Shang H, Fu QC, Hua XD, Liu YF, Lin J (2017) Pathology comparative study on the characteristic CT signs in solid pseudopapillary neoplasm of the pancreas. Experimental and therapeutic medicine 13 (6):3523-3528. https://doi.org/10.3892/etm.2017.4382

    Article  PubMed  PubMed Central  Google Scholar 

  22. Raman SP, Kawamoto S, Law JK, Blackford A, Lennon AM, Wolfgang CL, Hruban RH, Cameron JL, Fishman EK (2013) Institutional experience with solid pseudopapillary neoplasms: focus on computed tomography, magnetic resonance imaging, conventional ultrasound, endoscopic ultrasound, and predictors of aggressive histology. Journal of computer assisted tomography 37 (5):824-833. https://doi.org/10.1097/RCT.0b013e31829d44fa

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kang CM, Choi SH, Kim SC, Lee WJ, Choi DW, Kim SW (2014) Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection: a multicenter analysis in Korea. Annals of surgery 260 (2):348-355. https://doi.org/10.1097/sla.0000000000000583

    Article  PubMed  Google Scholar 

  24. . Rastogi A, Assing M, Taggart M, Rao B, Sun J, Elsayes K, Tamm E, Bhosale P (2018) Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm? J Comput Assist Tomogr 42 (3):405-411. https://doi.org/10.1097/rct.0000000000000698

    Article  PubMed  PubMed Central  Google Scholar 

  25. Baek JH, Lee JM, Kim SH, Kim SJ, Kim SH, Lee JY, Han JK, Choi BI (2010) Small (<or=3 cm) solid pseudopapillary tumors of the pancreas at multiphasic multidetector CT. Radiology 257 (1):97-106. https://doi.org/10.1148/radiol.10092089

    Article  PubMed  Google Scholar 

  26. Xu Y, Zhao G, Pu N, Nuerxiati A, Ji Y, Zhang L, Rong Y, Lou W, Wang D, Kuang T, Xu X, Wu W (2017) One Hundred Twenty-One Resected Solid Pseudopapillary Tumors of the Pancreas: An 8-Year Single-Institution Experience at Zhongshan Hospital, Shanghai, China. Pancreas 46 (8):1023-1028. https://doi.org/10.1097/mpa.0000000000000885

    Article  PubMed  Google Scholar 

  27. Liszka L, Mrowiec S, Pajak J, Kostrzab-Zdebel A, Lampe P, Kajor M (2014) Limited usefulness of histopathological features in identification of a clinically aggressive solid-pseudopapillary neoplasm of the pancreas. Polish journal of pathology : official journal of the Polish Society of Pathologists 65 (3):182-193. https://doi.org/10.5114/PJP.2014.45780

    Article  CAS  Google Scholar 

  28. Estrella JS, Lei L, Asif R, Hua W, Katz MH, Fleming JB, Abbruzzese JL, Huamin W (2014) Solid pseudopapillary neoplasm of the pancreas: clinicopathologic and survival analyses of 64 cases from a single institution. American Journal of Surgical Pathology 38 (2):147-157. https://doi.org/10.1097/PAS.0000000000000141

    Article  PubMed  Google Scholar 

  29. Yin Q, Wang M, Wang C, Wu Z, Yuan F, Chen K, Tang Y, Zhao X, Miao F (2012) Differentiation between benign and malignant solid pseudopapillary tumor of the pancreas by MDCT. European journal of radiology 81 (11):3010-3018. https://doi.org/10.1016/j.ejrad.2012.03.013

    Article  PubMed  Google Scholar 

  30. Kim MJ, Choi DW, Choi SH, Heo JS, Sung JY (2014) Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy. The British journal of surgery 101 (10):1266-1271. https://doi.org/10.1002/bjs.9577

    Article  CAS  PubMed  Google Scholar 

  31. Lin MY, Stabile BE (2010) Solid pseudopapillary neoplasm of the pancreas: a rare and atypically aggressive disease among male patients. Am Surg 76 (10):1075-1078.

    PubMed  Google Scholar 

  32. Hirabayashi K, Kurokawa S, Maruno A, Yamada M, Kawaguchi Y, Nakagohri T, Mine T, Sugiyama T, Tajiri T, Nakamura N (2015) Sex differences in immunohistochemical expression and capillary density in pancreatic solid pseudopapillary neoplasm. Annals of diagnostic pathology 19 (2):45-49. https://doi.org/10.1016/j.anndiagpath.2015.02.002

    Article  PubMed  Google Scholar 

  33. Choi JY, Kim MJ, Kim JH, Kim SH, Lim JS, Oh YT, Chung JJ, Yoo HS, Lee JT, Kim KW (2006) Solid pseudopapillary tumor of the pancreas: typical and atypical manifestations. AJR American journal of roentgenology 187 (2):W178-186. https://doi.org/10.2214/ajr.05.0569

    Article  PubMed  Google Scholar 

  34. Anil G, Zhang J, Al Hamar NE, Nga ME (2017) Solid pseudopapillary neoplasm of the pancreas: CT imaging features and radiologic-pathologic correlation. Diagnostic and interventional radiology (Ankara, Turkey) 23 (2):94-99. https://doi.org/10.5152/dir.2016.16104

    Article  Google Scholar 

  35. Hanada K, Kurihara K, Itoi T, Katanuma A, Sasaki T, Hara K, Nakamura M, Kimura W, Suzuki Y, Sugiyama M, Ohike N, Fukushima N, Shimizu M, Ishigami K, Gabata T, Okazaki K (2018) Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. Pancreas 47 (8):1019-1026. https://doi.org/10.1097/mpa.0000000000001114

    Article  PubMed  Google Scholar 

  36. Machado MC, Machado MA, Bacchella T, Jukemura J, Almeida JL, Cunha JE (2008) Solid pseudopapillary neoplasm of the pancreas: distinct patterns of onset, diagnosis, and prognosis for male versus female patients. Surgery 143 (1):29–34. https://doi.org/10.1016/j.surg.2007.07.030

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all authors for their continuous and excellent support with patient data collection, imaging analysis, statistical analysis, and valuable suggestions for the article.

Funding

This study was supported by the Key Program of Research and Development of Jiangsu Province (BE2017772) and the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX18_1651).

Author information

Affiliations

  1. Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, Jiangsu, China

    Jianhua Wang, Xiao Chen, Cheng Wang, Wenjing Cui, Shuai Ren, Zhonglan Wang & Zhongqiu Wang

  2. Department of Pathology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China

    Hui Li

Authors
  1. Jianhua Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenjing Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shuai Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhonglan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhongqiu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhongqiu Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed content

Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to CECT examinations by written consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, J., Chen, X., Wang, C. et al. Differentiation of aggressive from non-aggressive pancreatic solid pseudopapillary neoplasms using computed tomography. Abdom Radiol 44, 2448–2458 (2019). https://doi.org/10.1007/s00261-019-01969-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-01969-6

Keywords

  • Solid pseudopapillary neoplasm
  • Pancreas
  • Aggressive
  • Computed tomography