Abstract
Purpose
Pancreatic fibrosis or fibrosing reactions have been reported in intraductal papillary-mucinous neoplasm (IPMN) patients. We assessed whether a higher elastic modulus (EM) measured using shear wave elastography (SW-EG) correlated with the existence of branch-duct (BD) IPMN.
Methods
In total, 183 normal pancreas (NP) and 123 BD-IPMN cases were enrolled. First, we assessed the difference in pancreatic EM (PEM) at different sites (head or tail side of the cyst). Second, a comparison was done between the median PEM of the NP and the BD-IPMN cases. Receiver-operating characteristic analysis was performed to determine the BD-IPMN diagnostic capabilities. Finally, in patients whose cyst was not visualized, the test-positive rate was determined.
Results
No significant difference was seen between the cyst head side PEM (4.61 kPa) and the tail side PEM (5.35 kPa) (P = 0.471). Among these cases matched by age, 73 were selected each from NP and BD-IPMN cases (median age 65 years). The median PEM of the BD-IPMN cases (5.18 kPa) was significantly higher than that of the NP cases (3.17 kPa) (P < 0.001). When the cut-off value was set at 4.75 kPa, the sensitivity, specificity, PPV, NPV, and accuracy were 75.3%, 64.4%, 72.3%, 67.9%, and 69.9%, respectively. The cut-off value of 4.75 kPa helped for the indirect selection of BD-IPMN patients (10/17, 58.8%) whose cyst was not detected on B-mode ultrasonography.
Conclusion
SW-EG measurement of the underlying pancreatic parenchyma may correlate with the presence of BD-IPMN.
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References
Yamaguchi K, Kanemitsu S, Hatori T, et al. Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas. 2011;40:571–80.
Longnecker DS, Adler G, Hruban RH, et al. Intraductal papillary-mucinous neoplasm of the pancreas. In: Hamilton SR, Aalton LA, editors. WHO classification of tumors. Pathology and genetics of tumors of the digestive system. Lyon: IARC Press; 2000. p. 237–41.
Tanaka S, Nakao M, Ioka T, et al. Slight dilatation of the main pancreatic duct and presence of pancreatic cysts as predictive signs of pancreatic cancer: a prospective study. Radiology. 2010;254:965–72.
Sumi H, Itoh A, Kawashima H, et al. Preliminary study on evaluation of the pancreatic tail observable limit of transabdominal ultrasonography using a position sensor and CT-fusion image. Eur J Radiol. 2014;83:1324–31.
Kakizaki Y, Makino N, Tozawa T, et al. Stromal fibrosis and expression of matricellular proteins correlate with histological grade of intraductal papillary mucinous neoplasm of the pancreas. Pancreas. 2016;45:1145–52.
Shiina T. JSUM ultrasound elastography practice guidelines: basics and terminology. J Med Ultrason. 2013;40:309–23.
Hirooka Y, Kuwahara T, Irisawa A, et al. JSUM ultrasound elastography practice guidelines: pancreas. J Med Ultrason. 2015;42:151–74.
Kuwahara T, Hirooka Y, Kawashima H, et al. Quantitative evaluation of pancreatic tumor fibrosis using shear wave elastography. Pancreatology. 2016;16:1063–8.
Ito Y, Ito A, Kawashima H, et al. Quantitative analysis of diagnosing pancreatic fibrosis using EUS-elastography (comparison with surgical specimens). J Gastroenterol. 2014;49:1183–92.
Chantarojanasiri T, Hirooka Y, Ratanachu-Ek T, et al. Evolution of pancreas in aging: degenerative variation or early changes of disease? J Med Ultrason. 2015;42:177–83.
Stumpf S, Jaeger H, Greater T, et al. Elasto-study Group Ulm. Influence of age, sex, body mass index, alcohol, and smoking on shear wave velocity (p-SWE) of the pancreas. Abdom Radiol (NY). 2016;41:1310–6.
Tanaka M, Kobayashi K, Mizumoto K, et al. Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol. 2005;40:669–75.
Suzuki Y, Atomi Y, Sugiyama M, et al. Cystic neoplasm of the intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas. 2004;28:241–6.
Ringold DA, Shroff P, Sikka SK, et al. Pancreatitis is frequent among patients with side-branch intraductal papillary mucinous neoplasia diagnosed by EUS. Gastrointest Endosc. 2009;70:488–94.
Bastid C, Bernard JP, Sarles H, et al. Mucinous ductal ectasia of the pancreas: a premalignant disease and a cause of obstructive pancreatitis. Pancreas. 1991;6:15–22.
Loftus EV Jr, Olivares-Pakzad BA, Batts KP, et al. Intraductal papillary-mucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Members of the Pancreas Clinic, and Pancreatic Surgeons of Mayo Clinic. Gastroenterology. 1996;110:1909–18.
Suda K, Mogami M, Oyama T, et al. Histopathological and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: special emphasis on ductal obstruction and genesis of pancreatitis. Am J Gastroenterol. 1990;85:271–6.
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Koya, T., Kawashima, H., Ohno, E. et al. Increased hardness of the underlying pancreas correlates with the presence of intraductal papillary-mucinous neoplasm in a limited number of cases. J Med Ultrasonics 46, 441–447 (2019). https://doi.org/10.1007/s10396-019-00956-0
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DOI: https://doi.org/10.1007/s10396-019-00956-0