Effectiveness of Focal Pancreatic Parenchymal Atrophy in Diagnosing High-Grade Pancreatic Intraepithelial Neoplasia/Carcinoma in Situ

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11-Aug-2522.pdf
Published Aug 16, 2021
DOI: https://doi.org/10.18103/mra.v9i8.2522

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Masataka Kikuyama
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Jun Nakahodo
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Goro Honda
Department of Surgery, Tokyo Woman Medical University, Tokyo, Japan
Shinichiro Horiguchi
Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Mizuka Suzuki
Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Kazurou Chiba
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Hiroki Tabata
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Yuichiro Ome
Department of Surgery, Tokyo Woman Medical University, Tokyo, Japan
Terumi Kamisawa
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

Abstract

To improve the poor prognosis of pancreatic ductal adenocarcinoma (PDAC), the diagnosis of early-stage PDAC is essential. In particular, the diagnosis of high-grade intraepithelial pancreatic neoplasia/carcinoma in situ (HG-PanIN/CIS) is the best option. However, it is almost impossible to directly observe HG-PanIN/CIS. Thus, identifying a secondary imaging finding due to the disorder is important. Focal pancreatic parenchymal atrophy (FPPA) and hypoechoic area have been reported as preferred secondary signs. We studied 50 patients to clarify the effectiveness of FPPA in diagnosing HG-PanIN/CIS. Most patients had the opportunity to undergo further examination due to the presence of a cyst. Among the 50 patients, 23 (46%) had positive results for serial pancreatic-juice aspiration cytologic examination (SPACE), which has high sensitivity and specificity for diagnosing PADC; 20 of the 23 (87.0%) patients underwent surgery to resect the pancreatic part including the FPPA. Distal pancreatectomy and pancreatoduodenectomy were performed in 19 patients and one patient, respectively. In 13 of the 20 (65%) patients, histopathological examination revealed HG-PanIN/CIS in the pancreatic ductal epithelium of the resected specimens. FPPA could indicate HG-PanIN/CIS, but not satisfactorily. One of the factors for the unsatisfactory results might be the difficulty in identifying FPPA in the pancreatic head area. On the other hand, a pancreatic cyst, especially in the area of FPPA, could lead to the diagnosis of HG-PanIN/CIS. The size of the cyst does not affect the diagnosis of HG-PanIN/CIS.

Keywords: pancreatic cancer, PDAC, serial pancreatic-juice aspiration cytologic examination, SPACE, hypoechoic area, pancreatic cyst

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KIKUYAMA, Masataka et al. Effectiveness of Focal Pancreatic Parenchymal Atrophy in Diagnosing High-Grade Pancreatic Intraepithelial Neoplasia/Carcinoma in Situ. Medical Research Archives, [S.l.], v. 9, n. 8, aug. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2522>. Date accessed: 19 apr. 2024. doi: https://doi.org/10.18103/mra.v9i8.2522.
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Issue
Vol 9 No 8 (2021): Vol.9 Issue 8 August 2021
Section
Research Articles

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