CT features differentiate nonhypervascular pancreatic neuroendocrine neoplasm and pancreatic ductal adenocarcinoma: preliminary study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Zixing , YU Haopeng , LI Mou , WANG Yi ,  SONG Bin

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

SONG Bin, Email: cjr.songbin@vip.163.com

Keywords：

pancreatic neuroendocrine neoplasm; pancreatic ductal adenocarcinoma; computed tomography

DOI：

10.7507/1007-9424.201809016

Video：

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Objective To explore CT features that can be used to identify nonhypervascular pancreatic neuroendocrine neoplasm (pNEN) and pancreatic ductal adenocarcinoma (PDAC). Methods The patients with pathologically confirmed the pNEN and PDAC were retrospectively included from May 2010 to May 2017. The CT features were analyzed. The CT features were extracted by the multivariate logistic regression, and their diagnostic performances were calculated. Results Forty patients with the nonhypervascular pNEN (33 unfunctional, 7 functional) and 80 patients with the PDAC were included in this study. The features of significant differences between the nonhypervascular pNEN and the PDAC included: the location, long diameter, margin, uniform lesions, calcification, and vascular shadows of the lesion (P<0.05). The margin ［OR=14.63, 95% CI (2.82, 75.99)］, calcification ［OR=4.00, 95% CI (1.03, 15.59)］, and location ［OR=3.09, 95% CI(1.19, 7.99)］ of the lesion could independently identify the nonhypervascular pNEN. The multivariate logistic regression model of the differential diagnosis of the nonhypervascular pNEN and PDAC was obtained through the CT features of significant differences. The diagnostic sensitivity was 70.00%, 95% CI (53.5,83.4); specificity was 83.54%, 95% CI (73.5, 90.9); and area under the receiver operating curve was 0.824, 95% CI (0.743, 0.887). Conclusions Multivariate logistic regression model of CT features is helpful for differential diagnosis of nonhypervascular pNEN and PDAC. Features of margin and calcification of lesion are more valuable in differential diagnosis of nonhypervascular pNEN and PDAC.

Citation： HUANG Zixing, YU Haopeng, LI Mou, WANG Yi, SONG Bin. CT features differentiate nonhypervascular pancreatic neuroendocrine neoplasm and pancreatic ductal adenocarcinoma: preliminary study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(11): 1375-1379. doi: 10.7507/1007-9424.201809016 Copy

1.	Hallet J, Law CH, Cukier M, et al. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer, 2015, 121(4): 589-597.
2.	中國臨床腫瘤學會神經內分泌腫瘤專家委員會. 中國胃腸胰神經內分泌腫瘤專家共識 (2016 年版). 臨床腫瘤學雜志, 2016, 21(10): 927-946.
3.	張雨晴, 馬莉, 賀宇彤, 等. 2001~2010 年中國胰腺神經內分泌腫瘤的臨床流行病學特征分析. 中國腫瘤, 2016, 25(5): 329-333.
4.	張雨晴, 范金虎, 喬友林, 等. 中國胃腸胰腺神經內分泌腫瘤的十年回顧性臨床流行病學研究. 公共衛生, 2016.
5.	王齊艷, 黃子星, 吳明蓬, 等. 胰腺神經內分泌腫瘤的多層螺旋 CT 表現與其病理分級的關系. 中國普外基礎與臨床雜志, 2016, 23(2): 243-247.
6.	張笑, 王齊艷, 黃子星, 等. 基于文獻計量學的胰腺神經內分泌腫瘤的影像學研究熱點分析. 中國普外基礎與臨床雜志, 2015, 22(8): 1007-1013.
7.	劉曦嬌, 王威亞, 黃子星, 等. 胰腺神經內分泌癌的影像學表現. 中國普外基礎與臨床雜志, 2012, 19(10): 1126-1129.
8.	Jeon SK, Lee JM, Joo I, et al. Nonhypervascular pancreatic neuroendocrine tumors: differential diagnosis from pancreatic ductal adenocarcinomas at MR imaging-retrospective cross-sectional study. Radiology, 2017, 284(1): 77-87.
9.	Ichikawa T, Peterson MS, Federle MP, et al. Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology, 2000, 216(1): 163-171.
10.	Stafford-Johnson DB, Francis IR, Eckhauser FE, et al. Dual-phase helical CT of nonfunctioning islet cell tumors. J Comput Assist Tomogr, 1998, 22(2): 335-339.
11.	De Robertis R, Tinazzi Martini P, Cingarlini S, et al. Digital subtraction of magnetic resonance images improves detection and characterization of pancreatic neuroendocrine neoplasms. J Comput Assist Tomogr, 2017, 41(4): 614-618.
12.	Park HS, Kim SY, Hong SM, et al. Hypervascular solid-appearing serous cystic neoplasms of the pancreas: Differential diagnosis with neuroendocrine tumours. Eur Radiol, 2016, 26(5): 1348-1358.
13.	Al-Hawary MM, Francis IR, Chari ST, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology, 2014, 270(1): 248-260.
14.	馮婷婷, 凌孫彬, 劉碧霞, 等. 非功能型胰腺神經內分泌腫瘤手術預后分析— 一項基于 SEER 數據庫的回顧性研究. 中國腫瘤, 2017, 26(11): 910-914.
15.	Ito T, Hijioka S, Masui T, et al. Advances in the diagnosis and treatment of pancreatic neuroendocrine neoplasms in Japan. J Gastroenterol, 2017, 52(1): 9-18.
16.	Karakaxas D, Gazouli M, Liakakos T, et al. Pancreatic neuroendocrine tumors: current opinions on a rare, but potentially curable neoplasm. Eur J Gastroenterol Hepatol, 2014, 26(8): 826-835.
17.	Masciocchi M. Pancreatic imaging. Endocrinol Metab Clin North Am, 2017, 46(3): 761-781.
18.	Baur AD, Pavel M, Prasad V, et al. Diagnostic imaging of pancreatic neuroendocrine neoplasms (pNEN): tumor detection, staging, prognosis, and response to treatment. Acta Radiol, 2016, 57(3): 260-270.
19.	Ohmoto A, Rokutan H, Yachida S. Pancreatic neuroendocrine neoplasms: basic biology, current treatment strategies and prospects for the future. Int J Mol Sci, 2017, 18(1): pii: E143.
20.	Jin K, Xu J, Chen J, et al. Surgical management for non-functional pancreatic neuroendocrine neoplasms with synchronous liver metastasis: A consensus from the Chinese Study Group for Neuroendocrine Tumors (CSNET). Int J Oncol, 2016, 49(5): 1991-2000.
21.	Tamburrino D, Partelli S, Renzi C, et al. Systematic review and meta-analysis on laparoscopic pancreatic resections for neuroendocrine neoplasms (PNENs). Expert Rev Gastroenterol Hepatol, 2017, 11(1): 65-73.
22.	Partelli S, Cirocchi R, Crippa S, et al. Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg, 2017, 104(1): 34-41.
23.	張永嫦, 于浩鵬, 李謀, 等. CT 圖像紋理分析鑒別乏血供胰腺神經內分泌腫瘤與胰腺導管腺癌. 中國普外基礎與臨床雜志, 2018, 25(6): 748-753.
24.	Berenguer R, Pastor-Juan MDR, Canales-Vázquez J, et al. Radiomics of CT features may be nonreproducible and redundant: influence of CT acquisition parameters. Radiology, 2018, 288(2): 407-415.
25.	羅國培, 金凱舟, 程合, 等. 改良胰腺神經內分泌腫瘤分期的臨床解讀. 中國癌癥雜志, 2017, 27(5): 321-325.
26.	Lesniak RJ, Hohenwalter MD, Taylor AJ. Spectrum of causes of pancreatic calcifications. AJR Am J Roentgenol, 2002, 178(1): 79-86.
27.	Verde F, Fishman EK. Calcified pancreatic and peripancreatic neoplasms: spectrum of pathologies. Abdom Radiol (NY), 2017, 42(11): 2686-2697.
28.	Kuo JH, Lee JA, Chabot JA. Nonfunctional pancreatic neuroendocrine tumors. Surg Clin North Am, 2014, 94(3): 689-708.
29.	Manuel-Vazquez A, Ramia JM, Latorre-Fragua R, et al. Pancreatic neuroendocrine tumors and intraductal papillary mucinous neoplasm of the pancreas: a systematic review. Pancreas, 2018, 47(5): 551-555.

1. Hallet J, Law CH, Cukier M, et al. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer, 2015, 121(4): 589-597.
2. 中國臨床腫瘤學會神經內分泌腫瘤專家委員會. 中國胃腸胰神經內分泌腫瘤專家共識 (2016 年版). 臨床腫瘤學雜志, 2016, 21(10): 927-946.
3. 張雨晴, 馬莉, 賀宇彤, 等. 2001~2010 年中國胰腺神經內分泌腫瘤的臨床流行病學特征分析. 中國腫瘤, 2016, 25(5): 329-333.
4. 張雨晴, 范金虎, 喬友林, 等. 中國胃腸胰腺神經內分泌腫瘤的十年回顧性臨床流行病學研究. 公共衛生, 2016.
5. 王齊艷, 黃子星, 吳明蓬, 等. 胰腺神經內分泌腫瘤的多層螺旋 CT 表現與其病理分級的關系. 中國普外基礎與臨床雜志, 2016, 23(2): 243-247.
6. 張笑, 王齊艷, 黃子星, 等. 基于文獻計量學的胰腺神經內分泌腫瘤的影像學研究熱點分析. 中國普外基礎與臨床雜志, 2015, 22(8): 1007-1013.
7. 劉曦嬌, 王威亞, 黃子星, 等. 胰腺神經內分泌癌的影像學表現. 中國普外基礎與臨床雜志, 2012, 19(10): 1126-1129.
8. Jeon SK, Lee JM, Joo I, et al. Nonhypervascular pancreatic neuroendocrine tumors: differential diagnosis from pancreatic ductal adenocarcinomas at MR imaging-retrospective cross-sectional study. Radiology, 2017, 284(1): 77-87.
9. Ichikawa T, Peterson MS, Federle MP, et al. Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology, 2000, 216(1): 163-171.
10. Stafford-Johnson DB, Francis IR, Eckhauser FE, et al. Dual-phase helical CT of nonfunctioning islet cell tumors. J Comput Assist Tomogr, 1998, 22(2): 335-339.
11. De Robertis R, Tinazzi Martini P, Cingarlini S, et al. Digital subtraction of magnetic resonance images improves detection and characterization of pancreatic neuroendocrine neoplasms. J Comput Assist Tomogr, 2017, 41(4): 614-618.
12. Park HS, Kim SY, Hong SM, et al. Hypervascular solid-appearing serous cystic neoplasms of the pancreas: Differential diagnosis with neuroendocrine tumours. Eur Radiol, 2016, 26(5): 1348-1358.
13. Al-Hawary MM, Francis IR, Chari ST, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology, 2014, 270(1): 248-260.
14. 馮婷婷, 凌孫彬, 劉碧霞, 等. 非功能型胰腺神經內分泌腫瘤手術預后分析— 一項基于 SEER 數據庫的回顧性研究. 中國腫瘤, 2017, 26(11): 910-914.
15. Ito T, Hijioka S, Masui T, et al. Advances in the diagnosis and treatment of pancreatic neuroendocrine neoplasms in Japan. J Gastroenterol, 2017, 52(1): 9-18.
16. Karakaxas D, Gazouli M, Liakakos T, et al. Pancreatic neuroendocrine tumors: current opinions on a rare, but potentially curable neoplasm. Eur J Gastroenterol Hepatol, 2014, 26(8): 826-835.
17. Masciocchi M. Pancreatic imaging. Endocrinol Metab Clin North Am, 2017, 46(3): 761-781.
18. Baur AD, Pavel M, Prasad V, et al. Diagnostic imaging of pancreatic neuroendocrine neoplasms (pNEN): tumor detection, staging, prognosis, and response to treatment. Acta Radiol, 2016, 57(3): 260-270.
19. Ohmoto A, Rokutan H, Yachida S. Pancreatic neuroendocrine neoplasms: basic biology, current treatment strategies and prospects for the future. Int J Mol Sci, 2017, 18(1): pii: E143.
20. Jin K, Xu J, Chen J, et al. Surgical management for non-functional pancreatic neuroendocrine neoplasms with synchronous liver metastasis: A consensus from the Chinese Study Group for Neuroendocrine Tumors (CSNET). Int J Oncol, 2016, 49(5): 1991-2000.
21. Tamburrino D, Partelli S, Renzi C, et al. Systematic review and meta-analysis on laparoscopic pancreatic resections for neuroendocrine neoplasms (PNENs). Expert Rev Gastroenterol Hepatol, 2017, 11(1): 65-73.
22. Partelli S, Cirocchi R, Crippa S, et al. Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg, 2017, 104(1): 34-41.
23. 張永嫦, 于浩鵬, 李謀, 等. CT 圖像紋理分析鑒別乏血供胰腺神經內分泌腫瘤與胰腺導管腺癌. 中國普外基礎與臨床雜志, 2018, 25(6): 748-753.
24. Berenguer R, Pastor-Juan MDR, Canales-Vázquez J, et al. Radiomics of CT features may be nonreproducible and redundant: influence of CT acquisition parameters. Radiology, 2018, 288(2): 407-415.
25. 羅國培, 金凱舟, 程合, 等. 改良胰腺神經內分泌腫瘤分期的臨床解讀. 中國癌癥雜志, 2017, 27(5): 321-325.
26. Lesniak RJ, Hohenwalter MD, Taylor AJ. Spectrum of causes of pancreatic calcifications. AJR Am J Roentgenol, 2002, 178(1): 79-86.
27. Verde F, Fishman EK. Calcified pancreatic and peripancreatic neoplasms: spectrum of pathologies. Abdom Radiol (NY), 2017, 42(11): 2686-2697.
28. Kuo JH, Lee JA, Chabot JA. Nonfunctional pancreatic neuroendocrine tumors. Surg Clin North Am, 2014, 94(3): 689-708.
29. Manuel-Vazquez A, Ramia JM, Latorre-Fragua R, et al. Pancreatic neuroendocrine tumors and intraductal papillary mucinous neoplasm of the pancreas: a systematic review. Pancreas, 2018, 47(5): 551-555.

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CT features differentiate nonhypervascular pancreatic neuroendocrine neoplasm and pancreatic ductal adenocarcinoma: preliminary study

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