Dynamic computed tomography is useful for prediction of pathological grade in pancreatic neuroendocrine neoplasm

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Abstract

Background and Aim: Pathological grading is important in defining the therapeutic strategy in pancreatic neuroendocrine neoplasm (PNEN) but is difficult for unresectable cases. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in the diagnosis of PNEN, but its usefulness for pathological grading is not well established. No studies have examined the diagnostic ability of dynamic computed tomography (CT) for pathological grading of PNEN. We investigated the usefulness of EUS–FNA and dynamic CT in the diagnosis and pathological grading of PNEN. Methods: In this retrospective study, 39 PNEN patients finally diagnosed via EUS–FNA and/or surgical resection underwent dynamic CT. Pathological samples were diagnosed based on WHO2010; staging was based on the European Neuroendocrine Tumor Society classification. The proportion of the quantification value in the tumor to the pancreatic parenchyma in arterial phase was defined as the CT ratio. Immunohistochemical staining with CD31 was performed to evaluate microvessel density (MVD). We evaluated the relationship between pathological grade, CT ratio, and MVD. Results: By using EUS–FNA, 35 of 39 (90%) cases were diagnosed as PNEN. As for pathological grade, 15 of 35 (43%) cases could be identified correctly. CT ratio could predict pathological Grade 3 disease. The sensitivity, specificity, and diagnostic accuracy were 100%, 94%, and 95%. MVD was significantly correlated with CT ratio (r = 0.83, P < 0.0001) and pathological grade (P = 0.0074). Conclusions: Computed tomography ratio has a relationship with pathological grade in PNEN, which would help decide therapeutic strategy in unresectable cases and cases in which pathological grading is difficult.

Original languageEnglish
Pages (from-to)925-931
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume32
Issue number4
DOIs
Publication statusPublished - Apr 1 2017

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Pancreatic Neoplasms
Tomography
Microvessels
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Retrospective Studies
Staining and Labeling
Sensitivity and Specificity
Therapeutics
Neoplasms

Keywords

  • dynamic CT
  • microvessel density
  • pancreatic neuroendocrine neoplasm
  • pathological grade
  • WHO2010

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{57dcd85d5d0245c0b0f97f9cd47c8714,
title = "Dynamic computed tomography is useful for prediction of pathological grade in pancreatic neuroendocrine neoplasm",
abstract = "Background and Aim: Pathological grading is important in defining the therapeutic strategy in pancreatic neuroendocrine neoplasm (PNEN) but is difficult for unresectable cases. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in the diagnosis of PNEN, but its usefulness for pathological grading is not well established. No studies have examined the diagnostic ability of dynamic computed tomography (CT) for pathological grading of PNEN. We investigated the usefulness of EUS–FNA and dynamic CT in the diagnosis and pathological grading of PNEN. Methods: In this retrospective study, 39 PNEN patients finally diagnosed via EUS–FNA and/or surgical resection underwent dynamic CT. Pathological samples were diagnosed based on WHO2010; staging was based on the European Neuroendocrine Tumor Society classification. The proportion of the quantification value in the tumor to the pancreatic parenchyma in arterial phase was defined as the CT ratio. Immunohistochemical staining with CD31 was performed to evaluate microvessel density (MVD). We evaluated the relationship between pathological grade, CT ratio, and MVD. Results: By using EUS–FNA, 35 of 39 (90{\%}) cases were diagnosed as PNEN. As for pathological grade, 15 of 35 (43{\%}) cases could be identified correctly. CT ratio could predict pathological Grade 3 disease. The sensitivity, specificity, and diagnostic accuracy were 100{\%}, 94{\%}, and 95{\%}. MVD was significantly correlated with CT ratio (r = 0.83, P < 0.0001) and pathological grade (P = 0.0074). Conclusions: Computed tomography ratio has a relationship with pathological grade in PNEN, which would help decide therapeutic strategy in unresectable cases and cases in which pathological grading is difficult.",
keywords = "dynamic CT, microvessel density, pancreatic neuroendocrine neoplasm, pathological grade, WHO2010",
author = "Shigeru Horiguchi and Hironari Katou and Hidenori Shiraha and Koichiro Tsutsumi and Naoki Yamamoto and Kazuyuki Matsumoto and Takeshi Tomoda and Daisuke Uchida and Yutaka Akimoto and Syou Mizukawa and Takehiro Tanaka and Koichi Ichimura and Akinobu Takaki and Takahito Yagi and Hiroyuki Okada",
year = "2017",
month = "4",
day = "1",
doi = "10.1111/jgh.13594",
language = "English",
volume = "32",
pages = "925--931",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
issn = "0815-9319",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Dynamic computed tomography is useful for prediction of pathological grade in pancreatic neuroendocrine neoplasm

AU - Horiguchi, Shigeru

AU - Katou, Hironari

AU - Shiraha, Hidenori

AU - Tsutsumi, Koichiro

AU - Yamamoto, Naoki

AU - Matsumoto, Kazuyuki

AU - Tomoda, Takeshi

AU - Uchida, Daisuke

AU - Akimoto, Yutaka

AU - Mizukawa, Syou

AU - Tanaka, Takehiro

AU - Ichimura, Koichi

AU - Takaki, Akinobu

AU - Yagi, Takahito

AU - Okada, Hiroyuki

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background and Aim: Pathological grading is important in defining the therapeutic strategy in pancreatic neuroendocrine neoplasm (PNEN) but is difficult for unresectable cases. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in the diagnosis of PNEN, but its usefulness for pathological grading is not well established. No studies have examined the diagnostic ability of dynamic computed tomography (CT) for pathological grading of PNEN. We investigated the usefulness of EUS–FNA and dynamic CT in the diagnosis and pathological grading of PNEN. Methods: In this retrospective study, 39 PNEN patients finally diagnosed via EUS–FNA and/or surgical resection underwent dynamic CT. Pathological samples were diagnosed based on WHO2010; staging was based on the European Neuroendocrine Tumor Society classification. The proportion of the quantification value in the tumor to the pancreatic parenchyma in arterial phase was defined as the CT ratio. Immunohistochemical staining with CD31 was performed to evaluate microvessel density (MVD). We evaluated the relationship between pathological grade, CT ratio, and MVD. Results: By using EUS–FNA, 35 of 39 (90%) cases were diagnosed as PNEN. As for pathological grade, 15 of 35 (43%) cases could be identified correctly. CT ratio could predict pathological Grade 3 disease. The sensitivity, specificity, and diagnostic accuracy were 100%, 94%, and 95%. MVD was significantly correlated with CT ratio (r = 0.83, P < 0.0001) and pathological grade (P = 0.0074). Conclusions: Computed tomography ratio has a relationship with pathological grade in PNEN, which would help decide therapeutic strategy in unresectable cases and cases in which pathological grading is difficult.

AB - Background and Aim: Pathological grading is important in defining the therapeutic strategy in pancreatic neuroendocrine neoplasm (PNEN) but is difficult for unresectable cases. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in the diagnosis of PNEN, but its usefulness for pathological grading is not well established. No studies have examined the diagnostic ability of dynamic computed tomography (CT) for pathological grading of PNEN. We investigated the usefulness of EUS–FNA and dynamic CT in the diagnosis and pathological grading of PNEN. Methods: In this retrospective study, 39 PNEN patients finally diagnosed via EUS–FNA and/or surgical resection underwent dynamic CT. Pathological samples were diagnosed based on WHO2010; staging was based on the European Neuroendocrine Tumor Society classification. The proportion of the quantification value in the tumor to the pancreatic parenchyma in arterial phase was defined as the CT ratio. Immunohistochemical staining with CD31 was performed to evaluate microvessel density (MVD). We evaluated the relationship between pathological grade, CT ratio, and MVD. Results: By using EUS–FNA, 35 of 39 (90%) cases were diagnosed as PNEN. As for pathological grade, 15 of 35 (43%) cases could be identified correctly. CT ratio could predict pathological Grade 3 disease. The sensitivity, specificity, and diagnostic accuracy were 100%, 94%, and 95%. MVD was significantly correlated with CT ratio (r = 0.83, P < 0.0001) and pathological grade (P = 0.0074). Conclusions: Computed tomography ratio has a relationship with pathological grade in PNEN, which would help decide therapeutic strategy in unresectable cases and cases in which pathological grading is difficult.

KW - dynamic CT

KW - microvessel density

KW - pancreatic neuroendocrine neoplasm

KW - pathological grade

KW - WHO2010

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DO - 10.1111/jgh.13594

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