Humoral Predictors of Malignancy in IPMN: A Review of the Literature

Pancreatic cystic lesions are increasingly detected in cross-sectional imaging. Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system. IPMN is a potential precursor of pancreatic cancer. The transformation of IPMN in pancreatic cancer is progressive and requires the occurrence of low-grade dysplasia, high-grade dysplasia, and ultimately invasive cancer. Jaundice, enhancing mural nodule >5 mm, main pancreatic duct diameter >10 mm, and positive cytology for high-grade dysplasia are considered high-risk stigmata of malignancy. While increased levels of carbohydrate antigen 19-9 (CA 19-9) (>37 U/mL), main pancreatic duct diameter 5–9.9 mm, cyst diameter >40 mm, enhancing mural nodules <5 mm, IPMN-induced acute pancreatitis, new onset of diabetes, cyst grow-rate >5 mm/year are considered worrisome features of malignancy. However, cross-sectional imaging is often inadequate in the prediction of high-grade dysplasia and invasive cancer. Several studies evaluated the role of humoral and intra-cystic biomarkers in the prediction of malignancy in IPMN. Carcinoembryonic antigen (CEA), CA 19-9, intra-cystic CEA, intra-cystic glucose, and cystic fluid cytology are widely used in clinical practice to distinguish between mucinous and non-mucinous cysts and to predict the presence of invasive cancer. Other biomarkers such as cystic fluid DNA sequencing, microRNA (mi-RNA), circulating microvesicles, and liquid biopsy are the new options for the mini-invasive diagnosis of degenerated IPMN. The aim of this study is to review the literature to assess the role of humoral and intracystic biomarkers in the prediction of advanced IPMN with high-grade dysplasia or invasive carcinoma.

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Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus

BMJ Case Reports ◽

10.1136/bcr-2020-239485 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239485

Author(s):

Shwetambari Sonanis ◽

Benjamin Layton ◽

Oliver Nicholson ◽

DA Subar

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Splenic Artery ◽

Clinical Symptoms ◽

Cross Sectional ◽

Artery Pseudoaneurysm ◽

Risk Of Rupture ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Splenic Artery Pseudoaneurysm

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma—haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.

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EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross-sectional imaging in resected cases

Surgical Endoscopy ◽

10.1007/s00464-020-08166-3 ◽

2020 ◽

Author(s):

Sahar Wesali ◽

Mehmet A. Demir ◽

Caroline S. Verbeke ◽

Mats Andersson ◽

Svein Olav Bratlie ◽

...

Keyword(s):

Correct Diagnosis ◽

High Grade Dysplasia ◽

High Grade ◽

Cystic Lesions ◽

Tertiary Referral Centre ◽

Cross Sectional ◽

Surgical Specimen ◽

Prospective Comparison ◽

Cross Sectional Imaging ◽

Sectional Imaging

Abstract Background Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. Methods The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. Results Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, EUS-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). Conclusions EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma.

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Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring

Gut ◽

10.1136/gutjnl-2012-303957 ◽

2013 ◽

Vol 62 (12) ◽

pp. 1806-1816 ◽

Cited By ~ 67

Author(s):

Jose-Manuel Benitez ◽

Marie-Alice Meuwis ◽

Catherine Reenaers ◽

Catherine Van Kemseke ◽

Paul Meunier ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Monitoring ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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The Accuracy and Role of Cross-sectional Imaging in the Diagnosis of Acute Appendicitis

Advances in Surgery ◽

10.1016/j.yasu.2009.02.010 ◽

2009 ◽

Vol 43 (1) ◽

pp. 13-22 ◽

Cited By ~ 5

Author(s):

Joshua D. Hawkins ◽

Richard C. Thirlby

Keyword(s):

Acute Appendicitis ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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The Role of Cross-Sectional Imaging in the Investigation of Childhood Deaths

Essentials of Autopsy Practice ◽

10.1007/978-3-319-46997-3_1 ◽

2017 ◽

pp. 1-21

Author(s):

J. Ciaran Hutchinson ◽

Neil J. Sebire ◽

Owen J. Arthurs

Keyword(s):

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Optical coherence tomography of the pancreatic and bile ducts: are we ready for prime time?

Endoscopy International Open ◽

10.1055/a-1119-6248 ◽

2020 ◽

Vol 08 (05) ◽

pp. E644-E649

Author(s):

Amy Tyberg ◽

Isaac Raijman ◽

Aleksey A. Novikov ◽

Divyesh V. Sejpal ◽

Petros C. Benias ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Pancreatic Duct ◽

Imaging System ◽

Biliary Duct ◽

Optical Coherence ◽

Cross Sectional ◽

Reflective Surface ◽

Cross Sectional Imaging ◽

Sectional Imaging

Abstract Background and study aims First-generation optical coherence tomography (OCT) has been shown to increase diagnostic sensitivity for malignant biliary and pancreatic-duct strictures. A newer OCT imaging system, NVision Volumetric Laser Endomicroscopy (VLE), allows for in vivo cross-sectional imaging of the ductal wall at the microstructure level during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to identify and evaluate characteristics on OCT that are predictive of benign and malignant strictures. Patients and methods Consecutive patients from six centers who underwent OCT between September 2016 and September 2017 were included in a dedicated registry. OCT images were analyzed, and nine recurring characteristics were further assessed. Final diagnosis was based on histology and/or surgical pathology. Results 86 patients were included (49 % male, mean age 64.7). OCT was performed in the bile duct in 79 patients and the pancreatic duct in seven. Nine OCT characteristics were identified: dilated hypo-reflective structures (n = 7), onion-skin layering (n = 8), intact layering (n = 17), layering effacement (n = 25), scalloping (n = 20), thickened epithelium (n = 42), hyper-glandular mucosa (n = 13), prominent blood vessels (n = 6), and a hyper-reflective surface (n = 20). Presence of hyper-glandular mucosa, hyper-reflective surface and scalloping significantly increased the odds of malignancy diagnosis by 6 times more (P = 0.0203; 95 % CI 1.3 to 26.5), 4.7 times more (P = 0.0255; 95 % CI 1.2 to 18.0) and 7.9 times more (P = 0.0035; 95 % CI 1.97 to 31.8) respectively. Conclusion By providing in-vivo cross-sectional imaging of the pancreatic and biliary duct wall, OCT technology may improve sensitivity in diagnosing malignant strictures and provide standardizable criteria predictive of malignancy.

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A rare imaging case of bilateral plasmacytoma of the breast

BJR|case reports ◽

10.1259/bjrcr.20190131 ◽

2020 ◽

Vol 6 (2) ◽

pp. 20190131

Author(s):

Joleen Kirsty Eden ◽

Rita Borgen ◽

Rabea Haq ◽

Richard Dobrashian

Keyword(s):

Breast Cancer ◽

Multiple Myeloma ◽

Learning Outcomes ◽

Case Reports ◽

Definitive Diagnosis ◽

High Grade ◽

Nodal Involvement ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

This case reports on secondary extramedullary multiple myeloma within both breasts in the absence of axillary nodal involvement and discusses the difficulty in interpretation with clinical recommendations and learning outcomes. Differentiating plasmacytic lesions in the breast is often difficult as clinical and radiological appearances are known to mimic benignity and high-grade primary breast cancer. Extramedullary presentation can determine progression of the disease and can necessitate cross-sectional imaging. Therefore definitive diagnosis is essential as the clinical management of the patient may be altered.

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