Differentiation of aggressive from non-aggressive pancreatic solid pseudopapillary neoplasms using computed tomography
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Microscopic aggressive behaviors may be related with the prognosis of solid pseudopapillary neoplasms (SPNs). In this study, we investigate computed tomography (CT) features and differential diagnosis of aggressive and non-aggressive SPNs in pancreas.
Materials and methods
122 patients with pathologically proven SPNs in pancreas were included. Patients’ age, tumor site, texture, shape, margins, exophytic growth, capsule, calcification, hemorrhage, pancreatic duct dilatation or pancreatic parenchyma atrophy, peripancreatic infiltration or metastases, vascular encasement, and enhancement pattern were assessed. The diagnostic accuracy was analyzed by using the receiver operating characteristic curve (ROC).
There were 30 aggressive SPNs and 92 non-aggressive SPNs. Aggressive SPNs showed significantly higher frequencies of an ill-defined margin, patient age > 40.5 years, and tumor size < 42.1 mm, but lower frequencies of complete capsule, hemorrhage compared with non-aggressive SPNs (p < 0.05). Lack of complete capsule and age > 40.5 years were independent risk factors of aggressive SPNs (odd ratio 7.08 and 3.1, respectively). When we applied the two predictors in the logistic regression model, the area under the curve (AUC) was 0.77 with sensitivity of 86.7% and specificity of 55.4%.
Size less than 42.1 mm, lack of complete capsule, ill-defined, and absent bleeding are useful CT imaging features for predicating aggressive SPNs. Patient age > 40.5 years and lack of complete capsule showed acceptable diagnostic performance for discriminating aggressive from non-aggressive SPNs.
KeywordsSolid pseudopapillary neoplasm Pancreas Aggressive Computed tomography
We thank all authors for their continuous and excellent support with patient data collection, imaging analysis, statistical analysis, and valuable suggestions for the article.
This study was supported by the Key Program of Research and Development of Jiangsu Province (BE2017772) and the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX18_1651).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to CECT examinations by written consent.
- 1.Bosman FT, Carneiro F, Hruban RH, Theise ND, Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system. International Agency for Research on Cancer.Google Scholar
- 2.Law JK, Ahmed A, Singh VK, Akshintala VS, Olson MT, Raman SP, Ali SZ, Fishman EK, Kamel I, Canto MI, Dal Molin M, Moran RA, Khashab MA, Ahuja N, Goggins M, Hruban RH, Wolfgang CL, Lennon AM (2014) A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas 43 (3):331-337. https://doi.org/10.1097/mpa.0000000000000061 CrossRefGoogle Scholar
- 4.Lubezky N, Papoulas M, Lessing Y, Gitstein G, Brazowski E, Nachmany I, Lahat G, Goykhman Y, Ben-Yehuda A, Nakache R, Klausner JM (2017) Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 43 (6):1056-1060. https://doi.org/10.1016/j.ejso.2017.02.001 CrossRefGoogle Scholar
- 5.Pancreatic Surgery of Chinese Academic Society of Young Surgeons (2018) The current status of diagnosis and treatment of pancreatic cystic neoplasm in China: a report of 2 251 cases. Zhonghua wai ke za zhi [Chinese journal of surgery] 56 (1):24-29. https://doi.org/10.3760/cma.j.issn.0529-5815.2018.01.007 Google Scholar
- 10.Wang X, Chen YH, Tan CL, Zhang H, Xiong JJ, Chen HY, Ke NW, Liu XB (2018) Enucleation of pancreatic solid pseudopapillary neoplasm: Short-term and long-term outcomes from a 7-year large single-center experience. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 44 (5):644-650. https://doi.org/10.1016/j.ejso.2018.01.085 CrossRefGoogle Scholar
- 13.Ercelep O, Ozdemir N, Turan N, Topcu TO, Uysal M, Tanriverdi O, Demirci U, Taskoylu BY, Urakci Z, Duran AO, Aksoy A, Menekse S, Ozcelik M, Gumus M (2018) Retrospective evaluation of patients diagnosed solid pseudopapillary neoplasms of the pancreas. Current problems in cancer. https://doi.org/10.1016/j.currproblcancer.2018.06.014
- 15.Sacco Casamassima MG, Gause CD, Goldstein SD, Abdullah F, Meoded A, Lukish JR, Wolfgang CL, Cameron J, Hackam DJ, Hruban RH, Colombani PM (2016) Pancreatic surgery for tumors in children and adolescents. Pediatric surgery international 32 (8):779-788. https://doi.org/10.1007/s00383-016-3925-y CrossRefGoogle Scholar
- 16.Lee JH, Yu JS, Kim H, Kim JK, Kim TH, Kim KW, Park MS, Kim JH, Kim YB, Park C (2008) Solid pseudopapillary carcinoma of the pancreas: differentiation from benign solid pseudopapillary tumour using CT and MRI. Clin Radiol 63 (9):1006-1014. https://doi.org/10.1016/j.crad.2008.04.007 CrossRefGoogle Scholar
- 17.Park MJ, Lee JH, Kim JK, Kim YC, Park MS, Yu JS, Kim YB, Lee D (2014) Multidetector CT imaging features of solid pseudopapillary tumours of the pancreas in male patients: distinctive imaging features with female patients. The British journal of radiology 87 (1035):20130513. https://doi.org/10.1259/bjr.20130513 CrossRefGoogle Scholar
- 18.Marchegiani G, Andrianello S, Massignani M, Malleo G, Maggino L, Paiella S, Ferrone CR, Luchini C, Scarpa A, Capelli P, Mino-Kenudson M, Lillemoe KD, Bassi C, Castillo CF, Salvia R (2016) Solid pseudopapillary tumors of the pancreas: Specific pathological features predict the likelihood of postoperative recurrence. Journal of surgical oncology 114 (5):597-601. https://doi.org/10.1002/jso.24380 CrossRefGoogle Scholar
- 20.Wang P, Wei J, Wu J, Xu W, Chen Q, Gao W, Jiang K, Miao Y (2018) Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases. Pancreatology : official journal of the International Association of Pancreatology (IAP) [et al] 18 (4):415-419. https://doi.org/10.1016/j.pan.2017.12.012
- 22.Raman SP, Kawamoto S, Law JK, Blackford A, Lennon AM, Wolfgang CL, Hruban RH, Cameron JL, Fishman EK (2013) Institutional experience with solid pseudopapillary neoplasms: focus on computed tomography, magnetic resonance imaging, conventional ultrasound, endoscopic ultrasound, and predictors of aggressive histology. Journal of computer assisted tomography 37 (5):824-833. https://doi.org/10.1097/RCT.0b013e31829d44fa CrossRefGoogle Scholar
- 24.. Rastogi A, Assing M, Taggart M, Rao B, Sun J, Elsayes K, Tamm E, Bhosale P (2018) Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm? J Comput Assist Tomogr 42 (3):405-411. https://doi.org/10.1097/rct.0000000000000698 CrossRefGoogle Scholar
- 26.Xu Y, Zhao G, Pu N, Nuerxiati A, Ji Y, Zhang L, Rong Y, Lou W, Wang D, Kuang T, Xu X, Wu W (2017) One Hundred Twenty-One Resected Solid Pseudopapillary Tumors of the Pancreas: An 8-Year Single-Institution Experience at Zhongshan Hospital, Shanghai, China. Pancreas 46 (8):1023-1028. https://doi.org/10.1097/mpa.0000000000000885 CrossRefGoogle Scholar
- 27.Liszka L, Mrowiec S, Pajak J, Kostrzab-Zdebel A, Lampe P, Kajor M (2014) Limited usefulness of histopathological features in identification of a clinically aggressive solid-pseudopapillary neoplasm of the pancreas. Polish journal of pathology : official journal of the Polish Society of Pathologists 65 (3):182-193. https://doi.org/10.5114/PJP.2014.45780 CrossRefGoogle Scholar
- 28.Estrella JS, Lei L, Asif R, Hua W, Katz MH, Fleming JB, Abbruzzese JL, Huamin W (2014) Solid pseudopapillary neoplasm of the pancreas: clinicopathologic and survival analyses of 64 cases from a single institution. American Journal of Surgical Pathology 38 (2):147-157. https://doi.org/10.1097/PAS.0000000000000141 CrossRefGoogle Scholar
- 31.Lin MY, Stabile BE (2010) Solid pseudopapillary neoplasm of the pancreas: a rare and atypically aggressive disease among male patients. Am Surg 76 (10):1075-1078.Google Scholar
- 32.Hirabayashi K, Kurokawa S, Maruno A, Yamada M, Kawaguchi Y, Nakagohri T, Mine T, Sugiyama T, Tajiri T, Nakamura N (2015) Sex differences in immunohistochemical expression and capillary density in pancreatic solid pseudopapillary neoplasm. Annals of diagnostic pathology 19 (2):45-49. https://doi.org/10.1016/j.anndiagpath.2015.02.002 CrossRefGoogle Scholar
- 35.Hanada K, Kurihara K, Itoi T, Katanuma A, Sasaki T, Hara K, Nakamura M, Kimura W, Suzuki Y, Sugiyama M, Ohike N, Fukushima N, Shimizu M, Ishigami K, Gabata T, Okazaki K (2018) Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. Pancreas 47 (8):1019-1026. https://doi.org/10.1097/mpa.0000000000001114 CrossRefGoogle Scholar