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Focal parenchymal atrophy of pancreas: An important sign of underlying high-grade pancreatic intraepithelial neoplasia without invasive carcinoma, i.e., carcinoma in situ

医学 放射科 病理 胰管 胰腺癌 单变量分析 磁共振成像 萎缩 磁共振胰胆管造影术 内镜逆行胰胆管造影术 胰腺 癌症 胃肠病学 内科学 胰腺炎 多元分析
作者
Jun Nakahodo,Masataka Kikuyama,Shuko Nojiri,Kazuro Chiba,Kensuke Yoshimoto,Terumi Kamisawa,Shinichiro Horiguchi,Goro Honda
出处
期刊:Pancreatology [Elsevier BV]
卷期号:20 (8): 1689-1697 被引量:51
标识
DOI:10.1016/j.pan.2020.09.020
摘要

Diagnosing high-grade intraepithelial neoplasia without invasion, traditionally referred to as carcinoma in situ (CIS), is essential for improving prognosis. We examined the imaging findings of patients with and without CIS to identify significant aspects for the diagnosis of CIS. Forty-six patients strongly suspected of early pancreatic cancer without nodule on imaging (CIS group, n = 27; non-malignant group, n = 19) were retrospectively evaluated according to ten factors of computed tomography/magnetic resonance imaging (CT/MRI), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) using hierarchical cluster and univariate analyses. Two clusters were formed by hierarchical cluster analysis. One cluster consisted of 83.3% CIS cases with similar image findings such as focal pancreatic parenchymal atrophy (FPPA) on CT/MRI, main pancreatic duct (MPD) stricture surrounded by hypoechoic areas on EUS, and MPD stricture with upstream MPD dilation on ERCP. On univariate analysis, the CIS and non-malignant groups had FPPA on CT/MRI in 15 (55.6%) and 3 (15.8%) cases (p = 0.013), and MPD stricture surrounded by hypoechoic areas on EUS in 20 (74.1%) and 4 (21.1%) cases (p = 0.001), respectively. MPD stricture surrounded by hypoechoic areas was observed in 80% (12/15) of CIS cases with FPPA on CT/MRI and correlated with FPPA. Moreover, FPPA and MPD stricture surrounded by hypoechoic areas had histopathologically observed fibrosis or fat replacement due to pancreatic parenchymal atrophy. FPPA and MPD stricture surrounded by hypoechoic areas are significant findings for the diagnosis of CIS.
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