Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan; Department of Human Pathology, Juntendo University, Bunkyo-Ku, Tokyo, Japan.
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan.
Pancreatology. 2020 Dec;20(8):1689-1697. doi: 10.1016/j.pan.2020.09.020. Epub 2020 Sep 30.
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.
诊断无浸润的高级上皮内瘤变，传统上称为原位癌（CIS），对于改善预后至关重要。我们研究了有和无 CIS 的患者的影像学表现，以确定 CIS 诊断的重要方面。
回顾性分析了 46 例影像学上无结节的疑似早期胰腺癌患者（CIS 组，n=27；非恶性组，n=19），根据 CT/MRI、超声内镜（EUS）和内镜逆行胰胆管造影（ERCP）的 10 项因素进行分层聚类和单因素分析。
通过层次聚类分析形成了两个聚类。一个聚类由 83.3%的 CIS 病例组成，这些病例的影像学表现相似，如 CT/MRI 上的局灶性胰腺实质萎缩（FPPA）、EUS 上的低回声区域环绕的主胰管（MPD）狭窄、以及 ERCP 上的 MPD 狭窄伴上游 MPD 扩张。在单因素分析中，CIS 组和非恶性组在 CT/MRI 上有 FPPA 的病例分别为 15 例（55.6%）和 3 例（15.8%）（p=0.013），EUS 上有低回声区域环绕的 MPD 狭窄的病例分别为 20 例（74.1%）和 4 例（21.1%）（p=0.001）。在 CT/MRI 上有 FPPA 的 15 例 CIS 病例中，有 80%（12/15）观察到 MPD 狭窄伴低回声区，与 FPPA 相关。此外，FPPA 和 MPD 狭窄伴低回声区与胰腺实质萎缩引起的纤维化或脂肪替代有关。
FPPA 和 MPD 狭窄伴低回声区是 CIS 诊断的重要表现。
