Sagami Ryota, Yamao Kentaro, Nakahodo Jun, Minami Ryuki, Tsurusaki Masakatsu, Murakami Kazunari, Amano Yuji
Department of Gastroenterology, Oita San-ai Medical Center, 1213 Oaza Ichi, Oita, Oita 870-1151, Japan.
Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Osaka-Sayama, Osaka 589-8511, Japan.
Cancers (Basel). 2021 Feb 24;13(5):945. doi: 10.3390/cancers13050945.
Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN.
胰腺导管腺癌（PDAC）起源于胰腺上皮内瘤变（PanIN）和导管内乳头状黏液性肿瘤（IPMN）等前驱病变。尽管PDAC的总体预后较差，但包括高级别PanIN和高级别IPMN在内的高级别癌前病变在无浸润性癌时预后良好。因此，高级别PanIN作为浸润性PDAC之前的病变，是干预的主要靶点。然而，使用标准放射学方法时，检测局限性高级别PanIN很困难。因此，大多数关于高级别PanIN的研究是使用含有浸润性PDAC的标本进行的。最近，高级别PanIN的影像学特征已被揭示。高级别PanIN导致的胰腺导管梗阻可能会引起腺泡细胞丢失，被纤维化和小叶实质萎缩取代。这些变化以及胰腺分支导管（BPDs）周围的额外炎症会导致主胰管（MPD）狭窄、扩张、潴留性囊肿（BPD扩张）、局灶性胰腺实质萎缩和/或MPD周围低回声改变。这些间接影像学表现已成为检测局限性高级别PanIN的重要线索。为了对疑似病例进行术前组织病理学确认，连续胰液抽吸细胞学检查是有效的。在本综述中，我们概述了关于高级别PanIN影像学特征的当前知识。
