Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Turkey.
Department of General Surgery, Faculty of Medicine, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Turkey.
J Coll Physicians Surg Pak. 2021 Aug;31(8):959-964. doi: 10.29271/jcpsp.2021.08.959.
To evaluate the computed tomography (CT)-based differences between pancreaticobiliary (PBST) and intestinal (IST) subtypes of periampullary pancreatic ductal adenocarcinomas (PDAC).
Analytical study.
Faculty of Medicine, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Turkey between 2015 and 2018.
Overall 24 periampullary PDAC cases, in whom histomorphologic evaluation and CDx2 expression were used to discriminate between PBST and IST, were included. The lesion morphology (infiltrative versus nodular), common bile and main pancreatic ducts' dilation, tumor grade, enhancement pattern, pancreaticoduodenal groove, pancreaticoduodenal artery and lymphatic involvement were evaluated by CT.
Overall 24 PDAC cases [median age 67.5 (60.5-76.5) years] were enrolled. Histopathology revealed 9 (25%) IST and 18 (75%) PBST. The age [72.5 (69-81) versus 63 (57.75-75.5) years, respectively, p=0.204] and gender [3 (50%) versus 12 (66.7%) males, respectively, p=0.635] and the prevalence of all CT characteristics were similar between groups (p>0.05 for all) except for lesion morphology. Infiltrative morphology was more frequent in PBST than IST [14 (77.8%) versus 1 (16.7%), respectively, p=0.015]. Multiple variable logistic regression analysis revealed infiltrative morphology as the only independent CT predictor of PBST [OR: 14.9, 95% CI: 1.2-186), p=0.036]. The interrater reproducibility for lesion morphology was moderate (Cohen's Kappa: 0.55, p<0.007).
Infiltrative appearance is associated with PBST; whereas, nodular appearance more likely predicts IST. The potential role of CT lesion morphology on guiding appropriate chemotherapy in cases with no chance for surgery or biopsy requires addressing. Key Words: Intestinal differentiation, Pancreatobiliary differentiation, Periampullary adenocarcinoma.
评估胰胆管（PBST）和肠（IST）型壶腹周围胰腺导管腺癌（PDAC）的 CT 表现差异。
分析性研究。
土耳其伊斯坦布尔 Medeniyet 大学医学院，Göztepe 培训与研究医院，2015 年至 2018 年。
纳入 24 例经组织形态学评估和 CDx2 表达鉴别为 PBST 和 IST 的壶腹周围 PDAC 患者。通过 CT 评估病变形态（浸润性与结节性）、胆总管和主胰管扩张、肿瘤分级、增强模式、胰十二指肠沟、胰十二指肠动脉和淋巴结受累情况。
共纳入 24 例 PDAC 患者（中位年龄 67.5（60.5-76.5）岁）。组织病理学显示 9 例（25%）为 IST，18 例（75%）为 PBST。年龄[72.5（69-81）岁与 63（57.75-75.5）岁，p=0.204]和性别[3（50%）例与 12（66.7%）例男性，p=0.635]以及所有 CT 特征的发生率在两组间均相似（p>0.05），除病变形态外。浸润性形态在 PBST 中比 IST 更常见[14（77.8%）例与 1（16.7%）例，p=0.015]。多变量逻辑回归分析显示，浸润性形态是 PBST 的唯一独立 CT 预测因素[比值比：14.9，95%置信区间：1.2-186），p=0.036]。病变形态的观察者间重复性为中等（Cohen's Kappa：0.55，p<0.007）。
浸润性表现与 PBST 相关，而结节性表现更可能预测 IST。需要进一步研究 CT 病变形态在无手术或活检机会的情况下指导适当化疗中的潜在作用。关键词：肠型分化，胰胆管型分化，壶腹周围腺癌。
