Yamada Daisaku, Kobayashi Shogo, Takahashi Hidenori, Yoshioka Teppei, Iwagami Yoshifumi, Tomimaru Yoshito, Shigekawa Minoru, Akita Hirofumi, Noda Takehiro, Asaoka Tadafumi, Gotoh Kunihito, Tanemura Masahiro, Doki Yuichiro, Eguchi Hidetoshi
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Pancreatology. 2022 May;22(4):488-496. doi: 10.1016/j.pan.2022.03.016. Epub 2022 Apr 1.
Intraductal papillary mucinous neoplasms (IPMNs) are typically detected as incidental findings by computed tomography (CT); however, the conventional surveillance is not valid for the early detection of concomitant pancreatic cancer. The pancreas of IPMN is often accompanied by fatty infiltration in the parenchyma, and pancreatic fatty infiltration could be evaluated by pancreatic CT density (pancreatic index, PI). We aimed to investigate whether PI could be an imaging biomarker for the early prediction of malignancies in the pancreas with IPMN.
Two different cohorts were investigated. (Investigation cohort): A total of 1137 patients with initially low-risk IPMN were compensated by initial IPMN findings, and 2 groups (malignancy/possible benign, 50 cases each) were investigated for yearly changes in PI and for the cutoff value of PI indicating the development of malignancies. (Validation cohort): To validate the cutoff value, 256 patients radiologically suspected of having IPMNs were investigated.
(Investigation-cohort): The malignancy group showed a gradual decrease in PI every year, and PI significantly differed among the 2 groups 1 year prior to the last investigation. The cutoff value of PI was set at 0.65. (Validation-cohort): A total of 55% of the patients with a PI below the cutoff value had malignancy in the pancreas, including concomitant pancreatic cancer, and the cutoff value was the most significant risk factors for the development of malignancies in the pancreas compared to the conventional risk factors for IPMN.
Decreasing PI would be an optimal imaging biomarker for earlier detection of malignancies in the pancreas with IPMN.
导管内乳头状黏液性肿瘤（IPMNs）通常是在计算机断层扫描（CT）检查时偶然发现的；然而，传统的监测方法对于早期发现合并的胰腺癌并不有效。IPMN患者的胰腺实质常伴有脂肪浸润，胰腺脂肪浸润可通过胰腺CT密度（胰腺指数，PI）进行评估。我们旨在研究PI是否可作为早期预测IPMN患者胰腺恶性肿瘤的影像学生物标志物。
对两个不同的队列进行了研究。（研究队列）：共有1137例最初为低风险IPMN的患者因最初的IPMN检查结果而接受随访，对两组（恶性/可能为良性，每组50例）进行PI的年度变化以及提示恶性肿瘤发生的PI临界值的研究。（验证队列）：为验证临界值，对256例经放射学检查怀疑患有IPMN的患者进行了研究。
（研究队列）：恶性肿瘤组的PI每年逐渐下降，在最后一次检查前1年，两组之间的PI有显著差异。PI的临界值设定为0.65。（验证队列）：PI低于临界值的患者中，共有55%的患者胰腺存在恶性肿瘤，包括合并的胰腺癌，与IPMN的传统危险因素相比，临界值是胰腺发生恶性肿瘤的最显著危险因素。
PI降低将是早期检测IPMN患者胰腺恶性肿瘤的最佳影像学生物标志物。
