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; Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Japan.
Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan; Department of Gastroenterology, Tokyo Women's Medical University Hospital, Shinjuku-Ku, Tokyo, Japan.
Pancreatology. 2022 Dec;22(8):1148-1158. doi: 10.1016/j.pan.2022.10.003. Epub 2022 Oct 17.
BACKGROUND/OBJECTIVES: Radiological evidence of focal pancreatic parenchymal atrophy (FPPA) may presage early pancreatic ductal adenocarcinoma (PDAC) development. We aimed to clarify the incidence of FPPA and the clinicopathological features of PDAC with FPPA before diagnosis.
Data on endoscopic ultrasound-guided fine-needle biopsies and surgical samples from 170 patients with pancreatic cancer histologically diagnosed between 2014 and 2019 were extracted from the pathology database of Komagome Hospital and Juntendo University hospital and retrospectively evaluated together with 51 patients without PDAC.
FPPA was identified in 47/170 (28%) patients before PDAC diagnosis and in 2/51 (4%) patients in the control group (P < 0.01). The median duration from FPPA detection to diagnosis was 35 (interquartile range [IQR]:16-63) months. In 24/47 (51%) patients with FPPA, the atrophic area resolved. The lesion was in the head and body/tail in 7/40 and 67/56 of the patients with (n = 47) and without FPPA (n = 123), respectively (P < 0.001). Histopathologically confirmed non-invasive lesions in the main pancreatic duct and a positive surgical margin in the resected specimens occurred in 53% vs. 21% (P = 0.078) and 29% vs. 3% (P = 0.001) of the groups, respectively. The PDAC patients with FPPA accompanied by a malignant pancreatic resection margin had high-grade pancreatic intraepithelial neoplasia.
FPPA occurred in 28% of the PDAC group at 35 months prediagnosis. The FPPA area resolved before PDAC onset. Benchmarking previous images of the pancreas with the focus on FPPA may enable prediction of PDAC. PDAC with FPPA involves widespread high-grade pancreatic intraepithelial neoplasia requiring a wide surgical margin for surgical excision.
背景/目的：局部胰腺实质萎缩（FPPA）的放射学证据可能预示着早期胰腺导管腺癌（PDAC）的发展。我们旨在阐明 FPPA 的发生率以及 FPPA 诊断前 PDAC 的临床病理特征。
从驹込医院和顺天堂医院的病理学数据库中提取了 170 名经组织学诊断为胰腺癌的患者的内镜超声引导下细针活检和手术样本的数据，并与 51 名非 PDAC 患者一起进行回顾性评估。
在 170 名 PDAC 患者中有 47 名（28%）在诊断为 PDAC 之前发现 FPPA，在 51 名对照组患者中有 2 名（4%）（P < 0.01）。从 FPPA 检测到诊断的中位时间为 35（四分位距[IQR]：16-63）个月。在 47 名 FPPA 患者中有 24 名（51%）患者的萎缩区域得到缓解。病变位于头部和体尾部/尾部，在有 FPPA 的 47 名患者（n = 47）和无 FPPA 的 123 名患者（n = 123）中分别占 7/40 和 67/56（P < 0.001）。在病理证实的主胰管非浸润性病变和切除标本中阳性手术切缘方面，两组分别为 53%和 21%（P = 0.078）以及 29%和 3%（P = 0.001）。伴有恶性胰腺切缘的 FPPA 合并 PDAC 患者存在高级别胰腺上皮内瘤变。
在 35 个月的 PDAC 组中，FPPA 的发生率为 28%。FPPA 区域在 PDAC 发病前得到缓解。对胰腺的以前的图像进行基准测试并关注 FPPA 可能有助于预测 PDAC。伴有 FPPA 的 PDAC 涉及广泛的高级别胰腺上皮内瘤变，需要广泛的手术切缘进行手术切除。
