Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, 69120, Germany.
Institute of Pathology, University Medical Center Mainz, JGU-Mainz, Mainz, 55131, Germany.
Langenbecks Arch Surg. 2024 May 29;409(1):167. doi: 10.1007/s00423-024-03355-3.
Pancreatic cancer (PDAC) is characterized by infiltrative, spiculated tumor growth into the surrounding non-neoplastic tissue. Clinically, its diagnosis is often established by magnetic resonance imaging (MRI). At the invasive margin, tumor buds can be detected by histology, an established marker associated with poor prognosis in different types of tumors.
We analyzed PDAC by determining the degree of tumor spiculation on T2-weighted MRI using a 3-tier grading system. The grade of spiculation was correlated with the density of tumor buds quantified in histological sections of the respective surgical specimen according to the guidelines of the International Tumor Budding Consensus Conference (n = 28 patients).
64% of tumors revealed intermediate to high spiculation on MRI. In over 90% of cases, tumor buds were detected. We observed a significant positive rank correlation between the grade of radiological tumor spiculation and the histopathological number of tumor buds (r = 0.745, p < 0.001). The number of tumor buds was not significantly associated with tumor stage, presence of lymph node metastases, or histopathological grading (p ≥ 0.352).
Our study identifies a readily available radiological marker for non-invasive estimation of tumor budding, as a correlate for infiltrative tumor growth. This finding could help to identify PDAC patients who might benefit from more extensive peripancreatic soft tissue resection during surgery or stratify patients for personalized therapy concepts.
胰腺癌（PDAC）的特征是肿瘤向周围非肿瘤组织呈浸润性、刺状生长。临床上，其诊断通常通过磁共振成像（MRI）确定。在侵袭性边缘，可以通过组织学检测到肿瘤芽，这是不同类型肿瘤中与预后不良相关的一个既定标志物。
我们通过使用三级分级系统来确定 T2 加权 MRI 上肿瘤刺状程度来分析 PDAC。根据国际肿瘤芽共识会议（International Tumor Budding Consensus Conference）的指南（n=28 例患者），将肿瘤芽的密度与相应手术标本的组织学切片中定量的肿瘤芽密度相关联，来对刺状程度进行分级。
MRI 显示 64%的肿瘤具有中等到高度的刺状。在超过 90%的病例中，检测到了肿瘤芽。我们观察到放射学肿瘤刺状程度分级与组织病理学肿瘤芽数量之间存在显著的正秩相关（r=0.745，p<0.001）。肿瘤芽的数量与肿瘤分期、淋巴结转移的存在或组织病理学分级均无显著相关性（p≥0.352）。
我们的研究确定了一种易于获得的放射学标志物，用于非侵入性估计肿瘤芽，作为侵袭性肿瘤生长的相关指标。这一发现可能有助于识别可能受益于手术中更广泛的胰周软组织切除的 PDAC 患者，或为患者分层以制定个性化治疗方案。
