Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines

Kloth, Christopher; Haggenmüller, Benedikt; Beck, A.; Wagner, M.; Kornmann, Marko; Steinacker, Jochen P.; Steinacker-Stanescu, Nora; Vogele, Daniel; Beer, Meinrad; Juchems, Markus; Schmidt, Stefan A.

doi:10.3390/diagnostics13030454

Cited by 3 publications

(2 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Спектр кистозных образований включает первично кистозные опухоли, кистозные образования неопухолевой природы и солидные опухоли с кистозной дегенерацией, и продемонстрирован в табл. 1 [1,2]. Широкое внедрение и совершенствование методов лучевой диагностики повышает выявляемость кист ПЖ.…”

unclassified

See 1 more Smart Citation

Preconditions for radiomics-based approach in differential diagnosis of pancreatic cystic lesions: critical evaluation of meta-analyses and international guidelines

Kovalenko,

Karmazanovsky

2023

Lučevaâ diagn. ter.

View full text Add to dashboard Cite

INTRODUCTION: Pancreatic cystic lesions (PCLs) are a heterogenous group of lesions ranging from benign to malignant with variable histological, pathomorphological and prognostic characteristics. The development and improvement of radiation methods provides a great opportunity to diagnose such neoplasms. However, there are still difficulties in differential diagnosis and prediction malignant potential in pancreatic cyst subtypes due to their similar radiation characteristics.OBJECTIVE: To determine the diagnostic performane and difficulties of differentiating PCLs by invasive and non-invasive radiological methods. To determine the preconditions for radiomics-based approach in differential diagnosis of pancreatic cystic lesions based on a review and analysis of international guidelines.MATERIALS AND METHODS: We searched for scientific publications in the PubMed and Springer information and analytical systems for 2009–2023 by keywords: «pancreatic tumors», «pancreatic cyst», «pancreatic cystic lesion», «pancreatic radiomics», «intraductal papillary mucinous neoplasm», «pancreatic cystadenoma». As a result, 49 articles were selected for analysis.RESULTS: Despite the high potential of modern non-invasive radiation methods in the detection of pancreatic cysts, differentiation of PCLs subtypes is still very difficult. Due to the variability of international guidelines and a lack of their specificity, there is no universal consensus for management PCLs. In this regard, introduction new alternative diagnostic methods and markers is an important direction of research. At the moment, the assessment of the malignant potential of PCLs is comes down to only two main signs — the main pancreatic duct diameter and the vascularized solid component.CONCLUSION: Currently, common semiotic features, limitations of invasive diagnostic methods and increasing risks of recurrence and malignancy dictate the need to apply new diagnostic approaches to evaluation of PCLs. Searching and introduction new markers will allow us to analyze the lesion structure, to stratify risks and long-term prognosis more accurately. Textural image analysis is a new and promising noninvasive method with high power. This tool plays an important role to estimate those structural parameters which are impossible to judge according to the standard radiologic features, and to offset the problems of traditional diagnostic approach.

show abstract

unclassified

“…Anastasia A. Kovalenko� * ,1,2 Grigory G. Karmazanovsky� 1 А. V. Vishnevsky Mediсаl Reseаrсh Сenter of Surgery, Moscow, Russia 2 Pirogov Russian National Research Medical University, Moscow, Russia…”

mentioning

confidence: 99%

Preconditions for radiomics-based approach in differential diagnosis of pancreatic cystic lesions: critical evaluation of meta-analyses and international guidelines

Kovalenko,

Karmazanovsky

2023

Lučevaâ diagn. ter.

View full text Add to dashboard Cite

show abstract

Texture analysis of contrast enhancement CT in the differential diagnosis of tumor and tumor-like cystic lesions of the pancreas: possibilities in texture preprocessing and various segmentation parameters

Kovalenko,

Petrovichev,

Kryuchkova

et al. 2024

Lučevaâ diagn. ter.

View full text Add to dashboard Cite

INTRODUCTION: Until now, diagnosis the subtype of pancreas cystic lesion remains a major challenge. The accuracy of preoperative invasive diagnosis procedures is still very difficult due to the low cellularity of the aspirate. Accuracy verification of nature lesion’s is essential for predicting tactical planning and planning interventions.OBJECTIVE: To determine the diagnostic significance of texture analysis of contrast enhancement СT in differentiation of tumor and tumor-like pancreatic cystic lesions; to compare results of application of two models (2D and 3D) segmentation of CT images; to develop a diagnostic model including texture features to differentiate tumor and tumor-like pancreatic cystic lesions.MATERIALS AND METHODS: Clinical and CT data of 40 patients with pancreatic cystic lesions were collected for this study. Among these patients, 15 were pathologically diagnosed with serous cystadenoma, 15 were diagnosed with mucinous cystadenoma and 10 were diagnosed with pseudocyst. The radiomic features were extracted from four CT phases (native, arterial, venous and delayed). All images were normalized prior to the radiomics analysis, using spatial resampling with fixed voxel size of 1 mm3 (RES) and density threshold from 0 to 200 HU. For each phase, one radiologist (3 year`s experience in abdominal imaging) segmented the lesion contour on each slice (3D) and on the slice with maximum axial diameter (2D).Statistics: The program R 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria) was used. The Mann-Whitney test and AUC with 95% confidence interval were used to assess the discriminative texture predictors for tumour types. Texture features were included in the analysis after standardization, and L1 (LASSO) regularization was used to select predictors. Finally, discriminative models were evaluated by bootstrap estimation and Matthews correlation coefficient.RESULTS: Using 3D segmentation is preferable for differentiation of tumor and tumor-like pancreatic cystic lesions. A 2-D radiomics diagnostic model was included features (INTENSITY-HISTOGRAM_IntensityHistogram75th Percentile, MORPHOLOGICAL_Volume, INTENSITY-BASED_StandardDeviation) from native and arterial phases. It was resulted in an average AUC 0.89, with an sensitivity and specificity 70 and 93.3% according to pseudocysts, 73.3 and 92% according to mucinous cystadenomas, 86.7 and 80% according to serous cystadenomas. A 3-D radiomics diagnostic model was included features (MORPHOLOGICAL_SurfaceToVolumeRatio, INTENSITY-BASED_StandardDeviation, GLCM_Correlation, GLSZM_ZonePercentage) from native, arterial and delayed phases. It was resulted in an average AUC 0.96, with an sensitivity and specificity 80 and 96.7% according to pseudocysts, 86.7 and 88% according to mucinous cystadenomas, 80 and 88% according to serous cystadenomas. DISCUSSION: Currently, textural analysis is aimed at solve two main problems — differentiation of histological classes and grade of pancreatic cysts. The standardization of pre-processing and segmentation remains an unresolved issue. At the time of this study, we haven`t found any papers analyzing all the phases of CT imaging. A review of publications revealed that in the majority of cases researchers analyzed only one phase (arterial/venous) by 3D-segmentation. In our study, four phases of CT (native, arterial, venous and delayed) were analyzed by two types of segmentaion. In order to reduce texture ranges and offset the segmentation errors, we investigate preprocessing steps such as density distribitions (0–200 HU) and voxel resampling 1 mm3 (RES). In contrast to other papers, in our study there are no statistically significant textural features for the venous phase. Also, we don`t identify higher-order textural features as a differentiation predictors.CONCLUSION: Texture analysis of contrast enhancement СT have a favorable differential diagnostic performance for tumor and tumor-like cystic lesions of the pancreas.

show abstract

Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know

Martino,

Barresi,

Zito

et al. 2024

Gastroenterology Insights

View full text Add to dashboard Cite

Pancreatic cystic lesions (PCLs) have been increasingly identified in recent years, encompassing a wide spectrum ranging from benign non-evolutive to malignant invasive lesions. Despite various clinical, laboratory, imaging, endoscopic ultrasound, and cytohistological features that may aid clinicians in the complex differential diagnosis of PCLs, only a few pathognomic signs distinctive to specific PCLs have been identified. Although rarely encountered, their proper recognition is crucial for the appropriate management of PCLs. The aim of our review is to extensively discuss and illustrate pathognomic signs in the setting of PCLs.

show abstract

Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines

Cited by 3 publications

References 50 publications

Preconditions for radiomics-based approach in differential diagnosis of pancreatic cystic lesions: critical evaluation of meta-analyses and international guidelines

Preconditions for radiomics-based approach in differential diagnosis of pancreatic cystic lesions: critical evaluation of meta-analyses and international guidelines

Texture analysis of contrast enhancement CT in the differential diagnosis of tumor and tumor-like cystic lesions of the pancreas: possibilities in texture preprocessing and various segmentation parameters

Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know

Contact Info

Product

Resources

About