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Pancreatic cystic lesions (PCLs) include a broad spectrum of entities, which greatly differ in their malignant potential and may provide a diagnostic challenge. PCLs can be categorised into: pseudocysts; common cystic neoplasms; uncommon cystic neoplasms and tumours with cystic degeneration. Large lesions are usually possible to differentiate, but small lesions’ characterisation is often not possible. This means that many pancreatic cysts remain undetermined and guidelines are needed for follow-up and management. It is important to make distinction between mucinous cystic neoplasms (MCN) and intraductal pancreatic mucinous neoplasms (IPMN), because all MCN should be resected whereas there is time for observation in specific cases of side branch IPMN. With regards to IPMN, guidelines have established features associated with increased risk of malignancy: the “worrisome” features and high-risk stigmata. It should be considered that the presence of an IPMN may portend an increased risk of invasive pancreatic cancer in a different site of the pancreas. The assessment of PCLs should provide imaging features such as cyst morphology or presence of duct communication, and clinical findings including cystic fluid analysis to improve diagnostic accuracy. Radiomics represents an emerging field of interest that could add some information in the future for the differential diagnosis and follow-up of these lesions. The aim of this study was to define a diagnostic approach to PCLs according to the latest guidelines; a review of the latest developments in radiomics regarding PCLs was also carried out.
Pancreatic cystic lesions (PCLs) include a broad spectrum of entities, which greatly differ in their malignant potential and may provide a diagnostic challenge. PCLs can be categorised into: pseudocysts; common cystic neoplasms; uncommon cystic neoplasms and tumours with cystic degeneration. Large lesions are usually possible to differentiate, but small lesions’ characterisation is often not possible. This means that many pancreatic cysts remain undetermined and guidelines are needed for follow-up and management. It is important to make distinction between mucinous cystic neoplasms (MCN) and intraductal pancreatic mucinous neoplasms (IPMN), because all MCN should be resected whereas there is time for observation in specific cases of side branch IPMN. With regards to IPMN, guidelines have established features associated with increased risk of malignancy: the “worrisome” features and high-risk stigmata. It should be considered that the presence of an IPMN may portend an increased risk of invasive pancreatic cancer in a different site of the pancreas. The assessment of PCLs should provide imaging features such as cyst morphology or presence of duct communication, and clinical findings including cystic fluid analysis to improve diagnostic accuracy. Radiomics represents an emerging field of interest that could add some information in the future for the differential diagnosis and follow-up of these lesions. The aim of this study was to define a diagnostic approach to PCLs according to the latest guidelines; a review of the latest developments in radiomics regarding PCLs was also carried out.
Background: Pancreatic ductal adenocarcinoma (PDAC) is the seventh leading cause of cancer-related deaths worldwide. Surgical resection is the main driver to improving survival in resectable tumors, while neoadjuvant treatment based on chemotherapy (and radiotherapy) is the best option-treatment for a non-primally resectable disease. CT-based imaging has a central role in detecting, staging, and managing PDAC. As several authors have proposed radiomics for risk stratification in patients undergoing surgery for PADC, in this narrative review, we have explored the actual fields of interest of radiomics tools in PDAC built on pre-surgical imaging and clinical variables, to obtain more objective and reliable predictors. Methods: The PubMed database was searched for papers published in the English language no earlier than January 2018. Results: We found 301 studies, and 11 satisfied our research criteria. Of those included, four were on resectability status prediction, three on preoperative pancreatic fistula (POPF) prediction, and four on survival prediction. Most of the studies were retrospective. Conclusions: It is possible to conclude that many performing models have been developed to get predictive information in pre-surgical evaluation. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice.
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