Survival Outcomes of Pancreatic Intraepithelial Neoplasm (PanIN) versus Intraductal Papillary Mucinous Neoplasm (IPMN) Associated Pancreatic Adenocarcinoma

McGinnis, Timothy; Bantis, Leonidas E.; Madan, Rashna; Dandawate, Prasad; Kumer, Sean C.; Schmitt, Timothy M.; Paluri, Ravi Kumar; Kasi, Anup

doi:10.3390/jcm9103102

Cited by 14 publications

(8 citation statements)

References 24 publications

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“…The 5‐year post‐resection survival rate in IPMN patients was about 60%, and the 10‐year survival rate post‐resection was around 40%, in one study. However, there was no difference in the 5‐ and 10‐year survival rates between main duct versus branch duct IPMN cases 75 . Postoperative surveillance is required for resected IPMNs.…”

Section: Prognosismentioning

confidence: 84%

Intraductal papillary mucinous neoplasm of the pancreas: Cytomorphology, imaging, molecular profile, and prognosis

et al. 2021

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Background Intraductal papillary mucinous neoplasm (IPMN) constitutes up to 20% of all pancreatic resections, and has been increasing in recent years. Histomorphological findings of IPMN are well established; however, there are not many published papers regarding the cytological findings of IPMN on fine needle aspiration (FNA) specimens. We review the cytomorphological features, molecular profile, imaging findings, and prognosis of IPMN. Methods The English literature was thoroughly searched with key phrases containing IPMN. Observations IPMN is a rare entity, affecting men and women equally and is usually diagnosed at the age of 60‐70 years. The characteristic imaging features include a cystic lesion with associated dilatation of the main or branch pancreatic duct, and atrophy of surrounding pancreatic parenchyma. Cytomorphological features of IPMN include papillary fragments of mucinous epithelium in a background of abundant thick extracellular mucin, a hallmark feature. IPMNs should be evaluated for high‐grade dysplasia, which manifests with nuclear atypia, nuclear moulding, prominent nucleoli, nuclear irregularity, and cellular crowding. Molecular profiling of IPMN along with carcinoembryonic antigen and amylase levels is useful in predicting malignancy or high‐grade dysplasia arising in IPMN. Overall, the prognosis of IPMN is excellent except in those cases with high‐grade dysplasia and malignant transformation. Postoperative surveillance is required for resected IPMNs. Conclusion IPMN requires a multidisciplinary approach for management. Cytomorphological findings of IPMN on FNA, in conjunction with tumour markers in pancreatic fluid cytology and imaging findings, are of paramount importance in clinical decision‐making for IPMN.

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Section: Prognosismentioning

confidence: 84%

Intraductal papillary mucinous neoplasm of the pancreas: Cytomorphology, imaging, molecular profile, and prognosis

et al. 2021

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“…With this approach, imaging and staging of PanIN and IPMN in a tumor volume have the potential to contribute to diagnosis. This initial 3D overview of diagnostic tissue biopsies is helpful to not miss the presence of PanIN and IPMN as these common precursor lesions of PDAC determine the diagnosis including staging, therapy and prognosis [ 15 , 22 , 44 ]. Furthermore, we show, that the epithelial height of pancreatic ducts as critical feature of the PanIN staging varies enormously within the distance of one tracked pancreatic duct.…”

Section: Discussionmentioning

confidence: 99%

“…Despite decades of intensive research, PDAC subclassifications based on morphological features or gene mutations have so far not had a significant impact on the therapeutic approach [ 46 , 47 ]. However, an accurate histopathological examination of PDAC specimens for differential diagnosis still provides a good prognostic assessment [ 14 , 22 ]. The presented approach of an additional X-ray based data set of the tumor biopsy at microscopic resolution offers a comprehensive examination of the entire tumor material and is a valuable adjunct prior to histological workup of tumor specimens.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional analysis of human pancreatic cancer specimens by phase-contrast based X-ray tomography – the next dimension of diagnosis

Pinkert-Leetsch¹,

Frohn

Ströbel

et al. 2023

Cancer Imaging

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Background The worldwide increase of pancreatic ductal adenocarcinoma (PDAC), which still has one of the lowest survival rates, requires novel imaging tools to improve early detection and to refine diagnosis. Therefore, the aim of this study was to assess the feasibility of propagation-based phase-contrast X-ray computed tomography of already paraffin-embedded and unlabeled human pancreatic tumor tissue to achieve a detailed three-dimensional (3D) view of the tumor sample in its entirety. Methods Punch biopsies of areas of particular interest were taken from paraffin blocks after initial histological analysis of hematoxylin and eosin stained tumor sections. To cover the entire 3.5 mm diameter of the punch biopsy, nine individual tomograms with overlapping regions were acquired in a synchrotron parallel beam configuration and stitched together after data reconstruction. Due to the intrinsic contrast based on electron density differences of tissue components and a voxel size of 1.3 μm achieved PDAC and its precursors were clearly identified. Results Characteristic tissue structures for PDAC and its precursors, such as dilated pancreatic ducts, altered ductal epithelium, diffuse immune cell infiltrations, increased occurrence of tumor stroma and perineural invasion were clearly identified. Certain structures of interest were visualized in three dimensions throughout the tissue punch. Pancreatic duct ectasia of different caliber and atypical shape as well as perineural infiltration could be contiguously traced by viewing serial tomographic slices and by applying semi-automatic segmentation. Histological validation of corresponding sections confirmed the former identified PDAC features. Conclusion In conclusion, virtual 3D histology via phase-contrast X-ray tomography visualizes diagnostically relevant tissue structures of PDAC in their entirety, preserving tissue integrity in label-free, paraffin embedded tissue biopsies. In the future, this will not only enable a more comprehensive diagnosis but also a possible identification of new 3D imaging tumor markers.

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“…The models that did simulate both precursors in separate pathways assumed that 90% of PC developed from PanIN and 10% from cystic lesions. 9 , 10 , 11 If the proportion of cyst derived cancers is actually higher, as some studies indicate, 20 , 21 , 22 these models would also underestimate the efficacy of screening.…”

Section: Discussionmentioning

confidence: 99%

The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

Koopmann

Omidvari

Lansdorp–Vogelaar

et al. 2022

Intl Journal of Cancer

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Evidence supporting the effectiveness of pancreatic cancer (PC) screening is scant.Most clinical studies concern small populations with short follow-up durations. Mathematical models are useful to estimate long-term effects of PC screening using shortterm indicators. This systematic review aims to evaluate the impact of PC screening on life expectancy (LE) in model-based studies. Therefore, we searched four databases (Embase, Medline, Web-of-science, Cochrane) until 30 May 2022 to identify model-based studies evaluating the impact of PC screening on LE in different risk populations. Two authors independently screened identified papers, extracted data and assessed the methodological quality of studies. A descriptive analysis was performed and the impact of screening strategies on LE of different risk groups was reported. Our search resulted in 419 studies, of which eight met the eligibility criteria (mathematical model, PC screening, LE). Reported relative risks (RR) for PC varied from 1 to 70. In higher risk individuals (RR > 5), annual screening (by imaging with 56% sensitivity for HGD/early stage PC) predicted to increase LE of screened individuals by 20 to 260 days. In the general population, one-time PC screening was estimated to decrease LE (2-110 days), depending on the test characteristics and treatment mortality risk. In conclusion, although the models use different and sometimes outdated or unrealistic assumptions, it seems that PC screening in high-risk populations improves LE, and that this gain increases with a higher PC risk. Updated model studies, with data from large clinical trials are necessary to predict the longterm effect of PC screening more accurately.

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Survival Outcomes of Pancreatic Intraepithelial Neoplasm (PanIN) versus Intraductal Papillary Mucinous Neoplasm (IPMN) Associated Pancreatic Adenocarcinoma

Cited by 14 publications

References 24 publications

Intraductal papillary mucinous neoplasm of the pancreas: Cytomorphology, imaging, molecular profile, and prognosis

Intraductal papillary mucinous neoplasm of the pancreas: Cytomorphology, imaging, molecular profile, and prognosis

Three-dimensional analysis of human pancreatic cancer specimens by phase-contrast based X-ray tomography – the next dimension of diagnosis

The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

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