Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2809-2819
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2809
Prediction of the lymphatic, microvascular, and perineural invasion of pancreatic neuroendocrine tumors using preoperative magnetic resonance imaging
Yu-Liang Liu, Hai-Bin Zhu, Mai-Lin Chen, Wei Sun, Xiao-Ting Li, Ying-Shi Sun
Yu-Liang Liu, Hai-Bin Zhu, Mai-Lin Chen, Xiao-Ting Li, Ying-Shi Sun, Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
Wei Sun, Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China
Co-first authors: Yu-Liang Liu and Hai-Bin Zhu.
Author contributions: Liu YL and Zhu HB contributed equally to this work; Sun YS, Liu YL, Zhu HB, and Chen ML contributed to the conception and design of the research study, they contributed to the administrative support; Liu YL, Zhu HB, Chen ML, and Sun W provide the study materials or patients; Liu YL, Zhu HB, and Chen ML contributed to the collection and assembly of data; Liu YL, Zhu HB, and Li XT contributed to data analysis and interpretation; Liu YL and Zhu HB wrote the manuscript; and all authors have read and approve the final manuscript.
Supported by Beijing Hospitals Authority Youth Program, No. QML20231103.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and was approved by the institutional review board of our hospital.
Informed consent statement: The requirement for informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Shi Sun, MD, Chief Physician, Professor, Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. sys27@163.com
Received: October 7, 2023
Peer-review started: October 7, 2023
First decision: October 24, 2023
Revised: November 6, 2023
Accepted: December 6, 2023
Article in press: December 6, 2023
Published online: December 27, 2023
Abstract
BACKGROUND

Significant correlation between lymphatic, microvascular, and perineural invasion (LMPI) and the prognosis of pancreatic neuroendocrine tumors (PENTs) was confirmed by previous studies. There was no previous study reported the relationship between magnetic resonance imaging (MRI) parameters and LMPI.

AIM

To determine the feasibility of using preoperative MRI of the pancreas to predict LMPI in patients with non-functioning PENTs (NFPNETs).

METHODS

A total of 61 patients with NFPNETs who underwent MRI scans and lymphadenectomy from May 2011 to June 2018 were included in this retrospective study. The patients were divided into group 1 (n = 34, LMPI negative) and group 2 (n = 27, LMPI positive). The clinical characteristics and qualitative MRI features were collected. In order to predict LMPI status in NF-PNETs, a multivariate logistic regression model was constructed. Diagnostic performance was evaluated by calculating the receiver operator characteristic (ROC) curve with area under ROC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy.

RESULTS

There were significant differences in the lymph node metastasis stage, tumor grade, neuron-specific enolase levels, tumor margin, main pancreatic ductal dilatation, common bile duct dilatation, enhancement pattern, vascular and adjacent tissue involvement, synchronous liver metastases, the long axis of the largest lymph node, the short axis of the largest lymph node, number of the lymph nodes with short axis > 5 or 10 mm, and tumor volume between two groups (P < 0.05). Multivariate analysis showed that tumor margin (odds ratio = 11.523, P < 0.001) was a predictive factor for LMPI of NF-PNETs. The area under the receiver value for the predictive performance of combined predictive factors was 0.855. The sensitivity, specificity, PPV, NPV and accuracy of the model were 48.1% (14/27), 97.1% (33/34), 97.1% (13/14), 70.2% (33/47) and 0.754, respectively.

CONCLUSION

Using preoperative MRI, ill-defined tumor margins can effectively predict LMPI in patients with NF-PNETs.

Keywords: Pancreatic neuroendocrine tumors, Magnetic resonance imaging, Lymphatic invasion, Microvascular invasion, Perineural invasion

Core Tip: The correlation between comprehensive magnetic resonance imaging features and lymphatic, microvascular, and perineural invasion (LMPI) of non-functioning pancreatic neuroendocrine tumors (NF-PNETs) were analyzed. A multivariate model was constructed for predicting LMPI in NF-PNETs. Ill-defined tumor margins resulted as an independent risk factor for LMPI in patients with NF-PNETs.