Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2017; 23(17): 3092-3098
Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3092
Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors
Salvatore Paiella, Harmony Impellizzeri, Elisabetta Zanolin, Giovanni Marchegiani, Marco Miotto, Anna Malpaga, Riccardo De Robertis, Mirko D'Onofrio, Borislav Rusev, Paola Capelli, Sara Cingarlini, Giovanni Butturini, Maria Vittoria Davì, Antonio Amodio, Claudio Bassi, Aldo Scarpa, Roberto Salvia, Luca Landoni
Salvatore Paiella, Harmony Impellizzeri, Giovanni Marchegiani, Marco Miotto, Anna Malpaga, Claudio Bassi, Roberto Salvia, Luca Landoni, General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy
Elisabetta Zanolin, Department of Public Health and Community Medicine, University and Hospital Trust of Verona, 37134 Verona, Italy
Riccardo De Robertis, Department of Radiology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy
Mirko D'Onofrio, Department of Radiology, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy
Borislav Rusev, Paola Capelli, Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, 37134 Verona, Italy
Borislav Rusev, Aldo Scarpa, ARC-NET Research Center, University and Hospital Trust of Verona, 37134 Verona, Italy
Sara Cingarlini, Department of Oncology, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy
Giovanni Butturini, Hepato-bilio-pancreatic Surgery Unit, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy
Maria Vittoria Davì, Section of Endocrinology, Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University and Hospital Trust of Verona, 37134 Verona, Italy
Antonio Amodio, Gastroenterology B Department, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy
Author contributions: Paiella S, Marchegiani G, Bassi C, Salvia R and Landoni L designed the research; Rusev B, Capelli P and Scarpa A performed the pathological analysis; Impellizzeri H, Miotto M, Malpaga A, Cingarlini S, Davì MV and Amodio A collected data; De Robertis R and D'Onofrio M analyzed radiological data; Paiella S and Zanolin E performed the statistical analysis; Paiella S, Zanolin E, Marchegiani G, Scarpa A and Landoni L wrote the manuscript; Marchegiani G, De Robertis R, D'Onofrio M, Cingarlini S, Davì MV, Amodio A, Bassi C, Salvia R and Landoni L reviewed the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Local Ethics Committee (No. 42757).
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or are consultant/advisory board member for any organizations; None of the authors have received research funding from any organizations; None of the authors are employees of any organizations; None of the authors own stocks and/or share in any organizations; None of the authors own patents.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salvatore Paiella, MD, General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. salvatore.paiella@univr.it
Telephone: +39-04-58124553 Fax: +39-04-58124826
Received: October 24, 2016
Peer-review started: October 26, 2016
First decision: December 19, 2016
Revised: January 30, 2017
Accepted: March 31, 2017
Article in press: March 31, 2017
Published online: May 7, 2017
Processing time: 194 Days and 17.3 Hours
Abstract
AIM

To establish the ability of magnetic resonance (MR) and computer tomography (CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors (PanNET) in a caseload of a tertiary referral center.

METHODS

Patients submitted to surgery for PanNET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination (MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman (BA) and Mountain-Plot (MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok (PB) regression analysis was used to check the agreement between MR and CT.

RESULTS

Our study population consisted of 292 patients. Seventy-nine (27.1%) were functioning PanNET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning- PanNET, respectively. Limits of agreement (LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-PanNET, no statistical significance was found in the size estimation rate of MR and CT (P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology.

CONCLUSION

MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of PanNET.

Keywords: Pancreatic neoplasms; Neuroendocrine tumors; Magnetic resonance imaging; Diagnostic imaging; Pathological dimensions

Core tip: Radiological tumor size estimation of pancreatic neuroendocrine tumors is of utmost importance for therapeutic decision-making, especially for non-functioning ones. This study showed that both magnetic resonance and computer tomography are accurate and interchangeable in predicting pathologic tumor size.