Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2024; 16(6): 211-220
Published online Jun 28, 2024. doi: 10.4329/wjr.v16.i6.211
Comparison between solid pseudopapillary neoplasms of the pancreas and pancreatic ductal adenocarcinoma with cystic changes using computed tomography
Shuai Ren, Li-Chao Qian, Xiao-Jing Lv, Ying-Ying Cao, Marcus J Daniels, Zhong-Qiu Wang, Li-Na Song, Ying Tian
Shuai Ren, Xiao-Jing Lv, Ying-Ying Cao, Zhong-Qiu Wang, Li-Na Song, Ying Tian, Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Li-Chao Qian, Department of Geratology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, Jiangsu Province, China
Marcus J Daniels, Department of Radiology, NYU Langone Health, New York, NY 10016, United States
Co-first authors: Shuai Ren and Li-Chao Qian.
Co-corresponding authors: Li-Na Song and Ying Tian.
Author contributions: Ren S, Song LN, and Tian Y designed the research study; Qian LC and Lv XJ performed the research; Cao YY contributed to statistical analysis; Ren S and Lv XJ contributed to data acquisition; Ren S and Qian LC contributed to manuscript writing; Daniels MJ and Wang ZQ contributed to manuscript revision; All authors read and approved the final manuscript. Ren S and Qian LC contributed equally to this work; Ren S proposed and designed the research and prepared the first draft of the manuscript; Qian LC was responsible for conducting the research and preparing the first draft. Song LN and Tian Y have played important and indispensable roles in the research design, data interpretation, manuscript preparation, and addressing queries as co-corresponding authors. Both authors have made crucial and indispensable contributions toward the completion of the project and thus qualify as co-corresponding authors of the paper.
Supported by the National Natural Science foundation of China, No. 82202135, No. 82371919, No. 82372017 and No. 82171925; Project funded by China Postdoctoral Science Foundation, No. 2023M741808; Jiangsu Provincial Key research and development program, No. BE2023789; Young Elite Scientists Sponsorship Program by Jiangsu Association for Science and Technology, No. JSTJ-2023-WJ027; Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine, No. 2023QB0112; Project funded by Nanjing Postdoctoral Science Foundation, Natural Science Foundation of Nanjing University of Chinese Medicine, No. XZR2023036, No. XZR2021003 and No. XZR2021050; and Medical Imaging Artificial Intelligence Special Research Fund Project, Nanjing Medical Association Radiology Branch, Project of National Clinical Research Base of Traditional Chinese Medicine in Jiangsu Province, China, No. JD2023SZ16.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Affiliated Hospital of Nanjing University of Chinese Medicine (Approval No. 2017NL-137-05).
Informed consent statement: Informed consent statement was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: Patient imaging data and histopathology reports contain sensitive patient information and cannot be released publicly due to the legal and ethical restrictions imposed by the institutional ethics committee (Affiliated Hospital of Nanjing University of Chinese Medicine). Data are available upon reasonable request from the following at shuairen@njucm.edu.cn.
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 Tian, MD, PhD, Doctor, Senior Researcher, Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. yingtian52111@163.com
Received: March 20, 2024
Revised: May 12, 2024
Accepted: June 3, 2024
Published online: June 28, 2024
Processing time: 98 Days and 1.2 Hours
Abstract
BACKGROUND

Solid pseudopapillary neoplasms of the pancreas (SPN) share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes (PDAC with cystic changes), which may result in unnecessary surgery.

AIM

To investigate the value of computed tomography (CT) in differentiation of SPN from PDAC with cystic changes.

METHODS

This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes, confirmed through pathological diagnosis. Quantitative and qualitative analysis was performed, including assessment of age, sex, tumor size, shape, margin, density, enhancement pattern, CT values of tumors, CT contrast enhancement ratios, “floating cloud sign,” calcification, main pancreatic duct dilatation, pancreatic atrophy, and peripancreatic invasion or distal metastasis. Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes, and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination.

RESULTS

When compared to PDAC with cystic changes, SPN had a lower age (32 years vs 64 years, P < 0.05) and a slightly larger size (5.41 cm vs 3.90 cm, P < 0.05). SPN had a higher frequency of “floating cloud sign” and peripancreatic invasion or distal metastasis than PDAC with cystic changes (both P < 0.05). No significant difference was found with respect to sex, tumor location, shape, margin, density, main pancreatic duct dilatation, calcification, pancreatic atrophy, enhancement pattern, CT values of tumors, or CT contrast enhancement ratios between the two groups (all P > 0.05). The area under the receiver operating characteristic curve of the combination was 0.833 (95% confidence interval: 0.708-0.957) with 78.6% sensitivity, 81.3% specificity, and 80.4% accuracy in differentiation of SPN from PDAC with cystic changes.

CONCLUSION

A larger tumor size, “floating cloud sign,” and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.

Keywords: Solid pseudopapillary neoplasm; Pancreas; Pancreatic ductal adenocarcinoma; Computed tomography; Differential diagnosis

Core Tip: Most solid pseudopapillary neoplasms of the pancreas (SPN) are indolent tumors that could yield a perfect prognosis with complete surgical resection. Approximately 8% of pancreatic ductal adenocarcinoma (PDAC) may have cystic characteristics, which share similar radiological imaging features with SPN and lead to misinterpretation. It would be of great clinical value to preoperatively differentiate SPN from PDAC with cystic changes. In this study, a larger tumor size, “floating cloud sign,” and peripancreatic invasion or distal metastasis are useful computed tomography imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.