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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Higher volume growth rate is associated with development of worrisome features in patients with branch duct-intraductal papillary mucinous neoplasms
Tommaso Innocenti, Ginevra Danti, Erica Nicola Lynch, Gabriele Dragoni, Matteo Gottin, Filippo Fedeli, Daniele Palatresi, Maria Rosa Biagini, Stefano Milani, Vittorio Miele, Andrea Galli
Tommaso Innocenti, Erica Nicola Lynch, Gabriele Dragoni, Matteo Gottin, Maria Rosa Biagini, Stefano Milani, Andrea Galli, Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio”, University of Florence, Florence 50134, Italy
Ginevra Danti, Filippo Fedeli, Daniele Palatresi, Vittorio Miele, Emergency Radiology Unit, Department of Services, Careggi University Hospital, Florence 50134, Italy
Gabriele Dragoni, Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
Author contributions: Innocenti T designed the study and drafted the initial manuscript; Innocenti T, Danti G, Lynch EN and Gottin M participated in the acquisition, analysis and interpretation of the data; Danti G, Fedeli F and Palatresi D participated in the acquisition and segmentation of the CT and MRI images and provided important contribution to analysis and interpretation of the data; Biagini MR, Milani S, Miele V and Galli A revised the article critically for important intellectual content; Lynch EN provided English language revision as a native speaker; Galli A cooperated to set the study design, revised the statistical analysis and was the guarantor of the study; All authors approved the final version of the article.
Institutional review board statement: The study was approved by the local Ethical Committee of Careggi University Hospital on July 13th 2021 (protocol number: 20256_oss).
Informed consent statement: All study participants provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The Authors declare no conflict of interest and no financial interests in any products mentioned in this paper.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Andrea Galli, MD, PhD, Full Professor, Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio”, University of Florence, Viale G.B. Morgagni, 50, Florence 50134, Italy. a.galli@dfc.unifi.it
Received: December 21, 2021
Peer-review started: December 21, 2021
First decision: March 10, 2022
Revised: March 18, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 16, 2022
Processing time: 169 Days and 9.7 Hours
BACKGROUND
Branch duct-intraductal papillary mucinous neoplasms (BD-IPMNs) are the most common pancreatic cystic tumours and have a low risk of malignant transformation. Current guidelines only evaluate cyst diameter as an important risk factor but it is not always easy to measure, especially when comparing different methods. On the other side, cyst volume is a new parameter with low inter-observer variability and is highly reproducible over time.
AIM
To assess both diameter and volume growth rate of BD-IPMNs and evaluate their correlation with the development of malignant characteristics.
METHODS
Computed tomography scans and magnetic resonance imaging exams were retrospectively reviewed. The diameter was measured on three planes, while the volume was calculated by segmentation: The volume of the entire cyst was determined by manually drawing a region of interest along the edge of the neoplasm on each consecutive slice covering the whole lesion; therefore, a three-dimensional volume of interest was finally obtained with the calculated value expressed in cm3. Changes in size over time were measured. The development of worrisome features was evaluated.
RESULTS
We evaluated exams of 98 patients across a 40.5-mo median follow-up time. Ten patients developed worrisome features. Cysts at baseline were significantly larger in patients who developed worrisome features (diameters P = 0.0035, P = 0.00652, P = 0.00424; volume P = 0.00222). Volume growth rate was significantly higher in patients who developed worrisome features (1.12 cm3/year vs 0 cm3/year, P = 0.0001); diameter growth rate was higher as well, but the difference did not always reach statistical significance. Volume but not diameter growth rate in the first year of follow-up was higher in patients who developed worrisome features (0.46 cm3/year vs 0 cm3/year, P = 0.00634).
CONCLUSION
The measurement of baseline volume and its variation over time is a reliable tool for the follow-up of BD-IPMNs. Volume measurement could be a better tool than diameter measurement to predict the development of worrisome features.
Core Tip: Branch duct-intraductal papillary mucinous neoplasms (BD-IPMNs) are the most common pancreatic cystic tumours. Size is the most important risk factor in patients with BD-IPMNs. A high diameter growth-rate is associated with malignancy as well. In our study, we demonstrated that volume is associated with the development of worrisome features and that a higher volume growth-rate can lead to a higher risk of worrisome features. Moreover, in our cohort, volume growth-rate in the first year of follow-up predicted the development of worrisome features. Based on these data, measuring volume could be a better tool than the diameter to predict early BD-IPMNs malignant transformation.
