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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
ARTICLE HIGHLIGHTS
Research background
Branch duct-intraductal papillary mucinous neoplasms (BD-IPMNs) are the most common pancreatic cystic tumours. Cyst diameter growth rate is one of the parameters that current guidelines take into account to predict the development of malignant features in patients with BD-IPMN. However, to date, there are no studies investigating the correlation between cyst volume growth rate and the risk of BD-IPMNs malignant degeneration.
Research motivation
The optimal surveillance protocol for BD-IPMNs has not been established as there is lack of agreement on when follow-up should be intensified or interrupted mainly due to the slow growth rate of BD-IPMNs. We propose a more precise tool for the measurement of BD-IPMNs which allows an early prediction of the development of worrisome features.
Research objectives
The primary objective of our research was to assess the volume growth rate of BD-IPMNs without worrisome features or high-risk stigmata at baseline and to evaluate its correlation with the development of worrisome features or high-risk stigmata during follow-up. We also aimed to evaluate the impact of measuring volume vs diameter growth rate and to test the ability of first-year volume growth rate to predict the development of worrisome features or high-risk stigmata.
Research methods
We measured diameter in CT-scans and MRI on three planes, while we calculated the volume by manual segmentation: the volume of the cyst was determined by 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 and development of worrisome features or high-risk stigmata were measured.
Research results
Ninety-eight patients were evaluated across a 40.5-mo median follow-up time, of which 10 developed worrisome features, while none developed high-risk stigmata. Baseline volume was larger, and volume and first-year volume growth rate were higher in patients who developed worrisome features than in patients who did not. Baseline diameter was larger in patients who developed worrisome features. Diameter growth rate was higher as well but the difference did not always reach statistical significance.
Research conclusions
The measurement of baseline volume and of its variation over time is a reliable tool for the follow-up of BD-IPMNs. Particularly, in the first year of BD-IPMNs follow-up, volume measurement is more accurate than diameter alone for risk stratification.
Research perspectives
We suggest that measuring cyst volume routinely could be a useful tool to monitor low-risk IPMNs. Larger cohorts of patients and a longer follow-up time are needed to corroborate these data and to understand whether our findings could influence routine clinical practice.
