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Theranostics 2021Artificial intelligence can facilitate clinical decision making by considering massive amounts of medical imaging data. Various algorithms have been implemented for...
Artificial intelligence can facilitate clinical decision making by considering massive amounts of medical imaging data. Various algorithms have been implemented for different clinical applications. Accurate diagnosis and treatment require reliable and interpretable data. For pancreatic tumor diagnosis, only 58.5% of images from the First Affiliated Hospital and the Second Affiliated Hospital, Zhejiang University School of Medicine are used, increasing labor and time costs to manually filter out images not directly used by the diagnostic model. This study used a training dataset of 143,945 dynamic contrast-enhanced CT images of the abdomen from 319 patients. The proposed model contained four stages: image screening, pancreas location, pancreas segmentation, and pancreatic tumor diagnosis. We established a fully end-to-end deep-learning model for diagnosing pancreatic tumors and proposing treatment. The model considers original abdominal CT images without any manual preprocessing. Our artificial-intelligence-based system achieved an area under the curve of 0.871 and a F1 score of 88.5% using an independent testing dataset containing 107,036 clinical CT images from 347 patients. The average accuracy for all tumor types was 82.7%, and the independent accuracies of identifying intraductal papillary mucinous neoplasm and pancreatic ductal adenocarcinoma were 100% and 87.6%, respectively. The average test time per patient was 18.6 s, compared with at least 8 min for manual reviewing. Furthermore, the model provided a transparent and interpretable diagnosis by producing saliency maps highlighting the regions relevant to its decision. The proposed model can potentially deliver efficient and accurate preoperative diagnoses that could aid the surgical management of pancreatic tumor.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Pancreatic Ductal; Deep Learning; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Pancreatic Neoplasms; ROC Curve; Tomography, X-Ray Computed
PubMed: 33408793
DOI: 10.7150/thno.52508 -
Archives of Pathology & Laboratory... Jul 2020Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor generally associated with a good prognosis. Solid pseudopapillary neoplasms show peculiar... (Review)
Review
CONTEXT.—
Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor generally associated with a good prognosis. Solid pseudopapillary neoplasms show peculiar morphologic features, but sometimes the differential diagnosis with other pancreatic neoplasms (ie, pancreatic neuroendocrine tumors) can be a challenging task, especially in cytologic or biopsy specimens. In these cases immunohistochemistry is a useful tool, but the diagnostic utility of several proposed immunohistochemical markers is questionable. In recent years, despite several attempts to characterize the pathogenetic, molecular, and prognostic features of solid pseudopapillary neoplasms, they still remain unclear.
OBJECTIVE.—
To give the reader a comprehensive update on this entity.
DATA SOURCES.—
The PubMed database (US National Library of Medicine) was searched using the following string: pseudopapillary tumor [AND/OR] neoplasm [AND/OR] pancreas. All articles written in English were included. In addition, because a heterogeneous terminology has been used in the past to define solid pseudopapillary neoplasms, the reference lists of each paper selected in the PubMed database were also reviewed.
CONCLUSIONS.—
This review gives a comprehensive update on the pathologic, clinical, and molecular features of solid pseudopapillary neoplasms, particularly addressing issues and challenges related to diagnosis. In addition, we have tried to correlate the molecular alterations with the morphologic and clinical features.
Topics: Biomarkers, Tumor; Biopsy; Diagnosis, Differential; Genetic Predisposition to Disease; Humans; Immunohistochemistry; Molecular Diagnostic Techniques; Pancreatic Neoplasms; Phenotype; Predictive Value of Tests; Prognosis
PubMed: 31958381
DOI: 10.5858/arpa.2019-0473-RA -
Magyar Onkologia Oct 2021This review provides an overview about the role of endoscopy in the care of patients suffering from pancreatic cancer. In the field of diagnostics the role of endoscopic... (Review)
Review
This review provides an overview about the role of endoscopy in the care of patients suffering from pancreatic cancer. In the field of diagnostics the role of endoscopic ultrasound is highlighted in both solid and cystous pancreatic tumors. The decreasing diagnostic relevance of endoscopic retrograde cholangiopancreatography (ERCP) is also discussed. The issue of preoperative biliary drainage in case of obstruction is negotiated in detail, while palliative settings are appointed thoroughly. Besides conventional enteral stenting in case of gastric outlet syndrome caused by local spreading of pancreatic tumor, some new innovative endoscopic solutions are summarized. Several endoscopic ultrasound-guided antitumor interventions that are mainly in clinical trial phase are referred in the article. The diagnostics and treatment of pancreatic neuroendocrine tumors are discussed separately due to their different biological behavior. The review emphasizes the need for multidisciplinary approach of the patients suffering from malignant pancreatic tumors.
Topics: Endoscopy; Humans; Pancreatic Neoplasms
PubMed: 34614046
DOI: No ID Found -
Endocrine Pathology Jun 2024In the last two decades, the increasing availability of technologies for molecular analyses has allowed an insight in the genomic alterations of neuroendocrine neoplasms... (Review)
Review
In the last two decades, the increasing availability of technologies for molecular analyses has allowed an insight in the genomic alterations of neuroendocrine neoplasms (NEN) of the gastrointestinal tract and pancreas. This knowledge has confirmed, supported, and informed the pathological classification of NEN, clarifying the differences between neuroendocrine carcinomas (NEC) and neuroendocrine tumors (NET) and helping to define the G3 NET category. At the same time, the identification genomic alterations, in terms of gene mutation, structural abnormalities, and epigenetic changes differentially involved in the pathogenesis of NEC and NET has identified potential molecular targets for precision therapy. This review critically recapitulates the available molecular features of digestive NEC and NET, highlighting their correlates with pathological aspects and clinical characteristics of these neoplasms and revising their role as predictive biomarkers for targeted therapy. In this context, the feasibility and applicability of a molecular classification of gastrointestinal and pancreatic NEN will be explored.
Topics: Humans; Pancreatic Neoplasms; Neuroendocrine Tumors; Gastrointestinal Neoplasms; Biomarkers, Tumor
PubMed: 38470548
DOI: 10.1007/s12022-024-09807-2 -
The Ulster Medical Journal Jan 2020
Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Diagnosis, Differential; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Immunochemistry; Jaundice, Obstructive; Lymphoma, Non-Hodgkin; Male; Neoplasm Staging; Pancreas; Pancreatic Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32218630
DOI: No ID Found -
La Clinica Terapeutica 2023Pancreatic cancer is a leading cause of death worldwide, associated with poor prognosis outcomes and late treatment interventions. The pathological nature and extreme... (Review)
Review
Pancreatic cancer is a leading cause of death worldwide, associated with poor prognosis outcomes and late treatment interventions. The pathological nature and extreme tissue heterogeneity of this disease has hampered all efforts to correctly diagnose and treat it. Omics sciences and precision medicine have revolutionized our understanding of pan-creatic cancer, providing a new hope for patients suffering from this devastating disease. By analyzing large-scale biological data sets and developing personalized treatment strategies, researchers and clinicians are working together to improve patient outcomes and ultimately find a cure for pancreatic cancer.
Topics: Humans; Genomics; Precision Medicine; Pancreatic Neoplasms
PubMed: 37994752
DOI: 10.7417/CT.2023.2475 -
Korean Journal of Radiology Jun 2024Incidental pancreatic cystic lesions are a common challenge encountered by diagnostic radiologists. Specifically, given the prevalence of benign pancreatic cystic... (Review)
Review
Incidental pancreatic cystic lesions are a common challenge encountered by diagnostic radiologists. Specifically, given the prevalence of benign pancreatic cystic lesions, determining when to recommend aggressive actions such as surgical resection or endoscopic ultrasound with sampling is difficult. In this article, we review the common types of cystic pancreatic lesions including serous cystadenoma, intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm with imaging examples of each. We also discuss high-risk or worrisome imaging features that warrant a referral to a surgeon or endoscopist and provid several examples of these features. These imaging features adhere to the latest guidelines from the International Consensus Guidelines, American Gastroenterological Association (2015), American College of Gastroenterology (2018), American College of Radiology (2010, 2017), and European Guidelines (2013, 2018). Our focused article addresses the imaging dilemma of managing incidental cystic pancreatic lesions, weighing the options between imaging follow-up and aggressive interventions.
Topics: Humans; Pancreatic Cyst; Incidental Findings; Pancreatic Neoplasms; Diagnosis, Differential; Pancreas; Tomography, X-Ray Computed
PubMed: 38807337
DOI: 10.3348/kjr.2024.0085 -
Pancreas Feb 2022Cigarette smoking is an established risk factor for pancreatic ductal adenocarcinoma (PDAC). In this project, we investigated the effect of smoking and the role of...
OBJECTIVE
Cigarette smoking is an established risk factor for pancreatic ductal adenocarcinoma (PDAC). In this project, we investigated the effect of smoking and the role of histone deacetylase 4 (HDAC4) in PDAC invasion and metastasis.
METHODS
Cells were treated with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and cigarette smoke extract and the mRNA levels of HDACs were measured by real-time polymerase chain reaction. Invasion was measured using the Matrigel Invasion Assay. Syngeneic PDAC mice were treated with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone and metastasis measured. Human PDAC primary and metastatic tissues were analyzed by immunohistochemistry.
RESULTS
Levels of HDAC4 mRNA were increased by smoking. Smoking compounds significantly promoted invasion of cancer cells and promoted metastasis of PDAC cells to different organs, including the liver and the lung, whereas inhibition of HDAC4 prevented this effect. The effect of HDAC4 inhibition on preventing smoking-induced metastasis was greater in the liver compared with the lung. We found that HDAC4 is highly expressed in primary and metastatic PDAC tumors.
CONCLUSIONS
We found that HDAC4 is the only HDAC induced by smoking among all HDACs analyzed. We found that smoking promotes invasion and metastasis of PDAC cells through a mechanism that involves HDAC4 and that HDAC4 is a promising target for preventing PDAC metastasis.
Topics: Animals; Carcinoma, Pancreatic Ductal; Cell Line, Tumor; Gene Expression Regulation, Neoplastic; Histone Deacetylases; Humans; Mice; Neoplasm Metastasis; Pancreatic Neoplasms; RNA, Messenger; Repressor Proteins; Smoking
PubMed: 35404896
DOI: 10.1097/MPA.0000000000001998 -
Japanese Journal of Clinical Oncology Aug 2023Undifferentiated carcinoma (UC) of the pancreas is a rare subtype of pancreatic cancer displaying no definitive direction of differentiation. UC has been reported as a... (Review)
Review
Undifferentiated carcinoma (UC) of the pancreas is a rare subtype of pancreatic cancer displaying no definitive direction of differentiation. UC has been reported as a highly aggressive malignant neoplasm, with a median overall survival of <1 year, except for several surgical series. On the other hand, UC tissue sometimes contains non-neoplastic osteoclast-like giant cells (OGCs), and such cases have been reported to have relatively longer survival. Thus, the World Health Organization (WHO) classification histologically distinguishes UC with OGCs (UCOGCs) from UC, and UCs were subclassified into three subtypes: anaplastic UC, sarcomatoid UC and carcinosarcoma. However, still less is known about UC due to its rarity, and such situations lead to further difficulties in treatment for UC. To date, only surgical resection can offer curative treatment for patients with UC, and no clear evidence for chemotherapy exists for them. However, a retrospective cohort study and case reports showed that relatively promising results paclitaxel-containing regimens for treatment of patients with unresectable UC. Furthermore, high programmed cell death protein 1 expression has been reported in sarcomatoid UCs and UCOGCs, and promising responses to anti-programmed death-ligand 1 therapy have been described in case reports of UCOGCs. Recent advances in chemotherapeutic agents and molecular technologies are opening up the possibilities for expanded treatments.
Topics: Humans; Retrospective Studies; Pancreatic Neoplasms; Carcinoma; Pancreas
PubMed: 37325968
DOI: 10.1093/jjco/hyad062 -
World Journal of Surgery Jul 2020Due to the rarity of malignant insulinoma, a lack of the literature describing factors affecting outcomes exists. Our aim was to review malignant insulinoma incidence,... (Review)
Review
INTRODUCTION
Due to the rarity of malignant insulinoma, a lack of the literature describing factors affecting outcomes exists. Our aim was to review malignant insulinoma incidence, characteristics and survival trends.
METHODS
We identified all patients with malignant insulinoma in the SEER registries from 1973 to 2015. Incidence, neoplasm characteristics and factors affecting cancer-specific survival (CSS) were described.
RESULTS
A total of 121 patients were identified. The crude annual overall incidence was low (range 0.0-0.27 cases per million person years). The largest proportion had localized disease (40%), while 16% had regional disease, 39% distant metastatic disease, and stage was unreported in 5%. Most neoplasms were in the body/tail of the pancreas, followed by the head of the pancreas. Grade was reported in 40% of patients; only a single patient reported as having grade IV with the remainder all grades I/II. Surgical resection was performed in 64% of patients. Within surgical patients, the median primary neoplasm size was 1.8 cm. Regional lymph nodes were examined in 57.1% of surgical patients, while 34% of examined nodes were positive. The median CSS was 183 months. On multivariable analysis, surgical resection, male sex and absence of metastatic disease were associated with superior survival.
CONCLUSION
While the greatest proportion of patients with malignant insulinoma present with localized disease, regional lymph node involvement was found in 34% of whose nodes were tested. Further studies are needed to assess the role of lymph node dissection in improving survival and preventing recurrence given the observed frequency of lymph node involvement.
Topics: Humans; Insulinoma; Lymph Node Excision; Lymphatic Metastasis; Neuroendocrine Tumors; Pancreatic Neoplasms; Prognosis; Survival Rate
PubMed: 32128613
DOI: 10.1007/s00268-020-05445-x