Abstract
Objectives
To identify CT features distinguishing neuroendocrine carcinomas (NECs) of pancreas from well-differentiated neuroendocrine tumors (NETs) according to the World Health Organization 2017 and 2019 classification systems.
Methods
This retrospective study included 69 patients with pathologically confirmed pancreatic neuroendocrine neoplasms who underwent dynamic CT (17, 17, 18, and 17 patients for well-differentiated grade 1, 2, 3 NET and NEC, respectively). CT was used to perform qualitative analysis (component, homogeneity, calcification, peripancreatic infiltration, main pancreatic ductal dilatation, bile duct dilatation, intraductal extension, and vascular invasion) and quantitative analysis (interface between tumor and parenchyma [delta], arterial enhancement ratio [AER], portal enhancement ratio [PER], and dynamic enhancement pattern). Uni- and multivariate logistic regression analyses were performed to identify features indicating NEC. Optimal cutoff values for enhancement ratios were determined.
Results
NECs demonstrated significantly higher frequencies of main pancreatic ductal dilatation, bile duct dilatation, vascular invasion, and significantly lower delta (i.e., lower conspicuity), AER, and PER than well-differentiated NET (p < 0.05). On multivariate analysis, PER was the only independent factor selected by the model for differentiation of NEC from well-differentiated NET (odds ratio, < 0.001; 95% confidence interval [CI], < 0.001–0.012). PER < 0.8 showed the sensitivity of 94.1% (95% CI, 71.3–99.9) and the specificity of 88.5% (95% CI, 76.6–95.6). When three significant CT features were combined, the sensitivity and specificity for diagnosing NEC were 88.2% and 88.5%, respectively.
Conclusions
Tumor-parenchyma enhancement ratio in portal phase is a useful CT feature to distinguish NECs from well-differentiated NETs. Combining qualitative and quantitative CT features may aid in achieving good diagnostic accuracy in the differentiation between NEC and well-differentiated NET.
Key Points
• Neuroendocrine carcinoma of the pancreas should be distinguished from well-differentiated neuroendocrine tumor in line with the revised grading and staging system.
• Neuroendocrine carcinoma of the pancreas can be differentiated from well-differentiated neuroendocrine tumor on dynamic CT based on assessment of the portal enhancement ratio, arterial enhancement ratio, tumor conspicuity, dilatation of the main pancreatic duct or bile duct, and vascular invasion.
• Tumor-parenchyma enhancement ratio in portal phase of dynamic CT is a useful feature, which may help to distinguish neuroendocrine carcinoma from well-differentiated neuroendocrine tumor of the pancreas.
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Abbreviations
- AER:
-
Arterial enhancement ratio
- G1:
-
Grade 1
- G2:
-
Grade 2
- G3:
-
Grade 3
- HU:
-
Hounsfield unit
- NEC:
-
Neuroendocrine carcinoma
- NET:
-
Neuroendocrine tumor
- PanNEN:
-
Pancreatic neuroendocrine neoplasm
- PD:
-
Poorly differentiated
- PER:
-
Portal enhancement ratio
- ROC:
-
Receiver operating characteristics
- ROI:
-
Region of interest
- WD:
-
Well differentiated
- WHO:
-
World Health Organization
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Acknowledgments
Authors would like to express their appreciation to Dr. Yu Sub Sung for his assistance in measuring delta and making Fig. 2.
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The scientific guarantor of this publication is Hyoung Jung Kim.
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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in:
a. Kim DW, Kim HJ, Kim KW, et al (2015) Neuroendocrine neoplasms of the pancreas at dynamic enhanced CT: comparison between grade 3 neuroendocrine carcinoma and grade 1/2 neuroendocrine tumour. Eur Radiol 25:1375–1383.
b. Kim JY, Kim MS, Kim KS, et al (2015) Clinicopathologic and prognostic significance of multiple hormone expression in pancreatic neuroendocrine tumours. Am J Surg Pathol 39:592–601.
c. Son EM, Kim JY, An S et al (2015) Clinical and prognostic significances of cytokeratin 19 and KIT expression in surgically resectable pancreatic neuroendocrine tumors. J Pathol Transl Med 49:30–36.
d. Hwang HS, Kim Y, An S et al (2018) Grading by the Ki-67 labeling index of endoscopic ultrasound-guided fine-needle aspiration biopsy specimens of pancreatic neuroendocrine tumors can be underestimated. Pancreas 47:1296–1303.
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• retrospective
• diagnostic or prognostic study
• performed at one institution
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Park, H.J., Kim, H.J., Kim, K.W. et al. Comparison between neuroendocrine carcinomas and well-differentiated neuroendocrine tumors of the pancreas using dynamic enhanced CT. Eur Radiol 30, 4772–4782 (2020). https://doi.org/10.1007/s00330-020-06867-w
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DOI: https://doi.org/10.1007/s00330-020-06867-w