Prognostic value of pretreatment contrast-enhanced computed tomography in esophageal neuroendocrine carcinoma: A multicenter follow-up study

BACKGROUND The rare incidence of esophageal neuroendocrine carcinoma(NEC) and limited treatment experience result in insufficient clinical observations and unsuitable guidelines for its management.AIM To investigate the prognostic value of pretreatment contrast-enhanced computed tomography(CT) characteristics in patients with esophageal NEC.METHODS Seventy-seven esophageal NEC patients who received contrast-enhanced CT at two hospitals were enrolled in this study from June 2014 to December 2019. The clinical features and image characteristics were recorded accordingly. Univariate survival analysis was performed using the Kaplan-Meier method and log-rank test, and multivariate analysis was carried out with a Cox proportional hazards model.RESULTS The multivariate analysis performed using the Cox proportional hazards model showed that N stage, adjuvant chemotherapy, and degree of enhancement were independent prognostic factors for overall survival(OS). Meanwhile, adjuvant chemotherapy was an independent prognostic factor for progression-free survival (PFS). The hazard ratios(HRs) of N stage, adjuvant chemotherapy, and degree of enhancement(mild vs moderate/marked) for OS were 0.426(P = 0.024), 3.862(P = 0.006), and 2.169/0.809(P = 0.037), respectively. The HR of adjuvant chemotherapy for PFS was 6.432(P 0.001). Adjuvant chemotherapy was significantly associated with degree of enhancement(P = 0.018).CONCLUSION Adjuvant chemotherapy is an independent prognostic factor for OS and PFS. Additionally, N stage and degree of enhancement are prognostic factors for OS in patients with esophageal NEC.     

Update on surgical treatment of pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms (PNENs) are rare and account for only 2%-4% of all pancreatic neoplasms. All PNENs are potential (neurendocrine tumors PNETs) or overt (neuroendocrine carcinomas PNECs) malignant, but a subset of PNETs is low-risk. Even in case of low-risk PNETs surgical resection is frequently required to treat hormone-related symptoms and to obtain an appropriate pathological diagnosis. Low-risk PNETs in the body and the tail are ideal for minimally-invasive approaches which should be tailored to the individual patient. Generally, surgeons must aim for parenchyma sparing in these cases. In high-risk and malignant PNENs, indications for tumor resection are much wider than for pancreatic adenocarcinoma, in many cases due to the relatively benign tumor biology. Thus, patients with locally advanced and metastatic PNETs may benefit from extensive resection. In experienced hands, even multi-organ resections are accomplished with acceptable perioperative morbidity and mortality rates and are associated with excellent long term survival. However, poorly differentiated neoplasms with high proliferation rates are associated with a dismal prognosis and may frequently only be treated with chemotherapy. The evidence on surgical treatment of PNENs stems from reviews of mostly single-center series and some analyses of nation-wide tumor registries. No randomized trial has been performed to compare surgical and non-surgical therapies in potentially resectable PNEN. Though such a trial would principally be desirable, ethical considerations and the heterogeneity of PNENs preclude realization of such a study. In the current review, we summarize recent advances in the surgical treatment of PNENs.     

Advances in medical treatment for pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms (PanNENs) are rare neoplasms with strong heterogeneity that have experienced an increasing incidence rate in recent years. For patients with locally advanced or distant metastatic PanNENs, systemic treatment options vary due to the different differentiations, grades and stages. The available options for systemic therapy include somatostatin analogs, mole-cularly targeted agents, cytotoxic chemotherapeutic agents, immune checkpoint inhibitors, and peptide receptor radionuclide therapy. In addition, the development of novel molecularly targeted agents is currently in progress. The sequence of selection between different chemotherapy regimens has been of great interest, and resistance to chemotherapeutic agents is the major limitation in their clinical application. Novel agents and high-level clinical evidence continue to emerge in the field of antiangiogenic agents. Peptide receptor radionuclide therapy is increasingly employed for the treatment of advanced neuroendocrine tumors, and greater therapeutic efficacy may be achieved by emerging radio-labeled peptides. Since immune checkpoint inhibitor monotherapies for PanNENs appear to have limited antitumor activity, dual immune checkpoint inhibitor therapies or combinations of antiangiogenic therapies and immune checkpoint inhibitors have been applied in the clinic to improve clinical efficacy. Combining the use of a variety of agents with different mechanisms of action provides new possibilities for clinical treatments. In the future, the study of systemic therapies will continue to focus on the screening of the optimal benefit population and the selection of the best treatment sequence strategy with the aim of truly achieving individualized precise treatment of PanNENs.     

Enhancement parameters of contrast-enhanced computed tomography for pancreatic ductal adenocarcinoma: Correlation with pathologic grading

BACKGROUND Pancreatic ductal adenocarcinoma(PDA) is a malignancy with a high mortality rate and short survival time. The conventional computed tomography(CT) has been worldwide used as a modality for diagnosis of PDA, as CT enhancement pattern has been thought to be related to tumor angiogenesis and pathologic grade of PDA.AIM To evaluate the relationship between the pathologic grade of pancreatic ductal adenocarcinoma and the enhancement parameters of contrast-enhanced CT.METHODS In this retrospective study, 42 patients(Age, mean ± SD: 62.43 ± 11.42 years) with PDA who underwent surgery after preoperative CT were selected. Two radiologists evaluated the CT images and calculated the value of attenuation at the aorta in the arterial phase and the pancreatic phase(VA_(arterial) and VApancreatic) and of the tumor(VT_(arterial) and VT_(pancreatic)) by finding out four regions of interest. Ratio between the tumor and the aorta enhancement on the arterial phase and the pancreatic phase(TAR_(arterial) and TAR_(pancreatic)) was figured out through dividing VT_(arterial) by VA_(arterial) and VT_(pancreatic) by VA_(pancreatic). Tumor-to-aortic enhancement fraction(TAF) was expressed as the ratio of the difference between attenuation of the tumor on arterial and parenchymal images to that between attenuation of the aorta on arterial and pancreatic images. The Kruskal-Wallis analysis of variance and Mann-Whitney U test for statistical analysis were used.RESULTS Forty-two PDAs(23 men and 19 women) were divided into three groups: Welldifferentiated(n = 13), moderately differentiated(n = 21), and poorly differentiated(n = 8). TAF differed significantly between the three groups(P = 0.034) but TAR_(arterial)(P = 0.164) and TAR_(pancreatic)(P = 0.339) did not. The median value of TAF for poorly differentiated PDAs(0.1011; 95%CI: 0.01100-0.1796) was significantly higher than that for well-differentiated PDAs(0.1941; 95%CI: 0.1463-0.3194).CONCLUSION Calculation of TAF might be useful in predicting the pathologic grade of PDA.     

Prognostic factors of patients with gastroenteropancreatic neuroendocrine neoplasms

There is an increasing trend in the incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) worldwide. The aim of the present study was to identify the prognostic factors of patients with GEP-NENs. A cross-sectional, retrospective chart review study was conducted among patients with pathologically proven GEP-NENs between January 2003 and December 2016 at Kaohsiung Chung-Gung Memorial Hospital. A total of 97 patients who met the inclusion criteria were included (male/female = 56/41, age: 57.7 ± 15.4 years). The presentation, clinical characteristics, and disease outcomes were reviewed and analyzed. The most common primary site of the GEP-NENs was the rectum (49.5%), followed by the pancreas (17.5%), duodenum (11.3%), stomach (10.3%), colon (6.2%), and appendix (5.2%), and most GEP-NENs were hormonally nonfunctional (94.8%). There were 56 tumors classified as G1 neuroendocrine tumors (NETs), 9 as G2 NETs, and 14 as G3 neuroendocrine carcinoma (NEC). Metastasis was found in 15 patients (15%). Curative treatments, such as surgery or endoscopic resection, were performed in 83.5% of patients (n = 81). The mean overall survival duration was 107.2 ± 7.8 months. The estimated 3- and 5-year overall survival rates for all patients were 84% and 82%, respectively. Logistic regression analysis showed that large tumor size, non-rectal NENs, high histopathological grading, lymphatic metastases and distant metastases were associated with poor survival. This study suggested that the presence of lymphatic or distant metastases at diagnosis is an independent risk factor for poor prognosis in patients with GEP-NENs.     

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

AIM： To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms （IPMNs） in multi-detector row computed tomography （MDCT）.
METHODS： A total of 20 patients with pathologicallyconfirmed intraductal papillary mucinous neoplasms （IPMNs） were included in this study. Axial MDCT images combined with CT angiography （CTA） and multiplanar volume reformations （MPVR） or curved reformations （CR） were preoperatively acquired. Two radiologists （Tan L and Wang DB） reviewed all the images in consensus using an interactive picture archiving and communication system. The disputes in readings were resolved through consultation with a third experienced radiologist （Chen KM）. Finally, the findings and diagnoses were compared with the pathologic results.
RESULTS： The pathological study revealed 12 malignant IPMNs and eight benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts （MPDs） were significantly larger in malignant IPMNs compared with those of the benign IPMNs （P 〈 0.05）. The combinedtype IPMNs had a higher rate of malignancy than the other two types of IPMNs （P 〈 0.05）. Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features （P 〈 0.05）. Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images. From comparison with the pathological diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5% and 95%, respectively.
CONCLUSION： MDCT with CTA and MPVR or CR techniques can elucidate the imaging features of IPMNs and help predict the malignancy of these tumors.     

Clinicopathological features of small nonfunctioning pancreatic neuroendocrine tumors

AIM: To present our experiences in studying the clinicopathological features of small nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs).METHODS: The subjects included 9 patients with NF-pNETs who underwent pancreatectomy between April 1996 and September 2012. The surgical procedure, histopathological findings, and prognosis were assessed.RESULTS: All tumors were incidentally detected by computed tomography. The median diameter was 10 mm (5-32 mm). One patient was diagnosed with von Hippel-Lindau disease, and the others were sporadic cases. For the histopathological findings, 7 patients were G1; 1 patient was G2; and 1 patient, whose tumor was 22 mm, had neuroendocrine carcinoma (NEC). One patient who had a tumor that was 32 mm had direct invasion to a regional lymph node and 1 patient with NEC, had regional lymph node metastases. Six of the 7 patients with sporadic NF-pNETs, excluding the patient with NEC, had tumors that were smaller than 10 mm. Tumors smaller than 10 mm showed no malignancy and lacked lymph node metastasis.CONCLUSION: Sporadic NF-pNETs smaller than 10 mm tend to have less malignant potential. These findings suggest that lymphadenectomy may be omitted for small NF-pNETs after further investigation.     

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms

The proximity of the endoscopic ultrasound (EUS) transducer to the pancreas and the possibility to place needles or other accessories into a target located adjacent to the wall of the GI tract have encouraged researchers to develop various EUS-guided local treatments directed towards pancreatic neuroendocrine neoplasms (PanNENs). The use of pre-operative EUS-guided tattooing or fiducial marker placement to facilitate intraoperative tumor localization has proven effective in reducing operative time of laparoscopic surgeries. To reduce the mortality and morbidity rates of surgical resection, which is presently the mainstay treatment of PanNENs. EUS-guided loco-regional treatments, such as injection of alcohol and radiofrequency ablation have been proposed and results are hitherto promising. The present paper summarizes currently available data in the field of EUS-guided interventions to pancreatic neuroendocrine tumors, as well as possible future applications.     

Prognostic value of preoperative enhanced computed tomography as a quantitative imaging biomarker in pancreatic cancer

BACKGROUNDPancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with high mortality and short survival time. Computed tomography (CT) plays an important role in the diagnosis, staging and treatment of pancreatic tumour. Pancreatic cancer generally shows a low enhancement pattern compared with normal pancreatic tissue.AIMTo analyse whether preoperative enhanced CT could be used to predict postoperative overall survival in patients with PDAC.METHODSSixty-seven patients with PDAC undergoing pancreatic resection were enrolled retrospectively. All patients underwent preoperative unenhanced and enhanced CT examination, the CT values of which were measured. The ratio of the preoperative CT value increase from the nonenhancement phase to the portal venous phase between pancreatic tumour and normal pancreatic tissue was calculated. The cut-off value of ratios was obtained by the receiver operating characteristic (ROC) curve of the tumour relative enhancement ratio (TRER), according to which patients were divided into low- and high-enhancement groups. Univariate and multivariate analyses were performed using Cox regression based on TRER grouping. Finally, the correlation between TRER and clinicopathological characteristics was analysed.RESULTSThe area under the curve of the ROC curve was 0.768 (P < 0.05), and the cut-off value of the ROC curve was calculated as 0.7. TRER ≤ 0.7 was defined as the low-enhancement group, and TRER > 0.7 was defined as the high-enhancement group. According to the TRER grouping, the Kaplan-Meier survival curve analysis results showed that the median survival (10.0 mo) with TRER ≤ 0.7 was significantly shorter than that (22.0 mo) with TRER > 0.7 (P < 0.05). In the univariate and multivariate analyses, the prognosis of patients with TRER ≤ 0.7 was significantly worse than that of patients with TRER > 0.7 (P < 0.05). Our results demonstrated that patients in the low TRER group were more likely to have higher American Joint Committee on Cancer stage, tumour stage and lymph node stage (all P < 0.05), and TRER was significantly negatively correlated with tumour size (P < 0.05). CONCLUSIONTRER ≤ 0.7 in patients with PDAC may represent a tumour with higher clinical stage and result in a shorter overall survival.     

Systematic review and meta-analysis on laparoscopic pancreatic resections for neuroendocrine neoplasms (PNENs)

Introduction: The safety of laparoscopic resections (LPS) of pancreatic neuroendocrine neoplasms (PNENs) has been well established in the literature.

Areas covered: Studies conducted between January 2003 and December 2015 that reported on LPS and open surgery (OPS) were reviewed. The primary outcomes were the rate of post-operative complications and the length of hospital stay (LoS) after laparoscopic and open surgical resection. The rate of recurrence was the secondary outcome. Eleven studies were included with a total of 907 pancreatic resections for PNENs, of whom, 298 (32.8%) underwent LPS and 609 (67.2%) underwent open surgery. LPS resulted in a significantly shorter LoS (p < 0.0001) and lower blood loss (p < 0.0001). The meta-analysis did not show any significant difference in the pancreatic fistula rate, recurrence rate or post-operative mortality between the two groups.

Expert commentary: LPS is a safe approach even for PNENs and it is associated with a shorter LoS.     

Normal pancreatic volume assessment using abdominal computed tomography volumetry

To determine the normal range of pancreatic volume (PV) in Chinese adults using computed tomography (CT) volumetry. To assess the relationships of PV with patient demographics and clinical parameters. To analyze the degree of correlation between PV values determined by manual segmentation and those calculated by formulas.A total of 240 adults (120 women, 120 men) between the ages of 18 and 79 years were reviewed. There were 6 groups of patients, with 40 patients in each decade regarding age. PV was segmented manually on computed tomography images slice by slice for each patient, and 2 formulas were used to calculate PV^∗ and PV^#.The mean PV was 77.44 ± 19.11 cm³ (range from 28.55–138.15 cm³). PV was significantly correlated with height (r = 0.427, P < .001), weight (r = 0.525, P < .001), body mass index (r = 0.377, P < .001), the width of the first lumbar vertebral body (r = 0.166, P = .01), the transverse abdominal diameter (r = 0.455, P < .001), and the sagittal abdominal diameter (r = 0.456, P < .001). There was a negative correlation between PV and age (r = –0.209, P = .001). The correlation coefficients between PV and PV^∗ and PV^# were 0.676 and 0.376, respectively, with both P < .001.PV associated with patient demographics and clinical parameters. A more accurate and simpler formula should be used in the future to calculate and monitor changes in PV.     

胰腺神经内分泌肿瘤治疗指南(2014)

<正>胰腺神经内分泌肿瘤(pancreatic neuroendocrine neoplasms,p NEN),原称为胰岛细胞瘤,约占原发性胰腺肿瘤的3%。依据激素的分泌状态和患者的临床表现,分为功能性和无功能性p NEN。无功能性p NEN约占75%~85%;功能性p NEN常见的有胰岛素瘤和胃泌素瘤。胰岛素瘤一般位于胰腺,而胃泌素瘤多见于十二指肠或胰腺;其余的功能性p NEN均少见,统称     

Construction of a convolutional neural network classifier developed by computed tomography images for pancreatic cancer diagnosis

BACKGROUND Efforts should be made to develop a deep-learning diagnosis system to distinguish pancreatic cancer from benign tissue due to the high morbidity of pancreatic cancer.AIM To identify pancreatic cancer in computed tomography(CT) images automatically by constructing a convolutional neural network(CNN) classifier.METHODS A CNN model was constructed using a dataset of 3494 CT images obtained from 222 patients with pathologically confirmed pancreatic cancer and 3751 CT images from 190 patients with normal pancreas from June 2017 to June 2018. We established three datasets from these images according to the image phases, evaluated the approach in terms of binary classification(i.e., cancer or not) and ternary classification(i.e., no cancer, cancer at tail/body, cancer at head/neck of the pancreas) using 10-fold cross validation, and measured the effectiveness of the model with regard to the accuracy, sensitivity, and specificity.RESULTS The overall diagnostic accuracy of the trained binary classifier was 95.47%, 95.76%, 95.15% on the plain scan, arterial phase, and venous phase, respectively. The sensitivity was 91.58%, 94.08%, 92.28% on three phases, with no significant differences(χ~2 = 0.914, P = 0.633). Considering that the plain phase had same sensitivity, easier access, and lower radiation compared with arterial phase and venous phase, it is more sufficient for the binary classifier. Its accuracy on plain scans was 95.47%, sensitivity was 91.58%, and specificity was 98.27%. The CNN and board-certified gastroenterologists achieved higher accuracies than trainees on plain scan diagnosis(χ~2 = 21.534, P 0.001; χ~2 = 9.524, P 0.05; respectively). However, the difference between CNN and gastroenterologists was not significant(χ~2 = 0.759, P = 0.384). In the trained ternary classifier, the overall diagnostic accuracy of the ternary classifier CNN was 82.06%, 79.06%, and 78.80% on plain phase, arterial phase, and venous phase, respectively. The sensitivity scores for detecting cancers in the tail were 52.51%, 41.10% and, 36.03%, while sensitivity for cancers in the head was 46.21%, 85.24% and 72.87% on three phases, respectively. Difference in sensitivity for cancers in the head among the three phases was significant(χ~2 = 16.651, P 0.001), with arterial phase having the highest sensitivity.CONCLUSION We proposed a deep learning-based pancreatic cancer classifier trained on medium-sized datasets of CT images. It was suitable for screening purposes in pancreatic cancer detection.     

The role of 18fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer

BackgroundThe role of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer.Methods¹⁸Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3.ResultsOverall, 21% of patients had a maximum standardized uptake value ≤3, and 60% of those had undergone neoadjuvant treatment (P = 0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8 U/mL for the entire cohort and 292 U/mL for metastatic patients (P = 0.112).ConclusionsThe widespread application of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9 > 200 U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.     

Distinguishing pancreatic solid serous cystadenomas from nonfunctional pancreatic neuroendocrine tumors by computed tomography: A propensity score analysis

This study aims to evaluate the utility of calculated computed tomography (CT) attenuation value ratio (AVR) and enhancement pattern in distinguishing pancreatic solid serous cystadenomas (SCAs) from nonfunctional pancreatic neuroendocrine tumors (NF-pNETs). A total of 142 consecutive patients with 22 solid SCAs and 120 NF-pNETs confirmed by pathology were included in this retrospective study. All patients underwent preoperative contrast-enhanced CT and were categorized into 2 groups, solid SCA and NF-pNET groups. Patients with NF-pNETs were matched to patients with solid SCAs via propensity scores. AVR was measured and defined as: attenuation value of tumor/attenuation value of normal pancreas. AVR and enhancement pattern performance were assessed according to the discriminative abilities of patients. After matching, 29 patients were allocated to the NF-pNET group. Before matching, sex, age, and the peak enhanced value phase were significantly different between solid SCA and NF-pNET patients (P < .05). After matching, no significant difference was observed between both groups (P > .05). Solid SCAs AVRs were significantly smaller than NF-pNETs AVRs in all unenhanced, arterial, portal venous, and delayed phases (P < .05). Solid SCAs showed significantly more wash-in and wash-out enhancement patterns than NF-pNETs (P < .05). For unenhanced, arterial, portal venous, and delayed phases, and enhancement pattern, the area under the curve (AUC) values were 0.96, 0.72, 0.80, 0.85, and 0.86, respectively. Low AVR on unenhanced CT and wash-in and wash-out enhancement patterns were useful for differentiating solid SCAs from NF-pNETs and may be useful for clinical decisions, a clearer opinion will be formed with further studies to be conducted with larger patient numbers.     

Chronological improvement of pancreatectomy for resectable but advanced pancreatic neuroendocrine neoplasms

BackgroundProgress of non-surgical treatments in the last decade has improved the prognosis of pancreatic neuroendocrine neoplasms (PanNEN). However, the improvement of surgery for advanced PanNEN remains unknown. This study aimed to investigate the chronological changes of the clinical impact of pancreatectomy for PanNEN.MethodsPatients undergoing curative-intent pancreatectomy for PanNEN between 1991 and 2010 were categorized into the earlier period group, and those between 2011 and 2021 were into the later period group.Advanced PanNEN was defined as showing resectable synchronous liver metastases or invasion to portal venous systems or adjacent organs. The recurrence-free survival (RFS) and overall survival (OS) were analyzed among patients with non-advanced and advanced PanNENs. The independent prognostic risk factors were identified using a Cox proportional hazard model.ResultsA total of 189 patients (n = 54 in the earlier period and n = 135 in the later period) were included. The proportion of advanced PanNEN increased from 15% to 30% (P = 0.027). The RFS and OS of non-advanced PanNEN were similar between the periods. Whereas, among patients with advanced PanNEN, the later period group showed improved prognosis; The 5-year RFS of the earlier period vs. the later period was 0% vs. 27%, and the 5-year OS was 38% vs. 82% (p = 0.013).ConclusionsA radical surgical treatment for advanced PanNEN has shown prognostic improvement in this decade. However, more careful perioperative examinations and possibly, additional treatments are required for PanNEN with portal vein invasion.     

The size of well differentiated pancreatic neuroendocrine tumors correlates with Ki67 proliferative index and is not associated with age

BackgroundConcerns exist about a conservative management of well-differentiated nonfunctioning small pancreatic neuroendocrine tumors (NF-PanNET) in young patients and when preoperative Ki67 proliferative index is ≥3%.AimTo evaluate an association between age, tumor size and grading in patients with sporadic NF-PanNET who underwent curative resection.MethodsPatients who underwent surgery for sporadic NF-PanNET (excluding G3) were retrospectively analyzed. Linear regression analysis was performed to evaluate a possible correlation between continuous variables, whereas multiple logistic regression analysis was performed for determining predictors of NF-PanNET-G2.ResultsOverall, 235 patients with NF-PanNET-G1/G2 were included. The median largest radiological diameter was 25 mm. Age correlated neither with tumor size (P = 0.675) nor with Ki67 index (P = 0.376). On multivariate linear regression analysis, factors independently associated with Ki67 index were NF-PanNET size (P = 0.031), perineural invasion (P = 0.004), microvascular invasion (P = 0.001) and necrosis (P = 0.009). The most accurate NF-PanNET size for predicting NF-PanNET-G2 was 25 mm. On multivariate analysis, a NF-PanNET size >25 mm was independently associated with the risk of having a PanNET-G2 (P = 0.025).ConclusionNo correlations exist between age and NF-PanNET size or proliferative index. Therefore, an a priori aggressive attitude is not justified in young patients with small NF-PanNET, as a long-life expectancy is probably unlikely to increase the risk of malignant transformation.     

Prognostic significance of multiple-detector computed tomography in conjunction with TIMI risk score for patients with non-ST elevation acute coronary syndrome

Risk stratification among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) has been made by clinical scoring. Recently, multiple-detector computed tomography (MDCT) appeared to provide noninvasive coronary angiography (CAG). To clarify the prognostic significance of MDCT, we aimed to evaluate the clinical utility of MDCT in the early management and in predicting the long-term prognosis of NSTE-ACS with low to intermediate risk. Among 84 consecutive patients with NSTEACS, risk stratification using a TIMI risk score was done. A total of 48 patients were categorized as low to intermediate risk. Multiple-detector CT was performed in 30 patients using 16-slice MDCT. MDCT detected coronary stenoses in 18 patients. Compared to invasive CAG, MDCT successfully depicted the coronary stenosis (P < 0.005), with sensitivity of 100% and specificity of 86%. The incidence of in-hospital major adverse clinical events (death, subsequent myocardial infarction, revascularization) was significantly higher in patients with a positive MDCT than in those with a negative MDCT test (44% vs 0%, P < 0.005). Moreover, a Kaplan-Meier analysis showed a significant difference in the event — free survival between MDCT positive and negative groups (33% vs 100%, respectively, P < 0.0001) during the mean follow-up period of 9.9 ± 7.5 months. Sixteen-slice MDCT in conjunction with a TIMI risk score appeared to demonstrate prognostic significance in patients with NSTE-ACS.