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Neuroendocrine neoplasms of the pancreas at dynamic enhanced CT: comparison between grade 3 neuroendocrine carcinoma and grade 1/2 neuroendocrine tumour

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To identify the CT features in differentiating grade 3 neuroendocrine carcinomas from grade 1/2 neuroendocrine tumours.

Methods

This study included 161 patients with surgically confirmed pancreatic neuroendocrine neoplasms. Pathology slides were reviewed to determine the tumour grade. CT image analysis included size, pattern, calcification, margin, pancreatic duct dilatation, bile duct dilatation, vascular invasion, arterial enhancement ratio, and portal enhancement ratio. We used 2 cm, 3 cm, and 4 cm as cutoff values of tumour size and 0.9 and 1.1 of enhancement ratio to determine the sensitivity and specificity.

Results

Pathology analysis identified 167 lesions in 161 patients. 154 lesions (92 %) were grade 1/2 and 13 (8 %) were grade 3. Portal enhancement ratio (< 1.1) showed high sensitivity and specificity 92.3 % and 80.5 %, respectively in differentiating grade 3 from grade 1/2. It showed the highest odds ratio (49.60), followed by poorly defined margin, size (> 3 cm), bile duct dilatation, and vascular invasion. When at least two of these five criteria were used in combination, the sensitivity and specificity for diagnosing grade 3 were 92.3 % (12/13) and 87.7 % (135/154), respectively.

Conclusions

By using specific CT findings, grade 3 can be differentiated from grade 1/2 with a high diagnostic accuracy leading to an appropriate imaging staging.

Key points

• Neuroendocrine carcinomas should be differentiated from neuroendocrine tumours.

• Neuroendocrine carcinomas can be differentiated from neuroendocrine tumours on dynamic CT.

• Neuroendocrine carcinomas show iso- or hypo-enhancement on portal venous phase CT.

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Abbreviations

PanNEN:

Pancreatic neuroendocrine neoplasm

NET:

Neuroendocrine tumour

NEC:

Neuroendocrine carcinoma

G1:

Grade 1

G2:

Grade 2

G3:

Grade 3

ROI:

region of interest

WHO:

World Health Organization

HU:

Hounsfield unit

MVD:

Microvascular density

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Acknowledgments

The scientific guarantor of this publication is Hyoung Jung Kim. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea

    Dong Wook Kim, Hyoung Jung Kim, Kyung Won Kim & Jae Ho Byun

  2. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Ki Byung Song

  3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Ji Hoon Kim & Seung-Mo Hong

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  1. Dong Wook Kim
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Correspondence to Hyoung Jung Kim.

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Kim, D.W., Kim, H.J., Kim, K.W. et al. 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 (2015). https://doi.org/10.1007/s00330-014-3532-z

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  • DOI: https://doi.org/10.1007/s00330-014-3532-z

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