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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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