Korean Journal of Radiology

  • 제24권1호
  • /
  • Pages.39-50
  • /
  • 2023
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Contrast-Enhanced CT and Ultrasonography Features of Intracholecystic Papillary Neoplasm with or without associated Invasive Carcinoma

  • Jae Hyun Kim (Department of Radiology, Seoul National University Hospital) ;
  • Jung Hoon Kim (Department of Radiology, Seoul National University Hospital) ;
  • Hyo-Jin Kang (Department of Radiology, Seoul National University Hospital) ;
  • Jae Seok Bae (Department of Radiology, Seoul National University Hospital)
  • 투고 : 2022.08.15
  • 심사 : 2022.10.28
  • 발행 : 2023.01.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To assess the contrast-enhanced CT and ultrasonography (US) findings of intracholecystic papillary neoplasm (ICPN) and determine the imaging features predicting ICPN associated with invasive carcinoma (ICPN-IC). Materials and Methods: In this retrospective study, we enrolled 119 consecutive patients, including 60 male and 59 female, with a mean age ± standard deviation of 63.3 ± 12.1 years, who had pathologically confirmed ICPN (low-grade dysplasia [DP] = 34, high-grade DP = 35, IC = 50) and underwent preoperative CT or US. Two radiologists independently assessed the CT and US findings, focusing on wall and polypoid lesion characteristics. The likelihood of ICPN-IC was graded on a 5-point scale. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of ICPN-IC separately for wall and polypoid lesion findings. The performances of CT and US in distinguishing ICPN-IC from ICPN with DP (ICPN-DP) was evaluated using the area under the receiver operating characteristic curve (AUC). Results: For wall characteristics, the maximum wall thickness (adjusted odds ratio [aOR] = 1.4; 95% confidence interval [CI]: 1.1-1.9) and mucosal discontinuity (aOR = 5.6; 95% CI: 1.3-23.4) on CT were independently associated with ICPN-IC. Among 119 ICPNs, 110 (92.4%) showed polypoid lesions. Regarding polypoid lesion findings, multiplicity (aOR = 4.0; 95% CI: 1.6-10.4), lesion base wall thickening (aOR = 6.0; 95% CI: 2.3-15.8) on CT, and polyp size (aOR = 1.1; 95% CI: 1.0-1.2) on US were independently associated with ICPN-IC. CT showed a higher diagnostic performance than US in predicting ICPN-IC (AUC = 0.793 vs. 0.676; p = 0.002). Conclusion: ICPN showed polypoid lesions and/or wall thickening on CT or US. A thick wall, multiplicity, presence of wall thickening in the polypoid lesion base, and large polyp size are imaging findings independently associated with invasive cancer and may be useful for differentiating ICPN-IC from ICPN-DP.

키워드

과제정보

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2019S1A5A2A03036673).

참고문헌

  1. Basturk O, Aishima S, Esposito I. Intracholecystic papillary neoplasm. In: WHO Classification of Tumours Editorial Board, ed. WHO classification of tumours, 5th ed. Lyon: International Agency of Research on Cancer, 2019:276-278
  2. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17:738-753
  3. Nakanuma Y, Esposito I, Klimstra DS, Komuta M, Zen Y. Intraductal papillary neoplasm of the bile ducts. In: WHO Classification of Tumours Editorial Board. WHO classification of tumours, 5th ed. Lyon: International Agency for Research on Cancer, 2019:279-282
  4. Adsay V, Jang KT, Roa JC, Dursun N, Ohike N, Bagci P, et al. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are ≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases. Am J Surg Pathol 2012;36:1279-1301
  5. Akita M, Fujikura K, Ajiki T, Fukumoto T, Otani K, Hirose T, et al. Intracholecystic papillary neoplasms are distinct from papillary gallbladder cancers: a clinicopathologic and exome-sequencing study. Am J Surg Pathol 2019;43:783-791
  6. Kerlakian S, Dhar VK, Abbott DE, Kooby DA, Merchant NB, Kim HJ, et al. Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas: a seven institution study from the central pancreas consortium. HPB (Oxford) 2019;21:482-488
  7. Kim JH, Lee JY, Baek JH, Eun HW, Kim YJ, Han JK, et al. High-resolution sonography for distinguishing neoplastic gallbladder polyps and staging gallbladder cancer. AJR Am J Roentgenol 2015;204:W150-W159
  8. Joo I, Lee JY, Baek JH, Kim JH, Park HS, Han JK, et al. Preoperative differentiation between T1a and ≥T1b gallbladder cancer: combined interpretation of high-resolution ultrasound and multidetector-row computed tomography. Eur Radiol 2014;24:1828-1834
  9. Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: is follow-up necessary?-Long-term clinical and US analysis of 346 patients. Radiology 2011;258:277-282
  10. Jang JY, Kim SW, Lee SE, Hwang DW, Kim EJ, Lee JY, et al. Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg 2009;250:943-949
  11. Kim SJ, Lee JM, Lee JY, Kim SH, Han JK, Choi BI, et al. Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. AJR Am J Roentgenol 2008;191:765-771
  12. Lee ES, Kim JH, Joo I, Lee JY, Han JK, Choi BI. Xanthogranulomatous cholecystitis: diagnostic performance of US, CT, and MRI for differentiation from gallbladder carcinoma. Abdom Imaging 2015;40:2281-2292
  13. Mizobuchi N, Munechika J, Takeyama N, Ohgiya Y, Ohike N, Abe R, et al. Three cases of intracystic papillary neoplasm of gallbladder. Abdom Radiol (NY) 2018;43:1535-1539
  14. Shimizu T, Kubota K, Shiraki T, Sakuraoka Y, Matsumoto T, Kosuge T, et al. A case of intracystic papillary neoplasm with an associated invasive adenocarcinoma. Int Surg 2017;102:267-271
  15. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual, 8th ed. New York: Springer, 2017
  16. Choi TW, Kim JH, Park SJ, Ahn SJ, Joo I, Han JK. Risk stratification of gallbladder polyps larger than 10 mm using high-resolution ultrasonography and texture analysis. Eur Radiol 2018;28:196-205
  17. Hallgren KA. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 2012;8:23-34
  18. Park SH, Han K. How to clearly and accurately report odds ratio and hazard ratio in diagnostic research studies? Korean J Radiol 2022;23:777-784
  19. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837-845
  20. Goshima S, Chang S, Wang JH, Kanematsu M, Bae KT, Federle MP. Xanthogranulomatous cholecystitis: diagnostic performance of CT to differentiate from gallbladder cancer. Eur J Radiol 2010;74:e79-e83
  21. Kim SJ, Lee JM, Lee JY, Choi JY, Kim SH, Han JK, et al. Accuracy of preoperative T-staging of gallbladder carcinoma using MDCT. AJR Am J Roentgenol 2008;190:74-80
  22. Shinkai H, Kimura W, Muto T. Surgical indications for small polypoid lesions of the gallbladder. Am J Surg 1998;175:114-117
  23. Kim JS, Lee JK, Kim Y, Lee SM. US characteristics for the prediction of neoplasm in gallbladder polyps 10 mm or larger. Eur Radiol 2016;26:1134-1140
  24. Cha BH, Hwang JH, Lee SH, Kim JE, Cho JY, Kim H, et al. Preoperative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 2011;17:2216-2222
  25. Park JK, Yoon YB, Kim YT, Ryu JK, Yoon WJ, Lee SH, et al. Management strategies for gallbladder polyps: is it possible to predict malignant gallbladder polyps? Gut Liver 2008;2:88-94
  26. Wiles R, Thoeni RF, Barbu ST, Vashist YK, Rafaelsen SR, Dewhurst C, et al. Management and follow-up of gallbladder polyps: joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 2017;27:3856-3866
  27. Aslanian HR, Lee JH, Canto MI. AGA clinical practice update on pancreas cancer screening in high-risk individuals: expert review. Gastroenterology 2020;159:358-362
  28. Sultana A, Jackson R, Tim G, Bostock E, Psarelli EE, Cox TF, et al. What is the best way to identify malignant transformation within pancreatic IPMN: a systematic review and meta-analyses. Clin Transl Gastroenterol 2015;6:e130