Diffusion-Weighted MRI Predicts Lymph Node Metastasis and Tumor Aggressiveness in Resectable Pancreatic Neuroendocrine T
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ORIGINAL SCIENTIFIC REPORT
Diffusion-Weighted MRI Predicts Lymph Node Metastasis and Tumor Aggressiveness in Resectable Pancreatic Neuroendocrine Tumors Norifumi Harimoto1 • Kenichiro Araki1 • Kouki Hoshino1 • Ryo Muranushi1 • Kei Hagiwara1 • Norihiro Ishii1 • Mariko Tsukagoshi1,4 • Takamichi Igarashi1 • Akira Watanabe1 • Norio Kubo1 • Hiroyasu Tomonaga2 • Tetsuya Higuchi2 • Yoshito Tsushima2 • Hayato Ikota3 • Ken Shirabe1
Accepted: 4 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Objectives The aim of this study was to identify whether diffusion-weighted magnetic resonance imaging (DWMRI) can predict the malignant behavior of preoperative well-differentiated pancreatic neuroendocrine tumors (PanNETs). Method Forty patients with PanNETs who underwent pancreatectomy were enrolled in this study. The apparent diffusion coefficient (ADC) values were measured. Clinicopathological factors were compared in patients with high ADC and low ADC values and in patients with and without lymph node metastasis (LNM). Result The low ADC group was significantly associated with higher Ki-67 index, higher mitotic count, larger tumor size, higher rate of LNM, and venous invasion. In patients with low ADC values, the incidence of LNMs was 33.3%. In patients with high ADC values, there were no patients with LNM being 0%. A significant negative correlation was found between the mean ADC values and the Ki-67 index and between the mean ADC values and the mitotic count. In multivariate analysis, neural invasion and mean ADC values B 1458 were independent predictors of LNM. Conclusion ADC values obtained using DW-MRI in the preoperative assessment of patients with PanNETs might be a useful predictor of malignant potential, especially LNM.
Introduction Pancreatic neuroendocrine tumors (PanNETs) are rare among primary pancreatic malignancies [1, 2]. Surgical resection is still the most effective treatment, and PanNETs & Norifumi Harimoto [email protected] 1
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showamachi, Maebashi 371-8511, Japan
2
Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Maebashi, Japan
3
Department of Human Pathology, Gunma University, Maebashi, Japan
4
Department of Innovative Cancer Immunotherapy, Gunma University, Maebashi, Japan
are associated with a good prognosis because of their slow growth rate. Recently, some studies revealed that there were several factors to predict poor prognosis. Grading of PanNETs using the Ki-67 index and mitotic count is widely used in predictive prognosis [3, 4]. We previously reported that the WHO 2017 classification could predict poor prognosis in patients who underwent pancreatectomy for PanNETs, which need lymph node dissection (LND) [5, 6]. To predict the biological malignant behavior of PanNETs, preoperative information about PanNET grade is necessary. Grading of PanNETs determined in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy specimens
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