菊山　正隆
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Associate Professor (Fixed Term)
Article types Original article
Language English
Peer review Non peer reviewed
Title Focal pancreatic parenchyma atrophy is a harbinger of pancreatic cancer and a clue to the intraductal spreading subtype.
Journal Formal name：Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
Abbreviation：Pancreatology
ISSN code：14243911/14243903
Domestic / ForeginForegin
Volume, Issue, Page 22(8),pp.1148-1158
Author and coauthor NAKAHIDO Jun, KIKUYAMA Masataka, FUKUMURA Yuki, HORIGUCHI Shin-Ichiro, CHIBA Kazuro, TABATA Hiroki, SUZUKI Mizuka, KAMISAWA Terumi
Publication date 2022/12
Summary BACKGROUND/OBJECTIVES:Radiological evidence of focal pancreatic parenchymal atrophy (FPPA) may presage early pancreatic ductal adenocarcinoma (PDAC) development. We aimed to clarify the incidence of FPPA and the clinicopathological features of PDAC with FPPA before diagnosis.METHODS:Data on endoscopic ultrasound-guided fine-needle biopsies and surgical samples from 170 patients with pancreatic cancer histologically diagnosed between 2014 and 2019 were extracted from the pathology database of Komagome Hospital and Juntendo University hospital and retrospectively evaluated together with 51 patients without PDAC.RESULTS:FPPA was identified in 47/170 (28%) patients before PDAC diagnosis and in 2/51 (4%) patients in the control group (P < 0.01). The median duration from FPPA detection to diagnosis was 35 (interquartile range [IQR]:16-63) months. In 24/47 (51%) patients with FPPA, the atrophic area resolved. The lesion was in the head and body/tail in 7/40 and 67/56 of the patients with (n = 47) and without FPPA (n = 123), respectively (P < 0.001). Histopathologically confirmed non-invasive lesions in the main pancreatic duct and a positive surgical margin in the resected specimens occurred in 53% vs. 21% (P = 0.078) and 29% vs. 3% (P = 0.001) of the groups, respectively. The PDAC patients with FPPA accompanied by a malignant pancreatic resection margin had high-grade pancreatic intraepithelial neoplasia.CONCLUSIONS:FPPA occurred in 28% of the PDAC group at 35 months prediagnosis. The FPPA area resolved before PDAC onset. Benchmarking previous images of the pancreas with the focus on FPPA may enable prediction of PDAC. PDAC with FPPA involves widespread high-grade pancreatic intraepithelial neoplasia requiring a wide surgical margin for surgical excision.
DOI 10.1016/j.pan.2022.10.003
PMID 36273992