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Published on: February 1, 2020
Pancreatic cancer: correlation of MR findings, clinical features, and tumor grade
Jorge Elias1, Richard C Semelka, Ersan Altun
1Department of Radiology, University of North Carolina, Chapel Hill, North Carolina 27599-7510, USA.
Purpose:
To assess the frequency of occurrence of poorly-marginated and focally-defined pancreatic ductal adenocarcinoma by MRI and to determine whether these appearances correlate with clinical features and histopathological grade.
Materials And Methods:
Institutional review board with waiver of informed consent was obtained for this HIPAA compliant study. A total of 33 patients (16 female, 17 male, mean age = 63.5 +/- 12.8, ranging from 41 to 80 years) with histopathologically-proven pancreatic ductal adenocarcinoma who underwent MR examination between August 2000 and February 2005 were retrospectively evaluated. Clinical data and histopathological tumoral grade were obtained from clinical charts; nine of 33 patients were excluded of the histopathological evaluation since their diagnosis was performed by fine needle aspiration biopsy and it was not possible to obtain the histopathological grade. Two radiologists reviewed all cases independently to identify whether cancers were poorly-marginated or focally-defined. Agreement between radiologists was assessed using the kappa coefficient. The overall correlation between imaging findings, clinical features, and histopathological grade was assessed with contingency tables using the Fisher's exact test.
Results:
Of the 33 patients, nine (27.2%) were classified as poorly-marginated and 24 (72.8%) as focally-defined. Agreement between the two reviewers was excellent (k = 0.92, 95% confidence interval (CI) = 0.78-1.0). Poorly-marginated cancers exhibited well- to moderately-differentiated histopathology in 71.4% of cases, while focally-defined cancers had well- to moderately-differentiated histopathology in 17.6% of cases, P = 0.02.
Conclusion:
A poorly-marginated appearance of pancreatic ductal carcinoma on MRI is not uncommon. These cancers exhibited statistically significant moderate- to well-differentiated histopathology compared to focally-defined cancers.
Insights
Poorly-marginated pancreatic ductal adenocarcinoma appears on MRI in over a quarter of cases. These tumors show a significant association with moderate- to well-differentiated histopathology compared to focally-defined cancers.
Area of Science:
- Radiology
- Oncology
- Gastroenterology
Background:
- Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related mortality.
- Accurate preoperative assessment of PDAC is crucial for treatment planning and patient outcomes.
- MRI is a key imaging modality for evaluating pancreatic lesions.
Purpose of the Study:
- To determine the frequency of poorly-marginated and focally-defined PDAC on MRI.
- To investigate the correlation between these MRI appearances and clinical features.
- To assess the relationship between MRI findings and histopathological grade of PDAC.
Main Methods:
- Retrospective analysis of 33 patients with histopathologically-proven PDAC who underwent MRI.
- Two radiologists independently assessed tumors for margin characteristics (poorly-marginated vs. focally-defined).
- Correlation with clinical data and histopathological grade using Fisher's exact test.
Main Results:
- 27.2% of PDAC cases were classified as poorly-marginated, while 72.8% were focally-defined.
- Excellent inter-observer agreement was achieved (kappa = 0.92).
- Poorly-marginated cancers were significantly more likely to be well- to moderately-differentiated (71.4%) compared to focally-defined cancers (17.6%, P = 0.02).
Conclusions:
- A poorly-marginated appearance on MRI is a notable finding in PDAC.
- This imaging feature is significantly associated with better-differentiated tumors.
- MRI-based margin assessment may offer insights into PDAC biology and prognosis.