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Usefulness of intratumoral perfusion analysis for assessing biological features of non-functional pancreatic neuroendocrine neoplasm

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Abstract

Purpose

Here, we evaluated the usefulness of intratumoral perfusion analysis using preoperative contrast-enhanced CT (E-CT) to assess biological features of non-functional pancreatic neuroendocrine neoplasms (NF-PanNENs).

Methods

We retrospectively studied 44 patients who underwent curative surgery for NF-PanNENs. We used preoperative E-CT with compartment model analysis to calculate the tumor perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time), and K1/k2 (distribution volume). We assessed the association between perfusion parameters and biological features of NF-PanNENs, including the WHO classification tumor histopathological grade and prognosis after surgery.

Results

Patients in this study had a neuroendocrine tumor (NET) G1 (n = 32) or NET G2 (n = 12). Neither NET G3 or NEC tumors were observed. Among perfusion parameters, K1 was the most accurate predictor of the high-grade tumor (AUC: 0.726). K1-low (< 0.028 s−1) was significantly associated with large tumors (≥ 20 mm) (p = 0.022), high mitotic index (p = 0.017), high Ki-67 index (p = 0.004), and lymphatic invasion (p = 0.025). Synchronous extra-pancreatic metastasis, including lymph node metastasis or liver metastasis, more frequently developed in K1-low patients than in K1-high patients (29% vs 4%, p = 0.025). Disease-free survival of patients with a K1-low tumor was poorer than that of patients with a K1-high tumor (p = 0.005). Furthermore, no patient with a K1-high tumor developed recurrence after initial surgery.

Conclusion

The perfusion parameters obtained using E-CT were significantly associated with biological features and prognosis of NF-PanNENs.

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Acknowledgements

We thank Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan

    Tsuyoshi Notake, Akira Shimizu, Koji Kubota, Shinsuke Sugenoya, Kentaro Umemura, Takamune Goto & Yuji Soejima

  2. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan

    Akira Yamada & Yasunari Fujinaga

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  1. Tsuyoshi Notake
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Contributions

TN, AS, AY, YF and YS were involved in study design and data interpretation. TN and AY were involved in the drafting of the article. TN, KK, SS, KU, TG and AY were involved in the data analysis. YS was involved in the study supervision. All authors critically revised the report, commented on drafts of the article, and approved the final report.

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Correspondence to Tsuyoshi Notake.

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Notake, T., Shimizu, A., Kubota, K. et al. Usefulness of intratumoral perfusion analysis for assessing biological features of non-functional pancreatic neuroendocrine neoplasm. Langenbecks Arch Surg 409, 38 (2024). https://doi.org/10.1007/s00423-023-03219-2

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