Differential diagnosis of pancreatic diseases: new approaches in laboratory and radiologic diagnosis
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chronic pancreatitis, pancreatic cancer, fibronectin, median of enhancement gradient, diagnosis

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Vinokurova, L. V., Lesko, K. A., Bordin, D. S., Dubtsova, E. A., Tyulyaeva, E. Y., & Varvanina, G. G. (2020). Differential diagnosis of pancreatic diseases: new approaches in laboratory and radiologic diagnosis. Herald of Pancreatic Club, 46(1), 36-42. https://doi.org/10.33149/vkp.2020.01.04

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Aim. To assess significance of serum fibronectin (FN) and new approaches of processing computed tomography (CT) results for pancreatic cancer (PC) and chronic pancreatitis (CP) differential diagnosis.

Materials and methods. Data of 49 patients with pancreatic lesions who underwent multislice computed tomography (MSCT) with intravenous contrast enhancement and FN evaluation in 2018 were analyzed. There were 29 (59.2%) males and 20 (40.8%) females, mean age 51.9±13.9 (30–82). All patients were divided in 3 groups: 1 — PC (17 patients, 34.6%) — morphologically verified, 2 — chronic pancreatitis with previous pancreonecrosis (CPPN) — 16 patients, 32.7%, 3 — chronic calcifying pancreatitis (CCP) — 16 patients, 32.7%. We calculated median of enhancement gradient between region of interest and intact parenchyma (Мgrad) based on MSCT results. Pearson’s correlation coefficient (rp) was calculated for correlation assessment.

Results. We assessed mean Мgrad and mean serum FN rate in all three groups: PC — 28.1±2.6, р=0.0001, CPPN — 14.9±2.4, р=0.07, CCP — 13.3±0.7, р=0.08 for Мgrad, and 239.8±30.1, p=0.8, 243.5±33.8, p=0.7, 227.2±34.3, p=0.8 for serum FN rate, respectively. There was statistically significant strong correlation of Мgrad in patients with PC (rp=0.63, p=0.0001). We revealed cut-off point of Мgrad value for PC that was 20 (p=0.001). There were no statistically significant correlations of serum FN rate in all groups (PC rp=0.04, p=0.8; CPPN rp=0.06, p=0.7; CCP rp=-0.03, p=0.8).

Conclusions. Mgrad evaluation based on MSCT is an informative marker for differential diagnosis between PC and chronic pancreatitis, high rates of Мgrad positively correlate with PC existence. There was no correlation between serum FN rate and existence of PC, CPPN or CCP.

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1. Варванина Г. Г., Винокурова Л. В., Смирнова А. В., Гуляев А. С., Дубцова Е. А., Носкова К. К., Бордин Д. С. Факторы ремоделирования межклеточного матрикса в диагностике заболеваний поджелудочной железы. Гастроэнтерология Санкт-Петербурга. 2017. № 2. С. 42–48.
2. Винокурова Л. В., Дубцова Е. А., Шустова С. Г., Варванина Г. Г., Нилова Т. В., Агафонов М. А. Функциональная недостаточность поджелудочной железы при хроническом панкреатите различной этиологии. Эффективная фармакотерапия. 2012. № 24. С. 44–49.
3. Михеев Ю. А., Евсеев А. В., Канаки А. В. Структурная трансформация протоковой системы поджелудочной железы у больных хроническим панкреатитом. Гастроэнтерология. 2017. T. 51, № 4. C. 237–243.
4. Таргетная терапия солидных опухолей. Практическое руководство по современным методам лечения злокачественных новообразований. Под редакцией Руссо А., Росселля Р., Рольфо К. Москва: ГЭОТАР-Медиа», 2018. 360 с.
5. Ягудина Л. А., Новожилова А. А. Иммунодиагностика опухолей. Медицинский альманах. 2016. T. 2, № 42. C. 48–51.
6. Яшина Н. И., Кармазановский Г. Г., Козлов И. А., Винокурова Л. В. Компьютерно-томографические критерии выбора метода и оценки результатов хирургического лечения хронического панкреатита. Медицинская визуализация. 2006. № 3. С. 75–87.
7. Bendas G., Borsig L. Cancer cell adhesion and metastasis: selectins, integrins, and the inhibitory potential of heparins. Int. J. Cell. Biol. 2012. Epub 2012 Feb 12.
8. Clemmensen I. Fibronectin and its role in connective tissue diseases. Europ. Journ. Clin. Invest. 2008. Vol. 11, No 3. P. 145–146.
9. Diana A., Wang L. M., D’Costa Z. Prognostic value, localization and correlation of PD-1/PD-L1, CD8 and FOXP3 with the desmoplastic stroma in pancreatic ductal adenocarcinoma. Oncotarget. 2016. Vol. 7, No 27. P. 40992–41004.
10. Gress T., Menke A., Bachem M. Role of extracellular matrix in pancreatic diseases. Digestion. 1998, Vol. 59, No 6. P. 625–637.
11. Hata H., Mori H., Matsumoto S. Fibrous stroma and vascularity of pancreatic carcinoma: correlation with enhancement patterns on CT. Abdom. Imaging. 2010. Vol. 35. P. 172–180.
12. Hattori Y., Gabata T., Matsui O., Mochizuki K., Nakanuma Y. Enhancement patterns of pancreatic adenocarcinoma on conventional dynamic multi-detector row CT: correlation with angiogenesis and fibrosis. World Journal of Gastroenterology. 2009. Vol. 15, No 25. P. 3114–3121.
13. Jiang H., Hegde S., Knolhoff B. L. Targeting focal adhesion kinase renders pancreatic cancers responsive to checkpoint immunotherapy. Nat. Med. 2016. No 22. P. 851–860.
14. Kannengiesser K., Mahlke R., Petersen F. Instant evaluation of contrast enhanced endoscopic ultrasound helps to differentiate various solid pancreatic lesions in daily routine. World J. Clin. Cases. 2019. Vol. 7, No. 1. P. 19–27.
15. Lalwani H., Mannelli L., Ganeshan D. M., Shanbhogue A. K., Prasad S. R. Uncommon pancreatic tumors and pseudotumors. Abdominal Imaging. 2015. Vol. 40, No 1. P. 167–180.
16. Lew D., Afghani E., Pandol S. Chronic pancreatitis: current status and challenges for prevention and treatment. Dig. Dis. Sci. 2017. Vol. 62. P. 1702–1712.
17. Maitra A., Hruban R. H. Pancreatic cancer. Annual Review of Pathology. 2008. Vol. 3. P. 157–188.
18. Man S. F. P., Xing L., Connett J. E. Circulating fibronectin to C-reactive protein ratio and mortality: a biomarker in COPD. Eur. Respir. J. 2008, Vol. 32. P. 1451–1457.
19. Manohar M., Verma A., Venkateshaiah S., Sanders N., Mishra A. Pathogenic mechanisms of pancreatitis. World J. Gastrointest. Pharmacol. Ther. 2017. Vol. 8, No 1. P. 10–25.
20. Matuskova J., Chauhan A. K., Cambien B. Decreased plasma fibronectin leads to delayed thrombus growth in injured arterioles. Arterioscler. Thromb. Vasc. Biol. 2006. Vol. 26. P. 1391–1396.
21. Mosher D. F. Plasma Fibronectin concentration: a risk factor for arterial thrombosis? Arterioscler. Thromb. Vasc. Biol. 2006. Vol. 26. P. 1193–1195.
22. Okum S. D., Lewin D. N. Non-neoplastic lesions that may mimic malignancy. Semin. Diagn. Pathol. 2016. Vol. 33, No 1. P. 31–42.
23. Philip P. A., Mooney M., Jaffe D. Consensus report of the national cancer institute clinical trials planning meeting on pancreas cancer treatment. J. Clin. Oncol. 2009. Vol. 27. P. 5660–5669.
24. Pinho A. V., Chantrill L., Rooman I. Chronic pancreatitis: a path to pancreatic cancer. Cancer Letters. 2013. Vol. 345, No 2. P. 203–209.
25. Raimondi S., Lowenfels A. B., Morselli-Labate A. M. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Practice & Research Clinical Gastroenterology. 2010. Vol. 24. P. 349–358.
26. Rhim A. D., Oberstein P. E., Thomas D. H., Mirek E. T., Stanger B. Z. Stromal elements act to restrain, rather than support, pancreatic ductal adenocarcinoma. Cancer Cell. 2014. Vol. 25. P. 735–747.
27. Shevtsova A., Koval E., Ivanov A. Dynamics of fibronectin fragmentation in patients with myocardial infarction: diagnostical and prognostical value. Ann. Univers. Mariae Curie. 2006. Vol. 19, No 2. P. 187–190.
28. Su S. B., Qin S.-Y., Luo W., Jiang H. X. Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis. World J. Gastroenterol. 2015. Vol. 21, No 14. P. 4323–4333.
29. Tamm E. P., Balachandran A., Bhosale P. R. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol. Clin. North. Am. 2012. Vol. 50. P. 407–428.
30. Thomas D., Radhakrishnan P. Tumor-stromal crosstalk in pancreatic cancer and tissue fibrosis. Mol. Cancer. 2019. Vol. 18, No 1. P. 14.
31. Topalovski M., Brekken R. A. Matrix control of pancreatic cancer: new insights into fibronectin signaling. Cancer letters. 2015. Vol. 381, No 1. P. 252–258.
32. Torphy R. J., Wang Z., True-Yasaki A., Volmar K. E., Collisson E. A. Stromal content is correlated with tissue site. Contrast retention and survival in pancreatic adenocarcinoma. JCO Precis. Oncol. 2018. Epub 2018 Jan 16.
33. Wu X., Wang K., Hua W. Fibronectin induced ITGβ1/FAK-dependent apoptotic pathways determines the fate of degenerative NP cells. J. Orthop Res. 2019. Vol. 37, No 2. P. 439–448
34. Zhang L., Sanagapalli S., Stoita A. Challenges in diagnosis of pancreatic cancer. World J. Gastroenterol. 2018, Vol. 24, No 19. P. 2047–2060.