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Дифференциальная диагностика и определение резектабельности рака поджелудочной железы с помощью МСКТ и МРТ

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Цель публикации - осмысление современных достижений лучевой диагностики в области хирургической онкопанкреатологии на основе критического анализа англоязычных публикаций последних лет. МСКТ и МРТ играют важную роль в хирургической и онкологической панкреатологии. В статье представлен критический взгляд на критерии диагностики рака поджелудочной железы, возможности томографических исследований в оценке размера опухоли, в оценке сосудистой инвазии, в дифференциальной диагностике опухолей, а также в оценке возможных ранних послеоперационных осложнений и на лучевые признаки особенностей зоны интереса после неоадъювантной и адъювантной терапии опухолей поджелудочной железы. Влияние современных методов лучевой диагностики на повышение результативности лечения, напрямую связанной с ранним стадированием опухолей поджелудочной железы, ничтожно, поскольку непонятны факторы, влияющие на фазы медленного и бурного развития опухоли. Этапная оценка поджелудочной железы клиническими и лучевыми методами (диспансеризация), скорее всего, при огромных финансовых и физических затратах, не даст ожидаемых результатов. Возможно, одним из решений проблемы эффективного лечения рака поджелудочной железы будет признание каждым пациентом необходимости лабораторных и инструментальных обследований с такой частотой, какую он может себе позволить, в разумных пределах, с привлечением его собственных средств.

Ключевые слова:
поджелудочная железа, рак, МСКТ, МРТ, дифференциальная диагностика, сосудистая инвазия, оценка резектабельности, лучевые критерии эффективности химиотерапии, рецидивная опухоль, pancreas, cancer, MDCT, MRI, differential diagnosis, vascular invasion, evaluation of cancer resectability, radiological criteria for evaluating the effectiveness of chemotherapy, recurrent tumor

Литература:
1.Karmazanovsky G., Fedorov V., Kubyshkin V., Kotchatkov A. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom. Imaging. 2005; 30 (4): 488-500.
2.Bae J.S., Kim J.H., Joo I., Chang W., Han J.K. MDCT findings predicting post-operative residual tumor and survival in patients with pancreatic cancer. Eur. Radiol. 2019; 29 (7): 3714-3724. http://doi.org/10.1007/s00330-019-06140-9.
3.Garces-Descovich A., Morrison T.C., Beker K., Jaramillo-Cardoso A., Moser A.J., Mortele K.J. DWI of pancreatic ductal adenocarcinoma: a pilot study to estimate the correlation with metastatic disease potential and overall survival. AJR. Am. J. Roentgenol. 2019; 212 (2): 323-331. http://doi.org/10.2214/AJR.18.20017.
4.Karmazanovsky G., Belousova E., Schima W., Glotov A., Kalinin D., Kriger A. Nonhypervascular pancreatic neuro endocrine tumors: spectrum of MDCT imaging findings and differentiation from pancreatic ductal adenocarcinoma. Eur. J. Radiol. 2019; 110: 66-73. http://doi.org/10.1016/j.ejrad.2018.04.006.
5.Guo C.G., Ren S., Chen X., Wang Q.D., Xiao W.B., Zhang J.F., Duan S.F., Wang Z.Q. Cancer pancreatic neuroendocrine tumor: prediction of the tumor grade using magnetic resonance imaging findings and texture analysis with 3-T magnetic resonance. Manag. Res. 2019; 11: 1933-1944. http://doi.org/10.2147/CMAR.S195376. eCollection 2019.
6.Трапезников Н.Н., Аксель Е.М. Заболеваемость злокачественными новообразованиями и смертность от них населения стран СНГ в 1998 г. М., 2000. 270 с.
7.American Cancer Society (2014). Cancer facts & figures 2014. Retrieved from http://www.cancer.org/acs/groups/con-tent/@research/documents/webcontent/acspc-042151.
8.Chatterjee D., Katz M.H., Rashid A., Varadhachary G.R., Wolff R.A., Wang H., Lee J.E., Pisters P.W., Vauthey J.N., Crane C., Gomez H.F., Abbruzzese J.L., Fleming J.B., Wang H. Histologic grading of the extent of residual carcinoma following neoadjuvant chemoradiation in pancreatic ductal adeno carcinoma: a predictor for patient outcome. Cancer. 2012; 118 (12): 3182-3190. http://dx.doi.org/10.1002/cncr.26651.
9.Ishigami K., Yoshimitsu K., Irie H., Tajima T., Asayama Y., Nishie A., Hirakawa M., Ushijima Y., Okamoto D., Nagata S., Nishihara Y., Yamaguchi K., Taketomi A., Honda H. Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur. J. Radiol. 2009; 69 (1): 139-146. https://doi.org/10.1016/j.ejrad.2007.09.012.
10.Youn S.Y., Rha S.E., Jung E.S., Lee I.S. Pancreas ductal adenocarcinoma with cystic features on cross-sectional imaging: radiologic-pathologic correlation. Diagn. Interv. Radiol. 2018; 24 (1): 5-11. http://doi.org/10.5152/dir.2018.17250.
11.Cong L., Liu Q., Zhang R., Cui M., Zhang X., Gao X., Guo J., Dai M., Zhang T., Liao Q., Zhao Y. Tumor size classification of the 8th edition of TNM staging system is superior to that of the 7th edition in predicting the survival outcome of pancreatic cancer patients after radical resection and adjuvant chemotherapy. Sci. Rep. 2018; 8 (1): 10383. http://doi.org/10.1038/s41598-018-28193-4.
12.Kim J.H., Park S.H., Yu E.S., Kim M.H., Kim J., Byun J.H., Lee S.S., Hwang H.J., Hwang J.Y., Lee S.S., Lee M.G. Visually isoattenuating pancreatic adenocarcinoma at dynamicenhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology. 2010; 257 (1): 87-96. http://doi.org/10.1148/radiol.10100015.
13.Yoon S.H., Lee J.M., Cho J.Y., Lee K.B., Kim J.E., Moon S.K., Kim S.J., Baek J.H., Kim S.H., Kim S.H., Lee J.Y., Han J.K., Choi B.I. Small ( 20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multi phasic multidetector CT. Radiology. 2011; 259 (2): 442-452. http://doi.org/10.1148/radiol.11101133.
14.Tseng D.S., van Santvoort H.C., Fegrachi S., Besselink M.G., Zuithoff N.P., Borel Rinkes I.H., van Leeuwen M.S., Molenaar I.Q. Diagnostic accuracy of CT in assessing extraregional lymphadenopathy in pancreatic and periampullary cancer: a systematic review and meta-analysis. Surg. Oncol. 2014; 23 (4): 229-235. http://doi.org/10.1016/j.suronc.2014.10.005.
15.Roche C.J., Hughes M.L., Garvey C.J., Campbell F., White D.A., Jones L., Neoptolemos J.P. CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. AJR. Am. J. Roentgenol. 2003; 180 (2): 475-480. http://doi.org/10.2214/ajr.180.2.1800475.
16.Somers I., Bipat S. Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a metaanalysis of the positive predictive values of CT. Eur. Radiol. 2017; 27 (8): 3408-3435.
17.Gilbert J.W., Wolpin B., Clancy T., Wang J., Mamon H.,Shinagare A.B., Jagannathan J., Rosenthal M. Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification. Ann. Oncol. 2017; 28 (9): 2067-2076. Published online 2017 Apr. 12. http://doi.org/10.1093/annonc/mdx180.
18.Lopez N.E., Prendergast C., Lowy A.M. Borderline resectable pancreatic cancer: definitions and management. World J. Gastroenterol. 2014; 20 (31): 10740-10751. Published online 2014. Aug 21. http://doi.org/10.3748/wjg.v20.i31.10740.
19.Tempero M.A., Malafa M.P., Al-Hawary M., Asbun H., Bain A., Behrman S.W., Benson A.B. 3rd, Binder E., Cardin D.B., Cha C., Chiorean E.G., Chung V., Czito B., Dillhoff M., Dotan E., Ferrone C.R., Hardacre J., Hawkins W.G., Herman J., Ko A.H., Komanduri S., Koong A., LoConte N., Lowy A.M., Moravek C., Nakakura E.K., O''Reilly E.M., Obando J., Reddy S., Scaife C., Thayer S., Weekes C.D., Wolff R.A., Wolpin B.M., Burns J., Darlow S. Pancreatic Adenocarcinoma, Version 2. 2017, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Canc. Netw. 2017; 15 (8): 1028-1061. http://doi.org/10.6004/jnccn.2017.0131.
20.Lu D.S., Reber H.A., Krasny R.M., Kadell B.M., Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR. Am. J. Roentgenol. 1997; 168 (6): 1439-1443.
21.Rau B.M., Moritz K., Schuschan S., Alsfasser G., Prall F., Klar E. R1 resection in pancreatic cancer has significant impact on long-term outcome in standardized pathology modified for routine use. Surgery. 2012; 152 (3 Suppl 1): S103-111. http://doi.org/10.1016/j.surg.2012.05.015.
22.Felsenstein M., Hruban R., Wood L. New developments in the molecular mechanisms of pancreatic tumorigenesis. Adv. Anat. Pathol. 2018; 25 (2): 131-142. http://doi.org/10.1097/PAP.0000000000000172.
23.Egorov V.I., Yashina N.I., Fedorov A.V., Karmazanovsky G.G., Vishnevsky V.A., Shevchenko T.V. Celiaco-mesenterial arterial aberrations in patients undergoing extended pancreatic resections: correlation of CT angiography with findings at surgery. JOP. 2010; 11 (4): 348-357.
24.Egorov V.I., Petrov R.V., Lozhkin M.V., Maynovskaya O.A., Starostina N.S., Chernaya N.R., Filippova E.M. Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy. World J. Gastrointest. Surg. 2013; 5 (3): 51-61. http://doi.org/10.4240/wjgs.v5.i3.51.
25.Deal S., Nathan D., Rocha F.G. Modified Appleby procedure for locally advanced pancreatic cancer. Am. J. Surg. 2018; 215 (5): 853-855. http://doi.org/10.1016/j.amjsurg.2018.01.004.
26.Egorov V.I., Petrov R.V., Solodinina E.N., Karmazanovsky G.G., Starostina N.S., Kuruschkina N.A. Computed tomographybased diagnostics might be insufficient in the determination of pancreatic cancer unresectability. World J. Gastrointest. Surg. 2013; 5 (4): 83-96. http://doi.org/10.4240/wjgs.v5.i4.83.
27.Yamamoto Y., Shimada K., Takeuchi Y., Sofue K., Shibamoto K., Nara S., Esaki M., Sakamoto Y., Kosuge T., Hiraoka N. Assessment of the interface between retroperitoneal fat infiltration of pancreatic ductal carcinoma and the major artery by multidetector-row computed tomography: surgical outcomes and correlation with histopathological extension. World J. Surg. 2012; 36 (9): 2192-2201. http://doi.org/10.1007/s00268-012-1618-9.
28.Kurowecki D., Patlas M.N., Haider E., Alabousi A. Crosssectional pictorial review of IgG4-related disease. Br. J. Radiol. 2019; 20190448. http://doi.org/10.1259/bjr.20190448.
29.Harmsen F.R., Domagk D., Dietrich C.F., Hocke M. Discriminating chronic pancreatitis from pancreatic cancer: Contrastenhanced EUS and multidetector computed tomography in direct comparison. Endosc. Ultrasound. 2018; 7 (6): 395-403. http://doi.org/10.4103/eus.eus_24_18.
30.Aslan S., Nural M.S., Camlidag I., Danaci M. Efficacy of perfusion CT in differentiating of pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis and characteri zation of isoattenuating pancreatic lesions. Abdom. Radiol. (NY). 2019; 44 (2): 593-603. http://doi.org/10.1007/s00261-018-1776-9.
31.Hu S., Zhang H., Wang X., Sun Z., Ge Y., Yan G., Zhao C., Chen K. Asymptomatic versus symptomatic solid pseudopapillary tumors of the pancreas: clinical and MDCT manifestations. Cancer Imaging. 2019; 19 (1): 13. http://doi.org/10.1186/s40644-019-0198-4.
32.Hong W., Ha H.I., Lee J.W., Lee S.M., Kim M.J. Measurement of pancreatic fat fraction by CT histogram analysis to predict pancreatic fistula after pancreaticoduodenectomy. Korean J. Radiol. 2019; 20 (4): 599-608. http://doi.org/10.3348/kjr.2018.0557.
33.Rangarajan K., Pucher P.H., Armstrong T., Bateman A., Hamady Z. Systemic neoadjuvant chemotherapy in modern pancreatic cancer treatment: a systematic review and metaanalysis. Ann. R. Coll. Surg. Engl. 2019; 15: 1-4. http://doi.org/10.1308/rcsann.2019.0060.
34.Heinrich S., Besselink M., Moehler M., van Laethem J.L., Ducreux M., Grimminger P., Mittler J., Lang H., Lutz M.P., Lesurtel M. Scientific and Research Committee of the E-AHPBA and the EORTC pancreas working group. Opinions and use of neoadjuvant therapy for resectable, borderline resectable, and locally advanced pancreatic cancer: international survey and case-vignette study. BMC Cancer. 2019; 19 (1): 675. http://doi.org/10.1186/s12885-019-5889-5.
35.Scheufele F., Hartmann D., Friess H. Treatment of pancreatic cancer-neoadjuvant treatment in borderline resectable/locally advanced pancreatic cancer. Transl. Gastroenterol. Hepatol. 2019; 4: 32. http://doi.org/10.21037/tgh.2019.04.09. eCollection 2019.
36.Wei R., Lin K., Yan W., Guo Y., Wang Y., Li J., Zhu J. Computer-aided diagnosis of pancreas serous cystic neoplasms: a radiomics method on preoperative MDCT images. Technol. Cancer Res. Treat. 2019; 18: 1533033818824339. http://doi.org/10.1177/1533033818824339.
37.Groot V.P., Mosier S., Javed A.A., Teinor J.A., Gemenetzis G., Ding D., Haley L.M., Yu J., Burkhart R.A., Hasanain A., Debeljak M., Kamiyama H., Narang A., Laheru D.A., Zheng L., Lin M.T., Gocke C.D., Fishman E.K., Hruban R.H., Goggins M.G., Molenaar I.Q., Cameron J.L., Weiss M.J., Velculescu V.E., He J., Wolfgang C.L., Eshleman J.R. Circulating tumor DNA as a clinical test in resected pancreatic cancer. Clin. Cancer Res. Published online first 2019; May 29. http://doi.org/10.1158/1078-0432.CCR-19-0197.
38.Pandit S., Samant H., Kohli K., Shokouh-Amiri H.M., Wellman G., Zibari G.B. Incidental liver metastasis in pancreatic adenocarcinoma. J. Surg. Case Rep. 2019; 2019 (3): rjz084. http://doi.org/10.1093/jscr/rjz084. eCollection 2019 Mar.

Differential diagnosis and analysis of pancreatic cancer resectability using CT and MRI

The purpose of this publication is to comprehend the modern achievements of radiological diagnosis in surgical oncopancreatology via a critical analysis of recent English-language publications. CT and MRI are essential diagnostic methods in surgical and oncological pancreatology. The possibilities of tomography examination regarding analysis of tumor dimension, CT criteria for pancreatic cancer diagnosis, assessment of vascular invasion, differential diagnosis of tumors, as well as estimation of possible early postoperative complications and radiological features of the region of interest after neoadjuvant and adjuvant therapy for pancreatic tumors are critically analyzed. The role of modern diagnostic methods in improvement of treatment directly related to the early staging of pancreatic tumors is negligible, since the factors affecting the phases of slow and rapid tumor growth are unclear. Most likely, cyclic clinical and radiological evaluation of the pancreas will not give the expected results and is associated with advanced financial and physical costs. Perhaps, one of the approaches for effective treatment of pancreatic cancer will be the recognition of the need for laboratory and instrumental examinations by each patient. Acceptable frequency of examinations and own funds are determined by a patients himself in this case.

Keywords:
поджелудочная железа, рак, МСКТ, МРТ, дифференциальная диагностика, сосудистая инвазия, оценка резектабельности, лучевые критерии эффективности химиотерапии, рецидивная опухоль, pancreas, cancer, MDCT, MRI, differential diagnosis, vascular invasion, evaluation of cancer resectability, radiological criteria for evaluating the effectiveness of chemotherapy, recurrent tumor