Diagnostic Accuracy of MRI for Differentiation of Benign and Malignant Pancreatic Cystic Lesions Compared to CT and Endoscopic Ultrasound: Systematic Review and Meta-analysis.
endoscopic ultrasound-guided fine needle aspiration
magnetic resonance imaging
meta-analysis
multidetector computed tomography
pancreatic cyst
pancreatic neoplasms
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
02
03
2021
received:
26
01
2021
accepted:
03
03
2021
pubmed:
14
4
2021
medline:
30
9
2021
entrez:
13
4
2021
Statut:
ppublish
Résumé
Differentiation of benign and malignant pancreatic cystic lesions on MRI, computed tomography (CT), and endoscopic ultrasound (EUS) is critical for determining management. To perform a systematic review evaluating the diagnostic accuracy of MRI for diagnosing malignant pancreatic cystic lesions, and to compare the accuracy of MRI to CT and EUS. Systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched until February 2020 for studies reporting MRI accuracy for assessing pancreatic cystic lesions. 1.5T or 3.0T. Methodologic and outcome data were extracted by two reviewers (AU and MA, 2 years of experience each). All studies of pancreatic cystic lesions on MRI were identified. Studies with incomplete MRI technique were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Sensitivity/specificity was pooled using bivariate random-effects meta-analysis with 95% confidence intervals (95%CI). Pairwise-comparison of MRI to CT and EUS was performed. The impact of gadolinium-based contrast agents, mucinous lesions, and risk of bias were explored using meta-regression. MRI pooled sensitivity was 76% (95%CI 67% to 84%) and specificity was 80% (95%CI 74% to 85%) for distinguishing benign and malignant lesions. MRI and CT had similar sensitivity (P = 0.822) and specificity (P = 0.096), but MRI was more specific than EUS (80% vs. 75%, P < 0.05). Studies including only contrast-enhanced MRI were more sensitive than those including unenhanced exams (P < 0.05). MRI sensitivity and specificity did not differ for mucinous lesions (P = 0.537 and P = 0.384, respectively) or for studies at risk of bias (P = 0.789 and P = 0.791, respectively). MRI and CT demonstrate comparable accuracy for diagnosing malignant pancreatic cystic lesions. EUS is less specific than MRI, which suggests that, in some cases, management should be guided by MRI findings rather than EUS. 3 TECHNICAL EFFICACY STAGE: 2.
Sections du résumé
BACKGROUND
Differentiation of benign and malignant pancreatic cystic lesions on MRI, computed tomography (CT), and endoscopic ultrasound (EUS) is critical for determining management.
PURPOSE
To perform a systematic review evaluating the diagnostic accuracy of MRI for diagnosing malignant pancreatic cystic lesions, and to compare the accuracy of MRI to CT and EUS.
STUDY TYPE
Systematic review and meta-analysis.
DATA SOURCES
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched until February 2020 for studies reporting MRI accuracy for assessing pancreatic cystic lesions.
FIELD STRENGTH
1.5T or 3.0T.
ASSESSMENT
Methodologic and outcome data were extracted by two reviewers (AU and MA, 2 years of experience each). All studies of pancreatic cystic lesions on MRI were identified. Studies with incomplete MRI technique were excluded. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.
STATISTICAL TESTS
Sensitivity/specificity was pooled using bivariate random-effects meta-analysis with 95% confidence intervals (95%CI). Pairwise-comparison of MRI to CT and EUS was performed. The impact of gadolinium-based contrast agents, mucinous lesions, and risk of bias were explored using meta-regression.
RESULTS
MRI pooled sensitivity was 76% (95%CI 67% to 84%) and specificity was 80% (95%CI 74% to 85%) for distinguishing benign and malignant lesions. MRI and CT had similar sensitivity (P = 0.822) and specificity (P = 0.096), but MRI was more specific than EUS (80% vs. 75%, P < 0.05). Studies including only contrast-enhanced MRI were more sensitive than those including unenhanced exams (P < 0.05). MRI sensitivity and specificity did not differ for mucinous lesions (P = 0.537 and P = 0.384, respectively) or for studies at risk of bias (P = 0.789 and P = 0.791, respectively).
DATA CONCLUSION
MRI and CT demonstrate comparable accuracy for diagnosing malignant pancreatic cystic lesions. EUS is less specific than MRI, which suggests that, in some cases, management should be guided by MRI findings rather than EUS.
LEVEL OF EVIDENCE
3 TECHNICAL EFFICACY STAGE: 2.
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1126-1137Informations de copyright
© 2021 International Society for Magnetic Resonance in Medicine.
Références
Lee KS, Sekhar A, Rofsky NM, Pedrosa I. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 2010;105(9):2079-2084.
Zhang X-M, Mitchell DG, Dohke M, Holland GA, Parker L. Pancreatic cysts: Depiction on single-shot fast spin-Echo MR images. Radiology 2002;223(2):547-553.
Kimura W, Nagai H, Kuroda A, Muto T, Esaki Y. Analysis of small cystic lesions of the pancreas. Int J Pancreatol 1995;18(3):197-206.
de Jong K, Nio CY, Hermans JJ, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 2010;8(9):806-811.
Maguchi H, Tanno S, Mizuno N, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: A multicenter study in Japan. Pancreas 2011;40(3):364-370.
Ho C-K, Kleeff J, Friess H, Büchler MW. Complications of pancreatic surgery. HPB (Oxford) 2005;7(2):99-108.
Simons JP, Shah SA, Ng SC, Whalen GF, Tseng JF. National complication rates after pancreatectomy: Beyond mere mortality. J Gastrointest Surg 2009;13(10):1798-1805.
Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002;183(3):237-241.
Cusworth BM, Krasnick BA, Nywening TM, et al. Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP surgical risk calculator. HPB (Oxford) 2017;19(2):147-153.
Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG clinical guideline: Diagnosis and Management of Pancreatic Cysts. Am Gastroenterol 2018;113(4):464-479.
Megibow AJ, Baker ME, Morgan DE, et al. Management of incidental pancreatic cysts: A white paper of the ACR incidental findings committee. J Am Coll Radiol 2017;14(7):911-923.
Tanaka M, Fernandez-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17(5):738-753.
The European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67(5):789-804.
de Pretis N, Mukewar S, Aryal-Khanal A, Bi Y, Takahashi N, Chari S. Pancreatic cysts: Diagnostic accuracy and risk of inappropriate resections. Pancreatology 2017;17(2):267-272.
Sainani NI, Saokar A, Deshpande V, Fernandez-del Castillo C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 2009;193(3):722-731.
Visser BC, Yeh BM, Qayyum A, Way LW, McCulloch CE, Coakley FV. Characterization of cystic pancreatic masses: Relative accuracy of CT and MRI. AJR Am J Roentgenol 2007;189(3):648-656.
Kucera JN, Kucera S, Perrin SD, Caracciolo JT, Schmulewitz N, Kedar RP. Cystic lesions of the pancreas: Radiologic-endosonographic correlation. Radiographics 2012;32(7):E283-E301.
Procacci C, Biasiutti C, Carbognin G, et al. Characterization of cystic tumors of the pancreas: CT accuracy. J Comput Assist Tomogr 1999;23(6):906-912.
Barresi L, Tarantino I, Granata A, Curcio G, Traina M. Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle. World J Gastrointest Endosc 2012;4(6):247-259.
Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: A state-of-the-art review. World J Gastroenterol 2014;20(24):7864-7877.
Freeny PC, Saunders MD. Moving beyond morphology: New insights into the characterization and management of cystic pancreatic lesions. Radiology 2014;272(2):345-363.
Early DS, Acosta RD, Chandrasekhara V, et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013;77(6):839-843.
Khashab MA, Kim K, Lennon AM, et al. Should we do EUS/FNA on patients with pancreatic cysts? The incremental diagnostic yield of EUS over CT/MRI for prediction of cystic neoplasms. Pancreas 2013;42(4):717-721.
Lee HJ, Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol 2011;66(4):315-321.
Kauhanen S, Rinta-Kiikka I, Kemppainen J, et al. Accuracy of 18F-FDG PET/CT, multidetector CT, and MR imaging in the diagnosis of pancreatic cysts: A prospective single-center study. J Nucl Med 2015;56(8):1163-1168.
McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: The PRISMA-DTA statement. JAMA 2018;319(4):388-396.
McGrath TA, Bossuyt PM, Cronin P, et al. Best practices for MRI systematic reviews and meta-analyses. J Magn Reson Imaging 2019;49(7):e51-e64.
Frank RA, Bossuyt PM, McInnes MDF. Systematic reviews and meta-analyses of diagnostic test accuracy: The PRISMA-DTA statement. Radiology 2018;289(2):313-314.
McGrath TA, Alabousi M, Skidmore B, et al. Recommendations for reporting of systematic reviews and meta-analyses of diagnostic test accuracy: A systematic review. Syst Rev 2017;6(1):194.
McInnes MDF, Bossuyt PMM. Pitfalls of systematic reviews and meta-analyses in imaging research. Radiology 2015;277(1):13-21.
Alabousi M, Alabousi A, McGrath T, et al. Epidemiology of systematic reviews in imaging journals: Evaluation of publication trends and sustainability? Eur Radiol 2019;29(2):517-526.
Deeks JJ BP, Gatsonis C. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0.0. ed. Vol. 2020; 2013. Available: https://methods.cochrane.org/sdt/handbook-dta-reviews
Hwang J, Kim YK, Min JH, Jeong WK, Hong SS, Kim H-J. Comparison between MRI with MR cholangiopancreatography and endoscopic ultrasonography for differentiating malignant from benign mucinous neoplasms of the pancreas. Eur Radiol 2018;28(1):179-187.
Choi SY, Kim JH, Yu MH, Eun HW, Lee HK, Han JK. Diagnostic performance and imaging features for predicting the malignant potential of intraductal papillary mucinous neoplasm of the pancreas: A comparison of EUS, contrast-enhanced CT and MRI. Abdom Radiol 2017;42(5):1449-1458.
Kang HJ, Lee JM, Joo I, et al. Assessment of malignant potential in intraductal papillary mucinous neoplasms of the pancreas: Comparison between multidetector CT and MR imaging with MR cholangiopancreatography. Radiology 2016;279(1):128-139.
Kim JH, Eun HW, Park HJ, Hong SS, Kim YJ. Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct. Eur J Radiol 2012;81(11):2927-2935.
Yoon LS, Catalano OA, Fritz S, Ferrone CR, Hahn PF, Sahani DV. Another dimension in magnetic resonance cholangiopancreatography: Comparison of 2- and 3-dimensional magnetic resonance cholangiopancreatography for the evaluation of intraductal papillary mucinous neoplasm of the pancreas. J Comput Assist Tomogr 2009;33(3):363-368.
Sahani DV, Kadavigere R, Blake M, Fernandez-Del Castillo C, Lauwers GY, Hahn PF. Intraductal papillary mucinous neoplasm of pancreas: Multi-detector row CT with 2D curved reformations-correlation with MRCP. Radiology 2006;238(2):560-569.
Pilleul F, Rochette A, Partensky C, Scoazec JY, Bernard P, Valette PJ. Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 2005;21(3):237-244.
de Jong K, van Hooft JE, Nio CY, et al. Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions. Scand J Gastroenterol 2012;47(8-9):1056-1063.
Liu X, Xu W, Liu Z, Ye J. MRI combined with magnetic resonance Cholangiopancreatography for diagnosis of benign and malignant pancreatic Intraductal papillary mucinous neoplasms. Curr Med Imaging Rev 2019;15(5):504-510.
Lee JE, Choi SY, Min JH, et al. Determining malignant potential of Intraductal papillary mucinous neoplasm of the pancreas: CT versus MRI by using revised 2017 international consensus guidelines. Radiology 2019;293(1):134-143.
Kim SH, Lee JM, Lee ES, et al. Intraductal papillary mucinous neoplasms of the pancreas: Evaluation of malignant potential and surgical resectability by using MR imaging with MR cholangiography. Radiology 2015;274(3):723-733.
Seo N, Byun JH, Kim JH, et al. Validation of the 2012 international consensus guidelines using computed tomography and magnetic resonance imaging: Branch duct and Main duct Intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2016;263(3):557-564.
Igarashi T, Ashida H, Morikawa K, et al. Evaluating the malignant potential of intraductal papillary mucinous neoplasms of the pancreas: Added value of non-enhanced endoscopic ultrasound to supplement non-enhanced magnetic resonance imaging. Pol J Radiol 2018;83:e426-e436.
McGrath TA, McInnes MDF, Langer FW, Hong J, Korevaar DA, Bossuyt PMM. Treatment of multiple test readers in diagnostic accuracy systematic reviews-meta-analyses of imaging studies. Eur J Radiol 2017;93:59-64.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155(8):529-536.
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: A report of the cooperative pancreatic cyst study. Gastroenterology 2004;126(5):1330-1336.
Dwamena B. MIDAS: Stata module for meta-analytical integration of diagnostic test accuracy studies. Statistical software components S45688: Boston College Department of. Economics 2007.
Harbord RM, Whiting P. Metandi: Meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata J 2009;9(2):211-229.
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58(10):982-990.
Vogelgesang F, Schlattmann P, Dewey M. The evaluation of bivariate mixed models in meta-analyses of diagnostic accuracy studies with SAS, Stata and R. Methods Inf Med 2018;57(3):111-119.
Sainani NI, Saokar A, Deshpande V, CF-d C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR Cholangiopancreatography in characterizing small pancreatic cysts. Am J Roentgenol 2009;193(3):722-731.
Pozzi-Mucelli RM, Rinta-Kiikka I, Wünsche K, et al. Pancreatic MRI for the surveillance of cystic neoplasms: Comparison of a short with a comprehensive imaging protocol. Eur Radiol 2017;27(1):41-50.
Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in Intraductal papillary mucinous neoplasms of the pancreas: A meta-analysis. Clin Gastroenterol Hepatol 2013;11(8):913-921.
Kim KW, Park SH, Pyo J, et al. Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: A meta-analysis. Ann Surg 2014;259(1):72-81.
Hirono S, Yamaue H. Surgical strategy for intraductal papillary mucinous neoplasms of the pancreas. Surg Today 2020;50(1):50-55.