Differential diagnosis of pancreatoblastoma (PB) and solid pseudopapillary neoplasms (SPNs) in children by CT and MR imaging
EUROPEAN RADIOLOGY
Authors: Yang, Zhaoxia; Gong, Ying; Ji, Min; Yang, Bin; Qiao, Zhongwei
Abstract
Objectives To determine whether features on computed tomographic and/or magnetic resonance imaging can differentiate pancreatoblastoma (PB) from solid pseudopapillary neoplasms (SPNs) of the pancreas in children. Methods Clinical and imaging data for 20 cases of SPNs and 14 cases of PB confirmed by surgery or biopsy were retrospectively analysed. The size, border, calcification, haemorrhage, solid/cystic component proportion, intratumoural vessels, tumour capsulation, pancreatic duct dilatation, peripancreatic vessel invasion, distant metastasis status and apparent diffusion coefficient (ADC) values of the two groups were examined, and key diagnostic features were identified. Statistical analysis was performed using the chi-square test and Student'sttest. Sensitivity and specificity values were calculated when a single criterion was used. Results Age <= 5 years, elevated serum alpha-fetoprotein (AFP), larger size, ill-defined border, calcification, absence of haemorrhage, intratumoural vessel, peripancreatic vessel invasion and distant metastasis differentiated PB from SPN (p< 0.05). ADC values of SPN were higher than those of PB (p= 0.001). There were no significant differences regarding tumour capsule (p= 0.435), pancreatic duct dilatation (p= 1.000) or cystic degeneration area over 50% of the tumour volume (p= 1.000) between the two groups. Conclusions The following features are helpful for differentiating PB from SPN: age <= 5 years, elevated serum AFP, larger size, ill-defined border, calcification, haemorrhage absence, intratumoural vessel, peripancreatic vessel invasion, distant metastasis and lower ADC value.
Five-year comparative risk of hepatocellular carcinoma development under entecavir or tenofovir treatment-naive patients with chronic hepatitis B-related compensated cirrhosis in Taiwan
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
Authors: Hu, Tsung-Hui; Chiu, Sherry Yueh-Hsia; Tseng, Po-Lin; Chen, Chien-Hung; Lu, Sheng-Nan; Wang, Jing-Houng; Hung, Chao-Hung; Kee, Kwong-Ming; Lin, Ming-Tsung; Chang, Kuo-Chin; Lin, Meng-Chih; Chien, Rong-Nan
Abstract
Background: Comparative long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for prevention of disease progression to hepatocellular carcinoma (HCC) among high-risk patients with chronic hepatitis B (CHB)-related compensated cirrhosis is controversial. Aims: To compare the long-term efficacy of ETV and TDF in HCC prevention in patients with CHB-related cirrhosis, and to evaluate predictive risk factors for HCC development. Methods: From January 2008 to March 2018, 894 treatment-naive patients with CHB-related compensated cirrhosis on ETV or TDF were enrolled based on the longitudinal cohort study. Data were originally collected for 7.3 years of follow-up or after the launch of TDF in 2011. Only the 5-year cumulative incidence and risk factors of HCC were assessed. Result: Total 678 and 216 patients received ETV and TDF, respectively. The cumulative risk of HCC at 1, 3 and 5 years of follow-up was 1.6%, 11.3% and 18.7%, respectively, in the ETV group; and 0.9%, 6.7% and 10.7%, respectively, in the TDF group (P = 0.0305). Univariate and adjusted-multivariable models revealed that platelet count, alpha-fetoprotein (AFP) levels and upper gastrointestinal (UGI) varices were independent risk factors for HCC development. TDF resulted in risk of HCC development compared to ETV with adjusted hazard ratios (aHRs) of 0.66 (95% confidence interval [CI]:0.40, 1.08; P = 0.0971), 0.69 (95% CI: 0.42, 1.14; P = 0.1488) and 0.66 (95% CI: 0.38, 1.14; P = 0.1407) under stepwise selection, propensity score adjustment, and propensity score matching multivariable models, respectively. Conclusions: For treatment-naive patients with CHB-related compensated cirrhosis with 5-year follow-up, after variable adjustments, propensity score approaches and subgroup analyses, TDF showed a lower rate of HCC development that did not reach statistical significance, compared to the ETV.