Pancreatic volume does not correlate with histologic fibrosis in adult patients with recurrent acute and chronic pancreatitis

Mahya Faghih; Michaël Noë; Rifat Mannan; Ihab R Kamel; Atif Zaheer; Rita R Kalyani; Erica Hall; Elham Afghani; Daniel Warren; Niraj Desai; Zhaoli Sun; Christi Walsh; Martin A Makary; Michael Goggins; Ralph H Hruban; Jin He; Vikesh K Singh

doi:10.1016/j.pan.2020.07.409

Pancreatic volume does not correlate with histologic fibrosis in adult patients with recurrent acute and chronic pancreatitis

Pancreatology. 2020 Sep;20(6):1078-1084. doi: 10.1016/j.pan.2020.07.409. Epub 2020 Aug 1.

Authors

Mahya Faghih¹, Michaël Noë², Rifat Mannan³, Ihab R Kamel⁴, Atif Zaheer⁵, Rita R Kalyani⁶, Erica Hall⁶, Elham Afghani⁷, Daniel Warren⁸, Niraj Desai⁸, Zhaoli Sun⁸, Christi Walsh⁹, Martin A Makary⁹, Michael Goggins¹⁰, Ralph H Hruban¹¹, Jin He⁹, Vikesh K Singh¹²

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
² Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
³ Division of Gastrointestinal, Liver and Pancreatic Pathology, Department of Pathology, University of Pennsylvania, Perelman, School of Medicine, philadelphia, USA.
⁴ Division of Abdominal Imaging, Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁵ Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Abdominal Imaging, Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁶ Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁷ Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁸ Division of Transplant Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁹ Division of Surgical Oncology, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
¹⁰ Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
¹¹ Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
¹² Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Pancreatitis Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.

PMID: 32819846
DOI: 10.1016/j.pan.2020.07.409

Abstract

Objectives: Reduced pancreatic volume, often referred to as atrophy, is a commonly reported imaging feature of chronic pancreatitis (CP). This study evaluated whether there is an association between pancreatic volume and fibrosis, the criterion standard of CP, in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT) for recurrent acute pancreatitis (RAP) and CP.

Methods: All adult patients who underwent TPIAT between 2010 and 2019 were categorized into 3 groups: RAP, definite CP and indeterminate CP. Pancreatic volume was calculated by summing up the areas from each thin section of the pancreas on 3D CT imaging. Excisional biopsies of the pancreatic head as well as body/tail region were obtained at the time of TPIAT. Two different fibrosis scores were used for histologic assessment.

Results: A total of 16, 29 and 15 patients underwent TPIAT for RAP, definite CP and indeterminate CP, respectively. The mean pancreatic volumes for patients with RAP, definite CP and indeterminate CP were 65.7 ± 28.5 cc, 54.9 ± 22.9 cc and 61.8 ± 23.6 cc, respectively (p = 0.3). The mean fibrosis scores were significantly higher in patients with definite CP compared to RAP (p < 0.001) and indeterminate CP (p < 0.001). Pancreatic volume was not associated with either fibrosis score after adjusting for age, gender, duration of disease, BMI and diabetes in the multivariable analysis.

Conclusions: While the fibrosis scores were higher in definite CP compared to both RAP and indeterminate CP, there was no correlation between pancreatic volume and fibrosis. This suggests that atrophy alone cannot be used to diagnose CP.

Keywords: Chronic pancreatitis; Pancreatic atrophy; Pancreatic volume; Recurrent acute pancreatitis; TPIAT.

MeSH terms

Acute Disease
Adult
Atrophy
Female
Fibrosis
Humans
Islets of Langerhans Transplantation
Male
Middle Aged
Negative Results
Pancreas / pathology*
Pancreas / surgery
Pancreatectomy
Pancreatitis / diagnosis
Pancreatitis / pathology*
Pancreatitis / surgery
Pancreatitis, Chronic / diagnosis
Pancreatitis, Chronic / pathology*
Pancreatitis, Chronic / surgery
Recurrence
Tomography, X-Ray Computed