Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology – A retrospective study

Guru Trikudanathan, Satish Munigala, Usman Barlass, Ahmad Malli, Yusheng Han, Miroslav Sekulic, Melena Bellin, Srinath Chinnakotla, Ty Dunn, Timothy Pruett, Gregory Beilman, Jose Vega Peralta, Mustafa Arain, Stuart Amateau, Shawn Mallery, Martin L. Freeman, Rajeev Attam

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Abstract

Background Rosemont classification for chronic pancreatitis has not been evaluated specifically in non-calcific chronic pancreatitis (NCCP) patients and to this date, it has not been correlated with the gold standard namely histopathology. Objective To assess the correlation of EUS Rosemont criteria for NCCP with histopathology from surgical specimens and evaluate the impact of age, sex, BMI, smoking and alcohol on Rosemont classification. Methods Adult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were identified from our institutional database. The presence or absence of standard and Rosemont (major and minor) criteria were determined by expert endosonographers using linear endosonography. Patients were categorized into normal, indeterminate and suggestive with CP based on Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body and tail. All histopathology were re-reviewed by a GI pathologist blinded to endosonographic features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system. Results 50 patients with NCCP (42 females, mean age± SD = 37.9 ± 10.8) underwent TPIAT with preoperative EUS during the study period. Univariate analysis of features such as age, sex, BMI, smoking and alcohol history showed no significant difference between patients identified as normal and those identified as indeterminate/suggestive (p > 0.05). Rosemont “Normal” was poor in excluding CP as 5/9 patients (55.5%) had CP on histopathology. 25/26 patients (96.2%) with features “suggestive” of CP had evidence of CP on histopathology. 12/15 patients (80.0%) with “indeterminate” features had CP on histopathology. Conclusions Rosemont classification can be used independent of patient characteristics (age, sex and BMI) and environmental factors (smoking and alcohol exposure). In our cohort, Rosemont classification was strongly predictive of CP in patients with features “suggestive” of CP. However, “normal” Rosemont classification had poor correlation in this study. This is maybe due to lack of true comparator “normal” pancreas which cannot be obtained reasonably. The strength of agreement for diagnosis of CP was substantial between the standard and Rosemont criteria.

Original languageEnglish (US)
Pages (from-to)63-69
Number of pages7
JournalPancreatology
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2017

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Chronic Pancreatitis
Retrospective Studies
Smoking
Alcohols
Pancreas
Endosonography
Sex Characteristics
Histology
Fibrosis
History
Head
Databases
Biopsy

Keywords

  • EUS
  • Non-calcific chronic pancreatitis
  • Rosemont criteria

Cite this

Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology – A retrospective study. / Trikudanathan, Guru; Munigala, Satish; Barlass, Usman; Malli, Ahmad; Han, Yusheng; Sekulic, Miroslav; Bellin, Melena; Chinnakotla, Srinath; Dunn, Ty; Pruett, Timothy; Beilman, Gregory; Peralta, Jose Vega; Arain, Mustafa; Amateau, Stuart; Mallery, Shawn; Freeman, Martin L.; Attam, Rajeev.

In: Pancreatology, Vol. 17, No. 1, 01.01.2017, p. 63-69.

Research output: Contribution to journalArticle

Trikudanathan, Guru ; Munigala, Satish ; Barlass, Usman ; Malli, Ahmad ; Han, Yusheng ; Sekulic, Miroslav ; Bellin, Melena ; Chinnakotla, Srinath ; Dunn, Ty ; Pruett, Timothy ; Beilman, Gregory ; Peralta, Jose Vega ; Arain, Mustafa ; Amateau, Stuart ; Mallery, Shawn ; Freeman, Martin L. ; Attam, Rajeev. / Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology – A retrospective study. In: Pancreatology. 2017 ; Vol. 17, No. 1. pp. 63-69.
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abstract = "Background Rosemont classification for chronic pancreatitis has not been evaluated specifically in non-calcific chronic pancreatitis (NCCP) patients and to this date, it has not been correlated with the gold standard namely histopathology. Objective To assess the correlation of EUS Rosemont criteria for NCCP with histopathology from surgical specimens and evaluate the impact of age, sex, BMI, smoking and alcohol on Rosemont classification. Methods Adult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were identified from our institutional database. The presence or absence of standard and Rosemont (major and minor) criteria were determined by expert endosonographers using linear endosonography. Patients were categorized into normal, indeterminate and suggestive with CP based on Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body and tail. All histopathology were re-reviewed by a GI pathologist blinded to endosonographic features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system. Results 50 patients with NCCP (42 females, mean age± SD = 37.9 ± 10.8) underwent TPIAT with preoperative EUS during the study period. Univariate analysis of features such as age, sex, BMI, smoking and alcohol history showed no significant difference between patients identified as normal and those identified as indeterminate/suggestive (p > 0.05). Rosemont “Normal” was poor in excluding CP as 5/9 patients (55.5{\%}) had CP on histopathology. 25/26 patients (96.2{\%}) with features “suggestive” of CP had evidence of CP on histopathology. 12/15 patients (80.0{\%}) with “indeterminate” features had CP on histopathology. Conclusions Rosemont classification can be used independent of patient characteristics (age, sex and BMI) and environmental factors (smoking and alcohol exposure). In our cohort, Rosemont classification was strongly predictive of CP in patients with features “suggestive” of CP. However, “normal” Rosemont classification had poor correlation in this study. This is maybe due to lack of true comparator “normal” pancreas which cannot be obtained reasonably. The strength of agreement for diagnosis of CP was substantial between the standard and Rosemont criteria.",
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author = "Guru Trikudanathan and Satish Munigala and Usman Barlass and Ahmad Malli and Yusheng Han and Miroslav Sekulic and Melena Bellin and Srinath Chinnakotla and Ty Dunn and Timothy Pruett and Gregory Beilman and Peralta, {Jose Vega} and Mustafa Arain and Stuart Amateau and Shawn Mallery and Freeman, {Martin L.} and Rajeev Attam",
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T1 - Evaluation of Rosemont criteria for non-calcific chronic pancreatitis (NCCP) based on histopathology – A retrospective study

AU - Trikudanathan, Guru

AU - Munigala, Satish

AU - Barlass, Usman

AU - Malli, Ahmad

AU - Han, Yusheng

AU - Sekulic, Miroslav

AU - Bellin, Melena

AU - Chinnakotla, Srinath

AU - Dunn, Ty

AU - Pruett, Timothy

AU - Beilman, Gregory

AU - Peralta, Jose Vega

AU - Arain, Mustafa

AU - Amateau, Stuart

AU - Mallery, Shawn

AU - Freeman, Martin L.

AU - Attam, Rajeev

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background Rosemont classification for chronic pancreatitis has not been evaluated specifically in non-calcific chronic pancreatitis (NCCP) patients and to this date, it has not been correlated with the gold standard namely histopathology. Objective To assess the correlation of EUS Rosemont criteria for NCCP with histopathology from surgical specimens and evaluate the impact of age, sex, BMI, smoking and alcohol on Rosemont classification. Methods Adult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were identified from our institutional database. The presence or absence of standard and Rosemont (major and minor) criteria were determined by expert endosonographers using linear endosonography. Patients were categorized into normal, indeterminate and suggestive with CP based on Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body and tail. All histopathology were re-reviewed by a GI pathologist blinded to endosonographic features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system. Results 50 patients with NCCP (42 females, mean age± SD = 37.9 ± 10.8) underwent TPIAT with preoperative EUS during the study period. Univariate analysis of features such as age, sex, BMI, smoking and alcohol history showed no significant difference between patients identified as normal and those identified as indeterminate/suggestive (p > 0.05). Rosemont “Normal” was poor in excluding CP as 5/9 patients (55.5%) had CP on histopathology. 25/26 patients (96.2%) with features “suggestive” of CP had evidence of CP on histopathology. 12/15 patients (80.0%) with “indeterminate” features had CP on histopathology. Conclusions Rosemont classification can be used independent of patient characteristics (age, sex and BMI) and environmental factors (smoking and alcohol exposure). In our cohort, Rosemont classification was strongly predictive of CP in patients with features “suggestive” of CP. However, “normal” Rosemont classification had poor correlation in this study. This is maybe due to lack of true comparator “normal” pancreas which cannot be obtained reasonably. The strength of agreement for diagnosis of CP was substantial between the standard and Rosemont criteria.

AB - Background Rosemont classification for chronic pancreatitis has not been evaluated specifically in non-calcific chronic pancreatitis (NCCP) patients and to this date, it has not been correlated with the gold standard namely histopathology. Objective To assess the correlation of EUS Rosemont criteria for NCCP with histopathology from surgical specimens and evaluate the impact of age, sex, BMI, smoking and alcohol on Rosemont classification. Methods Adult patients undergoing TPIAT for NCCP between July 2009 and January 2013 were identified from our institutional database. The presence or absence of standard and Rosemont (major and minor) criteria were determined by expert endosonographers using linear endosonography. Patients were categorized into normal, indeterminate and suggestive with CP based on Rosemont classification. Histology was obtained at time of TPIAT from the resected pancreas by wedge biopsy of head, body and tail. All histopathology were re-reviewed by a GI pathologist blinded to endosonographic features and clinical outcomes. Available pancreatic tissue was graded for severity of intralobular and perilobular pancreatic fibrosis by the Ammann classification system. Results 50 patients with NCCP (42 females, mean age± SD = 37.9 ± 10.8) underwent TPIAT with preoperative EUS during the study period. Univariate analysis of features such as age, sex, BMI, smoking and alcohol history showed no significant difference between patients identified as normal and those identified as indeterminate/suggestive (p > 0.05). Rosemont “Normal” was poor in excluding CP as 5/9 patients (55.5%) had CP on histopathology. 25/26 patients (96.2%) with features “suggestive” of CP had evidence of CP on histopathology. 12/15 patients (80.0%) with “indeterminate” features had CP on histopathology. Conclusions Rosemont classification can be used independent of patient characteristics (age, sex and BMI) and environmental factors (smoking and alcohol exposure). In our cohort, Rosemont classification was strongly predictive of CP in patients with features “suggestive” of CP. However, “normal” Rosemont classification had poor correlation in this study. This is maybe due to lack of true comparator “normal” pancreas which cannot be obtained reasonably. The strength of agreement for diagnosis of CP was substantial between the standard and Rosemont criteria.

KW - EUS

KW - Non-calcific chronic pancreatitis

KW - Rosemont criteria

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