Ultrasound has limited diagnostic utility in children with acute lymphoblastic leukemia developing pancreatitis
Purpose Acute pancreatitis (AP) due to chemotherapy‐induced pancreatic injury is a common side effect of treatment for acute lymphoblastic leukemia (ALL), the most common childhood malignancy. The American College of Radiology recommends ultrasound (US) for initial imaging of AP in all populations t...
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Veröffentlicht in: | Pediatric blood & cancer 2021-01, Vol.68 (1), p.e28730-n/a |
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creator | Richardson, Rebecca Morin, Cara E. Wheeler, Charles A. Guo, Yian Li, Yimei Jeha, Sima Inaba, Hiroto Pui, Ching‐Hon Karol, Seth E. McCarville, M. Beth |
description | Purpose
Acute pancreatitis (AP) due to chemotherapy‐induced pancreatic injury is a common side effect of treatment for acute lymphoblastic leukemia (ALL), the most common childhood malignancy. The American College of Radiology recommends ultrasound (US) for initial imaging of AP in all populations to assess for ductal obstruction. However, US may be insensitive to diagnose and assess chemotherapy‐associated AP.
Methods and Materials
The institutional review board approved this retrospective study. Patients with ALL and AP were identified from protocol databases, using Common Terminology Criteria for Adverse Events (CTCAE) version 3. Chemotherapy dosing, amylase/lipase levels, clinical symptoms, and US/computed tomography (CT) reports within 10 days of diagnosis were recorded. All CT images were reviewed for revised Atlanta classification and CT severity index (CTSI).
Results
Sixty‐nine patients, aged 2‐21 years, experienced 88 episodes of AP, undergoing 98 US and 44 CT. Seventy‐two events (82%) occurred within 30 days of asparaginase administration. Sixty‐nine episodes (78%) were initially diagnosed by the presence of abdominal pain and pancreatic enzyme elevation. Overall sensitivities for AP detection were 47% using US and 98% for CT. US sensitivity was greatest in CTCAE grade 4 (86%) and necrotizing pancreatitis (67%).
Conclusions
Most cases of AP in children with ALL can be diagnosed with clinical history and labs. US has limited sensitivity in detecting pancreatitis in this population. Imaging to diagnose AP in this patient population could be limited to clinically equivocal cases. |
doi_str_mv | 10.1002/pbc.28730 |
format | Article |
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Acute pancreatitis (AP) due to chemotherapy‐induced pancreatic injury is a common side effect of treatment for acute lymphoblastic leukemia (ALL), the most common childhood malignancy. The American College of Radiology recommends ultrasound (US) for initial imaging of AP in all populations to assess for ductal obstruction. However, US may be insensitive to diagnose and assess chemotherapy‐associated AP.
Methods and Materials
The institutional review board approved this retrospective study. Patients with ALL and AP were identified from protocol databases, using Common Terminology Criteria for Adverse Events (CTCAE) version 3. Chemotherapy dosing, amylase/lipase levels, clinical symptoms, and US/computed tomography (CT) reports within 10 days of diagnosis were recorded. All CT images were reviewed for revised Atlanta classification and CT severity index (CTSI).
Results
Sixty‐nine patients, aged 2‐21 years, experienced 88 episodes of AP, undergoing 98 US and 44 CT. Seventy‐two events (82%) occurred within 30 days of asparaginase administration. Sixty‐nine episodes (78%) were initially diagnosed by the presence of abdominal pain and pancreatic enzyme elevation. Overall sensitivities for AP detection were 47% using US and 98% for CT. US sensitivity was greatest in CTCAE grade 4 (86%) and necrotizing pancreatitis (67%).
Conclusions
Most cases of AP in children with ALL can be diagnosed with clinical history and labs. US has limited sensitivity in detecting pancreatitis in this population. Imaging to diagnose AP in this patient population could be limited to clinically equivocal cases.</description><identifier>ISSN: 1545-5009</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.28730</identifier><identifier>PMID: 33111506</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Disease ; acute lymphoblastic leukemia ; Adolescent ; Adult ; asparaginase‐associated pancreatitis ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; pancreatitis ; Pancreatitis - diagnosis ; Pancreatitis - diagnostic imaging ; Pancreatitis - etiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed - methods ; Ultrasonography - methods ; ultrasound ; Young Adult</subject><ispartof>Pediatric blood & cancer, 2021-01, Vol.68 (1), p.e28730-n/a</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4150-5bf6323513b7d37b0017c3ababd7fadf82a4c5911d3954e598a10122ccb82ad43</citedby><cites>FETCH-LOGICAL-c4150-5bf6323513b7d37b0017c3ababd7fadf82a4c5911d3954e598a10122ccb82ad43</cites><orcidid>0000-0003-0605-7342 ; 0000-0003-1953-4486 ; 0000-0003-0303-5658 ; 0000-0001-8113-8180</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpbc.28730$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpbc.28730$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,778,782,883,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33111506$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Richardson, Rebecca</creatorcontrib><creatorcontrib>Morin, Cara E.</creatorcontrib><creatorcontrib>Wheeler, Charles A.</creatorcontrib><creatorcontrib>Guo, Yian</creatorcontrib><creatorcontrib>Li, Yimei</creatorcontrib><creatorcontrib>Jeha, Sima</creatorcontrib><creatorcontrib>Inaba, Hiroto</creatorcontrib><creatorcontrib>Pui, Ching‐Hon</creatorcontrib><creatorcontrib>Karol, Seth E.</creatorcontrib><creatorcontrib>McCarville, M. Beth</creatorcontrib><title>Ultrasound has limited diagnostic utility in children with acute lymphoblastic leukemia developing pancreatitis</title><title>Pediatric blood & cancer</title><addtitle>Pediatr Blood Cancer</addtitle><description>Purpose
Acute pancreatitis (AP) due to chemotherapy‐induced pancreatic injury is a common side effect of treatment for acute lymphoblastic leukemia (ALL), the most common childhood malignancy. The American College of Radiology recommends ultrasound (US) for initial imaging of AP in all populations to assess for ductal obstruction. However, US may be insensitive to diagnose and assess chemotherapy‐associated AP.
Methods and Materials
The institutional review board approved this retrospective study. Patients with ALL and AP were identified from protocol databases, using Common Terminology Criteria for Adverse Events (CTCAE) version 3. Chemotherapy dosing, amylase/lipase levels, clinical symptoms, and US/computed tomography (CT) reports within 10 days of diagnosis were recorded. All CT images were reviewed for revised Atlanta classification and CT severity index (CTSI).
Results
Sixty‐nine patients, aged 2‐21 years, experienced 88 episodes of AP, undergoing 98 US and 44 CT. Seventy‐two events (82%) occurred within 30 days of asparaginase administration. Sixty‐nine episodes (78%) were initially diagnosed by the presence of abdominal pain and pancreatic enzyme elevation. Overall sensitivities for AP detection were 47% using US and 98% for CT. US sensitivity was greatest in CTCAE grade 4 (86%) and necrotizing pancreatitis (67%).
Conclusions
Most cases of AP in children with ALL can be diagnosed with clinical history and labs. US has limited sensitivity in detecting pancreatitis in this population. Imaging to diagnose AP in this patient population could be limited to clinically equivocal cases.</description><subject>Acute Disease</subject><subject>acute lymphoblastic leukemia</subject><subject>Adolescent</subject><subject>Adult</subject><subject>asparaginase‐associated pancreatitis</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>pancreatitis</subject><subject>Pancreatitis - diagnosis</subject><subject>Pancreatitis - diagnostic imaging</subject><subject>Pancreatitis - etiology</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Ultrasonography - methods</subject><subject>ultrasound</subject><subject>Young Adult</subject><issn>1545-5009</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1v1DAQhi0Eoh9w4A8gH-GwrR3Hm-SCRFdQKlWih_ZsjT-yGXDsEDut9t_XdMsKDpxmpHn0zIxeQt5xdsYZq84nbc6qthHsBTnmspYryXjz8tCz7oicpPSjoGsm29fkSAjOuWTrYxLvfJ4hxSVYOkCiHkfMzlKLsA0xZTR0yegx7ygGagb0dnaBPmAeKJglO-p34zRE7eEJ9m756UYEat2983HCsKUTBDM7yJgxvSGvevDJvX2up-Tu65fbzbfV9ffLq83n65Wpy2Erqfu1qITkQjdWNJqVh4wADdo2Pdi-raA2suPcik7WTnYtcMaryhhdRrYWp-TT3jstenTWuFDe9GqacYR5pyKg-ncScFDbeK-aTnCx7orgw7Ngjr8Wl7IaMRnnPQQXl6SqWkretEzIgn7co2aOKc2uP6zhTP0OSJWA1FNAhX3_910H8k8iBTjfAw_o3e7_JnVzsdkrHwHxSJ4T</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Richardson, Rebecca</creator><creator>Morin, Cara E.</creator><creator>Wheeler, Charles A.</creator><creator>Guo, Yian</creator><creator>Li, Yimei</creator><creator>Jeha, Sima</creator><creator>Inaba, Hiroto</creator><creator>Pui, Ching‐Hon</creator><creator>Karol, Seth E.</creator><creator>McCarville, M. Beth</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0605-7342</orcidid><orcidid>https://orcid.org/0000-0003-1953-4486</orcidid><orcidid>https://orcid.org/0000-0003-0303-5658</orcidid><orcidid>https://orcid.org/0000-0001-8113-8180</orcidid></search><sort><creationdate>202101</creationdate><title>Ultrasound has limited diagnostic utility in children with acute lymphoblastic leukemia developing pancreatitis</title><author>Richardson, Rebecca ; Morin, Cara E. ; Wheeler, Charles A. ; Guo, Yian ; Li, Yimei ; Jeha, Sima ; Inaba, Hiroto ; Pui, Ching‐Hon ; Karol, Seth E. ; McCarville, M. Beth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4150-5bf6323513b7d37b0017c3ababd7fadf82a4c5911d3954e598a10122ccb82ad43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute Disease</topic><topic>acute lymphoblastic leukemia</topic><topic>Adolescent</topic><topic>Adult</topic><topic>asparaginase‐associated pancreatitis</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>pancreatitis</topic><topic>Pancreatitis - diagnosis</topic><topic>Pancreatitis - diagnostic imaging</topic><topic>Pancreatitis - etiology</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Ultrasonography - methods</topic><topic>ultrasound</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Richardson, Rebecca</creatorcontrib><creatorcontrib>Morin, Cara E.</creatorcontrib><creatorcontrib>Wheeler, Charles A.</creatorcontrib><creatorcontrib>Guo, Yian</creatorcontrib><creatorcontrib>Li, Yimei</creatorcontrib><creatorcontrib>Jeha, Sima</creatorcontrib><creatorcontrib>Inaba, Hiroto</creatorcontrib><creatorcontrib>Pui, Ching‐Hon</creatorcontrib><creatorcontrib>Karol, Seth E.</creatorcontrib><creatorcontrib>McCarville, M. Beth</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric blood & cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Richardson, Rebecca</au><au>Morin, Cara E.</au><au>Wheeler, Charles A.</au><au>Guo, Yian</au><au>Li, Yimei</au><au>Jeha, Sima</au><au>Inaba, Hiroto</au><au>Pui, Ching‐Hon</au><au>Karol, Seth E.</au><au>McCarville, M. Beth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasound has limited diagnostic utility in children with acute lymphoblastic leukemia developing pancreatitis</atitle><jtitle>Pediatric blood & cancer</jtitle><addtitle>Pediatr Blood Cancer</addtitle><date>2021-01</date><risdate>2021</risdate><volume>68</volume><issue>1</issue><spage>e28730</spage><epage>n/a</epage><pages>e28730-n/a</pages><issn>1545-5009</issn><eissn>1545-5017</eissn><abstract>Purpose
Acute pancreatitis (AP) due to chemotherapy‐induced pancreatic injury is a common side effect of treatment for acute lymphoblastic leukemia (ALL), the most common childhood malignancy. The American College of Radiology recommends ultrasound (US) for initial imaging of AP in all populations to assess for ductal obstruction. However, US may be insensitive to diagnose and assess chemotherapy‐associated AP.
Methods and Materials
The institutional review board approved this retrospective study. Patients with ALL and AP were identified from protocol databases, using Common Terminology Criteria for Adverse Events (CTCAE) version 3. Chemotherapy dosing, amylase/lipase levels, clinical symptoms, and US/computed tomography (CT) reports within 10 days of diagnosis were recorded. All CT images were reviewed for revised Atlanta classification and CT severity index (CTSI).
Results
Sixty‐nine patients, aged 2‐21 years, experienced 88 episodes of AP, undergoing 98 US and 44 CT. Seventy‐two events (82%) occurred within 30 days of asparaginase administration. Sixty‐nine episodes (78%) were initially diagnosed by the presence of abdominal pain and pancreatic enzyme elevation. Overall sensitivities for AP detection were 47% using US and 98% for CT. US sensitivity was greatest in CTCAE grade 4 (86%) and necrotizing pancreatitis (67%).
Conclusions
Most cases of AP in children with ALL can be diagnosed with clinical history and labs. US has limited sensitivity in detecting pancreatitis in this population. Imaging to diagnose AP in this patient population could be limited to clinically equivocal cases.</abstract><cop>United States</cop><pmid>33111506</pmid><doi>10.1002/pbc.28730</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-0605-7342</orcidid><orcidid>https://orcid.org/0000-0003-1953-4486</orcidid><orcidid>https://orcid.org/0000-0003-0303-5658</orcidid><orcidid>https://orcid.org/0000-0001-8113-8180</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Acute Disease acute lymphoblastic leukemia Adolescent Adult asparaginase‐associated pancreatitis Child Child, Preschool Female Follow-Up Studies Humans Male pancreatitis Pancreatitis - diagnosis Pancreatitis - diagnostic imaging Pancreatitis - etiology Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications Prognosis Retrospective Studies Tomography, X-Ray Computed - methods Ultrasonography - methods ultrasound Young Adult |
title | Ultrasound has limited diagnostic utility in children with acute lymphoblastic leukemia developing pancreatitis |
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