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
Hauptverfasser: 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
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container_issue 1
container_start_page e28730
container_title Pediatric blood & cancer
container_volume 68
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
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Beth</creator><creatorcontrib>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</creatorcontrib><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><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 &amp; 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 &amp; 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. 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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. 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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 &amp; 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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