Estimation of pancreatic histology and likelihood of postoperative pancreatic fistula using extracellular volume fraction from contrast-enhanced computed tomography

doi:10.12998/wjcc.v13.i27.109243

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World Journal of Clinical Cases

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Retrospective Study

World J Clin Cases. Sep 26, 2025; 13(27): 109243
Published online Sep 26, 2025. doi: 10.12998/wjcc.v13.i27.109243

Estimation of pancreatic histology and likelihood of postoperative pancreatic fistula using extracellular volume fraction from contrast-enhanced computed tomography

Akihiro Nakamura, Takafumi Ogawa, Kuniya Tanaka, Yuki Takahashi, So Murai, Yuki Tashiro, Akane Wada, Yasuo Ueda, Yosuke Sasaki, Yuzo Minegishi, Kenichi Matsuo, Toshiko Yamochi

Akihiro Nakamura, So Murai, Yosuke Sasaki, Toshiko Yamochi, Department of Diagnostic Pathology, Showa Medical University, Shinagawa-ku 1428666, Tōkyō, Japan

Takafumi Ogawa, Akane Wada, Yasuo Ueda, Department of Pathology and Laboratory Medicine, Showa Medical University Fujigaoka Hospital, Yokohama 2270043, Kanagawa, Japan

Kuniya Tanaka, Yuki Takahashi, Yuzo Minegishi, Kenichi Matsuo, Department of Gastroenterological and General Surgery, Showa Medical University Fujigaoka Hospital, Yokohama 2270043, Kanagawa, Japan

Yuki Tashiro, Department of Radiology, Showa Medical University Fujigaoka Hospital, Yokohama 2270043, Kanagawa, Japan

Author contributions: Nakamura A, Tanaka K and Ogawa T conceived and designed the study; Minegishi Y and Matsuo K collected clinical and surgical data; Nakamura A and Murai S conducted pathological evaluations, with assistance from Wada A and Ueda Y; Tashiro Y and Takahashi Y contributed to imaging evaluations; Sasaki Y performed immunohistochemical staining; Tanaka K and Matsuo K supervised the statistical analysis; Yamochi T supervised the overall study; Nakamura A drafted the manuscript; All authors reviewed and approved the final version of the manuscript.

Institutional review board statement: This study is a retrospective analysis of anonymized clinical and pathological data. It was approved by the Institutional Review Board of Showa Medical University (Approval No. 2023-290-A). In accordance with national ethical guidelines in Japan, written informed consent was waived and an opt-out procedure was employed.

Informed consent statement: Informed consent was not individually obtained due to the retrospective nature of the study. In accordance with national ethical guidelines in Japan, an opt-out procedure was employed: The study was publicly disclosed on the institutional website to allow patients the opportunity to decline participation. The explanatory materials were provided only in Japanese, as the study population consisted entirely of Japanese patients.

Conflict-of-interest statement: The authors declare no conflicts of interest related to this manuscript.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. All data have been anonymized to ensure patient confidentiality and are not publicly available due to institutional regulations.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Akihiro Nakamura, MD, Doctorate Student, Department of Diagnostic Pathology, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku 1428666, Tōkyō, Japan. jarw.bn9@med.showa-u.ac.jp

Received: May 6, 2025
Revised: June 4, 2025
Accepted: June 23, 2025
Published online: September 26, 2025
Processing time: 92 Days and 14.3 Hours

Core Tip

Core Tip: This study evaluated the utility of extracellular volume fraction (ECV), a computed tomography (CT)-based quantitative marker, in estimating pancreatic tissue composition and predicting postoperative pancreatic fistula (POPF). ECV was strongly correlated with histological fibrosis and inversely with acinar cell content. In patients undergoing pancreatoduodenectomy, low ECV (< 36%) and small main pancreatic duct diameter (≤ 2 mm) were identified as independent risk factors for POPF. These findings suggest that CT-derived ECV can noninvasively reflect pancreatic histology and may serve as a valuable preoperative imaging biomarker to stratify the risk of POPF.