Qualitative imaging features of pancreatic neuroendocrine neoplasms predict histopathologic characteristics including tumor grade and patient outcome

Objectives: To identify PanNEN imaging features associated with tumor grade and aggressive histopathological features. Methods: Associations between histopathological and imaging features of resected PanNEN were retrospectively tested. Histopathologic features included WHO grade, lymphovascular invasion (LVI), growth pattern (infiltrative, circumscribed), and intratumoral fibrosis (mature, immature). Imaging features included size, degree/uniformity of enhancement, progressive enhancement, contour, infiltrative appearance (infiltrative_im), calcifications, cystic components, tumor thrombus, vascular occlusion (VO), duct dilatation, and atrophy. Multinomial logistic regression analyses evaluated the magnitude of associations. Association of variables with outcome was assessed using Cox-proportional hazards regression. Results: 133 patients were included. 3 imaging features (infiltrative_im, ill-defined contour [contour_ill], and VO) were associated with all histopathologic parameters and poor outcome. Increase in grade increased odds of contour_ill by 15.6 times (p = 0.0001, 95% CI 3.8–64.4). PanNEN with VO were 51.1 times (p = 0.0002, 6.5–398.6) more likely to demonstrate LVI. For PanNEN with contour_ill, infiltrative growth pattern was 51.3 times (p < 0.0001, 9.1–288.4), and fibrosis was 14 times (p = 0.0065, 2.1–93.7) more likely. Contour_ill was associated with decreased recurrence-free survival (p = 0.0003, HR 18.29, 3.83–87.3) and VO (p = 0.0004, HR6.08, 2.22–16.68) with decreased overall survival. Conclusions: Infiltrative_im, contour_ill, and VO on imaging are associated with higher grade/histopathological parameters linked to tumor aggression, and poor outcome.