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Ultrasound has limited diagnostic utility in children with acute lymphoblastic leukemia developing pancreatitis
Author(s) -
Richardson Rebecca,
Morin Cara E.,
Wheeler Charles A.,
Guo Yian,
Li Yimei,
Jeha Sima,
Inaba Hiroto,
Pui ChingHon,
Karol Seth E.,
McCarville M. Beth
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28730
Subject(s) - medicine , acute pancreatitis , pancreatitis , common terminology criteria for adverse events , radiology , abdominal pain , chemotherapy , population , malignancy , institutional review board , surgery , environmental health
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.