# Surgical Strategy and Prognosis of Pancreatic Neuroendocrine Tumors Based on Smart Medical Imaging

Authors: Ming Huang; Jian Li; Qinghua Yin; Lixin Xiong
Journal: Contrast Media & Molecular Imaging
 (2022)

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## Abstract

It is imperative to seize the “golden rescue time” and implement new concepts and new skills in modern trauma rescue. Combining with the development background of smart medical image analysis, this topic focuses on surgical strategies and prognostic measures and studies a serious and difficult disease frequently occurring in middle-aged and elderly people: pancreatic neuroendocrine tumors. This article uses the comparative test method and sample collection method to collect the medical records of patients with neuroendocrine tumors diagnosed by pathology from July 2010 to January 2018 in the First Affiliated Hospital of X City and analyze the samples with gender and age. At the same time, routine tumor marker examination and the location of NEN in the digestive system were performed. The distribution analysis of EUS characteristics of neuroendocrine tumor mucosa in each site was performed after operation, and the analysis of survival-related factors was performed during postoperative follow-up. The experimental data showed that among the tumor causes, WHO tumor grade (p<0.05) and whether the surgical method was R0 resection (p<0.05) were associated with prognosis. However, factors such as gender, age, and functional status were associated with prognosis. It has successfully completed the subject of surgical strategy and prognosis of pancreatic neuroendocrine tumors based on smart medical image analysis.


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## Body

## 1. Introduction

Life expectancy continues to increase, and people pay more and more attention to people’s health. Medical needs are also increasing. However, due to the unbalanced development of regional economy, the medical resources in different regions are very different. Generally speaking, the medical treatment enjoyed by first-tier cities with developed economy and population is much higher than that of small- and medium-sized cities. The medical treatment and technical level in the cities are also much higher than those in the rural areas. With the support of science and technology, coupled with the patient’s desire for telemedicine and the development of communication technology, the smart medical system came into being. Smart medical care can meet various medical needs in an intelligent way. It provides convenient and humanized services for patients and alleviates medical conflicts. People have access to effective health services. Tumor is a deadly disease that threatens human health. According to survey data, there are more than 1,000 new cases of cancer worldwide each year. Among them, nearly half died of tumors, and the incidence group is also getting younger. The usual treatment is surgical resection. However, there are certain risks in the treatment process. In order to reduce the risk of surgery, it combines smart medical image analysis with tumor resection surgery, hoping to reduce the risk of surgery.In specific clinical applications, doctors need to select appropriate diagnostic techniques for application according to the specific disease types and actual conditions of patients. Imaging allows the analysis and production of malignant neuroendocrine tumors. It is of great practical importance for the clinical diagnosis and treatment of malignant neuroendocrine tumors of the pancreas in the future. The use of intelligent medical systems for case consolidation can determine the role of medical care in cases and improve function and the role of diagnosis.Analyze the importance of medical imaging divorce for clinical research and provide the basis for designing the best noise reduction algorithms. Advise a smart cloud application model. For the first time, it is recommended to measure business processes in the working medical environment, compare local weaknesses and process compatibility after the introduction of occupational medicine materials and programs, and improve performance in the actual work process. The application of intelligent medical treatment in pancreatic neuroendocrine tumor surgery is analyzed in detail.


## 2. Related Work

With the advancement of technology and technology, medical devices are becoming more and more advanced and the highly advanced medical technology provides flexibility in medical diagnosis. How to combine advanced medical technology with surgery for neuroendocrine tumors of the pancreas is a hot topic right now. Ge et al. compared the outcomes of asymptomatic and end-patient survival by comparing the patient’s condition and evaluating patients carefully. Test results show that compared to symptomatic NF-PNETs, asymptomatic NF-PNETs have a lower degree of damage and a better prognosis [1]. To investigate the clinical features, treatment, and prognostic causes of pancreatic neuroendocrine tumors (pNETs) in patients receiving sunitinib, Xu monitors and evaluates the clinical data of patients with pNET as part of the Assistance Program Medication. Tests have found that age, Ki-67 index, surgery, and other factors are related to the 3-year survival rate of patients with pNET [2]. The consequences of recurrence of modified pancreatic neuroendocrine tumors (PNETs) are not well understood. For this purpose, Chouliaras K investigates the repair rates and the range of motion and analyzes the effect on the clinical results. Examinations show that the overall survival rates of patients with relapse and no relapse are 96.3% and 100% [3]. Li et al. analyzed histopathologically confirmed NETP imaging features. Experimental results show that NETP is indicated mainly as subarachnoid lesions of the pancreas on conventional ultrasound, with normal morphology, significant improvement in arterial level and no apparent recurrence during the CEUS waiting period [4]. Chaudhary et al. proposed a new secure cryptocurrency system for smart health in the future smart cities (LSCSH). This system has been evaluated in terms of communication and statistical significance compared to other competing concepts. Compared to existing programs, its effectiveness is much better [5]. Rodic-Trmcic et al. present a method for designing a comprehensive medical technology curriculum. The results of the tests show that the method has a positive effect on both the learning process and the good educational experience [6]. Ghoneim et al. propose a new medical imaging system for the healthcare system to ensure that health-related images are not distorted or distorted. The program processes the image noise map, applies a multipart regression filter to the noise map, and feeds the output to the SVM source and higher education-based classics [7]. Du et al. aim to investigate the application of blockchain technology in specialized medical care, uses a sophisticated system to filter out unwanted features, recommends the Experimental and Experimental Evaluation Laboratory (DEMATEL) to manage complex interactions between sites and features, and uses the Interpretation Management System (ISM) to create shared processes (ISMs) layer. Experimental results show that expert agreements depend on the management of medical records and that the system is limited. Improving the application is the key to system upgrades [8]. Although these studies have discussed medical specialists and surgery for pancreatic neuroendocrine tumors, the combination of both is not necessary. Moreover, as the strategy and prognosis of tumor surgery, there is no targeted plan, and the content of smart medical care is rarely involved, so it is necessary to propose the topic of this paper.


## 3. Surgical Strategy and Prognosis of Pancreatic Neuroendocrine Tumors

### 3.1. Smart Healthcare

With the improvement of economic level, people’s demand for medical resources is expanding. Making full use of technical means to promote the vertical flow of medical resources is an important trend in the current medical development [9,10]. Smart healthcare uses emerging technologies such as cloud computing to integrate medical resources and innovate the medical service model and is committed to creating a new medical experience for patients [11].In essence, the smart medical service model improves the traditional service model [12]. Figure 1 shows the structure of the smart medical service platform: Among them, the service of smart medical care is in the core position, bearing the contact between users and hospitals, and analyzing the data of the system.Figure 1
Structure diagram of smart medical service platform.In traditional medical services, each part of the information is in a single state. They cannot be shared in real time, which leads to a drop in service efficiency [13]. The smart medical service platform connects various parts to each other, so that the medical data of each part can be shared. For the client and hospital, the data between them has dimensions, so it must be processed to realize data sharing. Patients can provide medical services through the medical service terminal without re-examination. This improves work efficiency and saves time. At the same time, the service model will continuously enrich its own data and continuously improve the service model [14, 15]. There are many different types of smart medical products on the market today. Its main work is shown in Figure 2: For system users and system hospitals, network signals are transmitted, while for individual users, computers and mobile devices are used to connect with the network through WiFi.Figure 2
Structure principle of intelligent medical products.Smart medical technology was first used in large hospitals. With the advancement and advancement of technology and technology, smart medical technology enables family members to provide personalized services [16, 17]. The patient enters the device, the device can detect the human ECG signal and the patient can observe the ECG signal through the device [18, 19]. Figure 3 shows the initial smart medical structure.Figure 3
The initial smart medical structure.WITMED, referred to as medical English for short, is a newly arisen proprietary medical term. By building a regional medical information platform for health records and using the most advanced Internet of Things technology, the interaction between patients, medical staff, medical institutions and medical equipment can be realized, and informationization can be gradually achieved. Compared to the Western research process, China’s research on advanced medical technology began slowly and the depth of the study could not be compared with it [20]. The application of occupational medical care did not appear until the early 1990s. That is, the PLA General Hospital communicates with foreign hospitals via remote video. But so far, this technology has not been widely used in China [21, 22]. The research and development of wearable technology is similar to that in other countries, and the information collection equipment is distributed on the coat. The collected information will be transmitted through the wireless network, and the patient’s condition can be grasped in real time [23, 24]. Figure 4 shows the specific working structure.Figure 4
Intelligent system diagram.


### 3.2. Image Processing

Medical imaging technology is actually a comprehensive concept. The main point of the difference in the application of this technology lies in different forms of diagnostic technology, which have certain differences in applicable scope and disease types. From the analysis of its own technical types, the more common influencing technologies are ultrasonic diagnostic technology, X-ray diagnostic technology, CT scanning technology, MRI technology, etc.Medical image processing technology is used more and more frequently in the treatment and diagnosis. Although imaging technology has great advantages in image acquisition, the image will be disturbed during the acquisition process. Therefore, the images need to be processed before they can be analyzed.(1)ha=ka∗gq+fs.Formula (1) represents the noise model, ka represents the original image, ha represents the actual image, and fs represents the noise.(2)ha=ka∗gq.In the process of image processing, if the various points of the image are connected, the diagnostic information can be more accurate. Especially in medical images, fuzzy points and discrete points are often mixed, and the analysis of them is often interfered by hands.In recent years, certain development has been made in the medical field, and its function expression is defined as(3)Fa=−q∑i=1mki,lnki.Among them, when∑i=1mki=1, k1=k2=k3=⋯km, F takes the maximum value.(4)Qa=∫01Qinta+Qimageadc.Among them,Qinta represents the internal energy, and its form is as follows:(5)Qinta=14χca′c3+ηca″c3.Among them,χc and ηc represent weight coefficients.The expression of the gray value is expressed as follows:(6)D1a=−q∑i=0q−1kilnki,ki=gi∑j=0q−1gi.Among them,gi is the gray value function, q is a constant, and ki represents the gray value range of 0–1.The sum of the two entropies is(7)Da=D1a+D2a.WhenDa is the largest, the threshold a is the maximum entropy threshold, that is, the threshold that distinguishes the foreground color from the background color.According to the relationship between noise and signal, image noise can be divided into two types. One is additive noise, which is independent of the original image. Noise is always present whether there is a signal or not. The other term is multiplicative noise, which varies with signal strength [25].(8)ta,b=ha,b+ga,b.Formula (8) is the expression of additive noise, and ta,b is the target image containing noise. ha,b is the original image and ga,b is the noise.(9)ta,b=ha,bga,b.Formula (9) is an expression for multiplicative noise. This is converted into additive noise during processing. When performing image conversion, it is necessary to determine its conversion process, especially parameter conversion. It needs to find the corresponding relationship between the parameters. Its main operation process is shown in Figure 5.Figure 5
Image conversion process.Gaussian noise refers to a kind of noise whose probability density function obeys Gaussian distribution (i.e., normal distribution). Common Gaussian noise includes fluctuation noise, cosmic noise, thermal noise, and shot noise. Besides the common noise suppression methods, mathematical statistics is often used to suppress Gaussian noise. Gaussian noise is very common in life. It also has the highest degree of impact on the image. In order to reduce the influence of noise, Gaussian noise is the most important part.(10)ya=u∂2πe−a−ε2/2∂2.Among them, the expected value of the Gaussian distribution isε, the standard deviation is ∂, and the standard Gaussian distribution is ε = 0, ∂  = 1.The expression is expressed as(11)Ha,b=12πλ2e−a2+b2/2λ2.Among them,λ represents the standard deviation.The noise mainly comes from the thermal noise of the scanned body. Based on this, Fourier transform can be used to reduce the interference of noise.(12)Qb=Qf+Yf+kQk+Yk.Among them,Qf is the real part and Yf is zero. The observed image amplitude in this case is(13)Q=Qb=Qf+Yf2+Qk+Yk2.The evolution of the curve is described in training as a glossy curve in a two-dimensional Euclidean field. Depending on your direction and movement at a certain speed, you can create a series of curved curves. This process is called press evolution. This evolutionary process is defined as(14)βAzc,bcβc=Szc,bcM.In the curvature evolution, it is obvious that the larger the curvaturek is, the faster the evolution speed is. Therefore, the curved part moves fast, while the flat part moves slowly, or even tends to zero. Therefore, according to this way of evolution, after a period of evolution, any closed curve will evolve into a circle. In the function expression, A represents the curve function. The evolution direction of the curve is shown in Figure 6.Figure 6
Curve evolution direction.Formal transformations are often required when exploring the evolution of curves. The curvature deformation of the curve is expressed as(15)θAθz=∂kM.Among them,∂ represents a constant number. In expressions, constant deformation can be expressed as(16)θAθz=βM.Among them,β represents a constant, M represents a unit normal vector, but when β is a constant, the curvature of the front curve is not considered. Therefore, there will be abnormal points in the calculation.(17)Ra=h,j,ph,j,a=r.Among them,ph,j,a represents the time-varying level set and Ra represents the evolution curve point set.At any time, the zero-level set of the corresponding face of the curve is(18)βQx,y,t=0.When the point is inside the curve it can be expressed as(19)M=−∇θ∇θ.Arranging the expression, it can get(20)ϕθϕt=−∇θ∗ZM=∇θ∗Z∗∇θ∇θ=Z∇θ.


### 3.3. Overview of Pancreatic Neuroendocrine Tumor Surgery

Pancreatic neuroendocrine tumor (PNET) is a heterogeneous tumor derived from pluripotent stem cells of the neuroendocrine system, accounting for 3%∼7% of pancreatic tumors. The median age of onset of PNET is 56 years old. Women are slightly more than men, and most of them are sporadic. In the past, PNET was divided into carcinoid, islet cell tumor and APUD tumor according to its cell source. Pancreatic neuroendocrine tumors are relatively rare tumors in clinical practice. Little was known about it before. However, with the advancement of science and technology, especially the advancement of medical imaging technology, the possibility of some tumors without clinical manifestations being detected is increasing. Therefore, the research on pancreatic neuroendocrine tumors (pNENs) is also deepening [26]. pNENs originate from pancreatic exocrine cells. It will have different clinical responses depending on the level of hormones. However, excessive insulin secretion can cause hypoglycemia. pNENs are malignant tumors. It is named for its similarity in shape and function to nerve cells. The disease is distributed in many parts of the body. When the organs are violated, a series of substances will be secreted to cause physiological changes and damage human health.Pathological diagnosis is an important basis for judging pNENs. Under a high-powered microscope, the tumor cells look similar. The cytoplasm is composed of fine eosinophilic granules. Nuclei are centrally located, round or quasi-round, and some contain prominent nucleoli. PNET is divided into functional and non-functional according to whether it causes clinical symptoms. The former includes insulinoma, gastrinoma, vasoactive intestinal peptide tumor, glucagon tumor, somatostatin tumor, growth hormone-releasing hormone tumor, adrenocorticotropic hormone tumor and parathyroid tumor, while the latter accounts for 40%∼60%. Although the diagnostic judgments of tumors are similar, pNENs are different from other tumors. It is mainly determined by immunohistochemical studies. Imaging is currently an important tool for the diagnosis of pNENs. Taking B-ultrasound as an example, ultrasound can not only directly display the shape and distribution of the tumor, but also display the situation around the lesion area. This is not only affordable but also very accurate for patients [27, 28].


## 3.1. Smart Healthcare

With the improvement of economic level, people’s demand for medical resources is expanding. Making full use of technical means to promote the vertical flow of medical resources is an important trend in the current medical development [9,10]. Smart healthcare uses emerging technologies such as cloud computing to integrate medical resources and innovate the medical service model and is committed to creating a new medical experience for patients [11].In essence, the smart medical service model improves the traditional service model [12]. Figure 1 shows the structure of the smart medical service platform: Among them, the service of smart medical care is in the core position, bearing the contact between users and hospitals, and analyzing the data of the system.Figure 1
Structure diagram of smart medical service platform.In traditional medical services, each part of the information is in a single state. They cannot be shared in real time, which leads to a drop in service efficiency [13]. The smart medical service platform connects various parts to each other, so that the medical data of each part can be shared. For the client and hospital, the data between them has dimensions, so it must be processed to realize data sharing. Patients can provide medical services through the medical service terminal without re-examination. This improves work efficiency and saves time. At the same time, the service model will continuously enrich its own data and continuously improve the service model [14, 15]. There are many different types of smart medical products on the market today. Its main work is shown in Figure 2: For system users and system hospitals, network signals are transmitted, while for individual users, computers and mobile devices are used to connect with the network through WiFi.Figure 2
Structure principle of intelligent medical products.Smart medical technology was first used in large hospitals. With the advancement and advancement of technology and technology, smart medical technology enables family members to provide personalized services [16, 17]. The patient enters the device, the device can detect the human ECG signal and the patient can observe the ECG signal through the device [18, 19]. Figure 3 shows the initial smart medical structure.Figure 3
The initial smart medical structure.WITMED, referred to as medical English for short, is a newly arisen proprietary medical term. By building a regional medical information platform for health records and using the most advanced Internet of Things technology, the interaction between patients, medical staff, medical institutions and medical equipment can be realized, and informationization can be gradually achieved. Compared to the Western research process, China’s research on advanced medical technology began slowly and the depth of the study could not be compared with it [20]. The application of occupational medical care did not appear until the early 1990s. That is, the PLA General Hospital communicates with foreign hospitals via remote video. But so far, this technology has not been widely used in China [21, 22]. The research and development of wearable technology is similar to that in other countries, and the information collection equipment is distributed on the coat. The collected information will be transmitted through the wireless network, and the patient’s condition can be grasped in real time [23, 24]. Figure 4 shows the specific working structure.Figure 4
Intelligent system diagram.


## 3.2. Image Processing

Medical imaging technology is actually a comprehensive concept. The main point of the difference in the application of this technology lies in different forms of diagnostic technology, which have certain differences in applicable scope and disease types. From the analysis of its own technical types, the more common influencing technologies are ultrasonic diagnostic technology, X-ray diagnostic technology, CT scanning technology, MRI technology, etc.Medical image processing technology is used more and more frequently in the treatment and diagnosis. Although imaging technology has great advantages in image acquisition, the image will be disturbed during the acquisition process. Therefore, the images need to be processed before they can be analyzed.(1)ha=ka∗gq+fs.Formula (1) represents the noise model, ka represents the original image, ha represents the actual image, and fs represents the noise.(2)ha=ka∗gq.In the process of image processing, if the various points of the image are connected, the diagnostic information can be more accurate. Especially in medical images, fuzzy points and discrete points are often mixed, and the analysis of them is often interfered by hands.In recent years, certain development has been made in the medical field, and its function expression is defined as(3)Fa=−q∑i=1mki,lnki.Among them, when∑i=1mki=1, k1=k2=k3=⋯km, F takes the maximum value.(4)Qa=∫01Qinta+Qimageadc.Among them,Qinta represents the internal energy, and its form is as follows:(5)Qinta=14χca′c3+ηca″c3.Among them,χc and ηc represent weight coefficients.The expression of the gray value is expressed as follows:(6)D1a=−q∑i=0q−1kilnki,ki=gi∑j=0q−1gi.Among them,gi is the gray value function, q is a constant, and ki represents the gray value range of 0–1.The sum of the two entropies is(7)Da=D1a+D2a.WhenDa is the largest, the threshold a is the maximum entropy threshold, that is, the threshold that distinguishes the foreground color from the background color.According to the relationship between noise and signal, image noise can be divided into two types. One is additive noise, which is independent of the original image. Noise is always present whether there is a signal or not. The other term is multiplicative noise, which varies with signal strength [25].(8)ta,b=ha,b+ga,b.Formula (8) is the expression of additive noise, and ta,b is the target image containing noise. ha,b is the original image and ga,b is the noise.(9)ta,b=ha,bga,b.Formula (9) is an expression for multiplicative noise. This is converted into additive noise during processing. When performing image conversion, it is necessary to determine its conversion process, especially parameter conversion. It needs to find the corresponding relationship between the parameters. Its main operation process is shown in Figure 5.Figure 5
Image conversion process.Gaussian noise refers to a kind of noise whose probability density function obeys Gaussian distribution (i.e., normal distribution). Common Gaussian noise includes fluctuation noise, cosmic noise, thermal noise, and shot noise. Besides the common noise suppression methods, mathematical statistics is often used to suppress Gaussian noise. Gaussian noise is very common in life. It also has the highest degree of impact on the image. In order to reduce the influence of noise, Gaussian noise is the most important part.(10)ya=u∂2πe−a−ε2/2∂2.Among them, the expected value of the Gaussian distribution isε, the standard deviation is ∂, and the standard Gaussian distribution is ε = 0, ∂  = 1.The expression is expressed as(11)Ha,b=12πλ2e−a2+b2/2λ2.Among them,λ represents the standard deviation.The noise mainly comes from the thermal noise of the scanned body. Based on this, Fourier transform can be used to reduce the interference of noise.(12)Qb=Qf+Yf+kQk+Yk.Among them,Qf is the real part and Yf is zero. The observed image amplitude in this case is(13)Q=Qb=Qf+Yf2+Qk+Yk2.The evolution of the curve is described in training as a glossy curve in a two-dimensional Euclidean field. Depending on your direction and movement at a certain speed, you can create a series of curved curves. This process is called press evolution. This evolutionary process is defined as(14)βAzc,bcβc=Szc,bcM.In the curvature evolution, it is obvious that the larger the curvaturek is, the faster the evolution speed is. Therefore, the curved part moves fast, while the flat part moves slowly, or even tends to zero. Therefore, according to this way of evolution, after a period of evolution, any closed curve will evolve into a circle. In the function expression, A represents the curve function. The evolution direction of the curve is shown in Figure 6.Figure 6
Curve evolution direction.Formal transformations are often required when exploring the evolution of curves. The curvature deformation of the curve is expressed as(15)θAθz=∂kM.Among them,∂ represents a constant number. In expressions, constant deformation can be expressed as(16)θAθz=βM.Among them,β represents a constant, M represents a unit normal vector, but when β is a constant, the curvature of the front curve is not considered. Therefore, there will be abnormal points in the calculation.(17)Ra=h,j,ph,j,a=r.Among them,ph,j,a represents the time-varying level set and Ra represents the evolution curve point set.At any time, the zero-level set of the corresponding face of the curve is(18)βQx,y,t=0.When the point is inside the curve it can be expressed as(19)M=−∇θ∇θ.Arranging the expression, it can get(20)ϕθϕt=−∇θ∗ZM=∇θ∗Z∗∇θ∇θ=Z∇θ.


## 3.3. Overview of Pancreatic Neuroendocrine Tumor Surgery

Pancreatic neuroendocrine tumor (PNET) is a heterogeneous tumor derived from pluripotent stem cells of the neuroendocrine system, accounting for 3%∼7% of pancreatic tumors. The median age of onset of PNET is 56 years old. Women are slightly more than men, and most of them are sporadic. In the past, PNET was divided into carcinoid, islet cell tumor and APUD tumor according to its cell source. Pancreatic neuroendocrine tumors are relatively rare tumors in clinical practice. Little was known about it before. However, with the advancement of science and technology, especially the advancement of medical imaging technology, the possibility of some tumors without clinical manifestations being detected is increasing. Therefore, the research on pancreatic neuroendocrine tumors (pNENs) is also deepening [26]. pNENs originate from pancreatic exocrine cells. It will have different clinical responses depending on the level of hormones. However, excessive insulin secretion can cause hypoglycemia. pNENs are malignant tumors. It is named for its similarity in shape and function to nerve cells. The disease is distributed in many parts of the body. When the organs are violated, a series of substances will be secreted to cause physiological changes and damage human health.Pathological diagnosis is an important basis for judging pNENs. Under a high-powered microscope, the tumor cells look similar. The cytoplasm is composed of fine eosinophilic granules. Nuclei are centrally located, round or quasi-round, and some contain prominent nucleoli. PNET is divided into functional and non-functional according to whether it causes clinical symptoms. The former includes insulinoma, gastrinoma, vasoactive intestinal peptide tumor, glucagon tumor, somatostatin tumor, growth hormone-releasing hormone tumor, adrenocorticotropic hormone tumor and parathyroid tumor, while the latter accounts for 40%∼60%. Although the diagnostic judgments of tumors are similar, pNENs are different from other tumors. It is mainly determined by immunohistochemical studies. Imaging is currently an important tool for the diagnosis of pNENs. Taking B-ultrasound as an example, ultrasound can not only directly display the shape and distribution of the tumor, but also display the situation around the lesion area. This is not only affordable but also very accurate for patients [27, 28].


## 4. Experiments and Data

### 4.1. Data Sources

#### 4.1.1. Research Object

The medical records of patients with neuroendocrine tumors diagnosed by pathology from July 2010 to January 2018 in the First Affiliated Hospital of X City were collected. The age of onset, gender, initial symptoms, primary tumor site, tumor size, tumor stage, endoscopic characteristics, confirmed disease stage, treatment and follow-up were recorded for retrospective analysis. Inclusion and exclusion criteria must be strictly implemented, and a total of 300 patients were included.


#### 4.1.2. Inclusion Criteria

(1)
Age > 18 years old(2)
Patients who received surgical treatment or biopsy, and were diagnosed as pNET by postoperative pathological and immunohistochemical results(3)
Complete case data at the time of definite diagnosis


#### 4.1.3. Elimination Criteria

(1)
The pathology department has not made a clear diagnosis of neuroendocrine tumors(2)
Other fatal diseases(3)
The case data is incomplete, which affects the indicators that need to be counted and observedAt present, the most commonly used classification methods at home and abroad are mainly based on histological manifestations and proliferative activity. Tumor proliferative activity was assessed by mitotic figures and/or Ki-67 positivity index (at least 50 high-power fields are counted in the mitotically active area. It uses MIBI antibody to count the positive percentage of 500–2000 cells in the area with the strongest nuclear labeling).


### 4.2. Patient Data

Patients with neuroendocrine tumors diagnosed by pathology from July 2010 to January 2018 in the First Affiliated Hospital of X City were collected, and the patients were arranged according to the year of diagnosis. The result is shown in Figure7.Figure 7
Year distribution of confirmed patients.As shown in Figure5, it can be seen that the distribution of the number of confirmed PNET patients has increased year by year in recent years, with 34 cases in 2016, 51 cases in 2017, and 78 cases in 2018.The comparison between the patient’s brain CT image and the normal person’s brain CT image is shown in Figure8.Figure 8
Comparison of the patient’s brain CT image and the normal person’s brain CT image. (a) PNET patients. (b) Normal person.
(a)(b)Among them, a shadow part can be clearly seen in the ct image of the patient’s brain.It focuses on 78 cases in 2018 and counts the age distribution by gender, as shown in Table1.Table 1
Sex and age distribution of 78 PNET patients in 2018.
AgeNumber of casesGenderComposition percentageMaleFemale<201011.320–39105512.840–592920937.260–793627946.1≧802112.6Total785325100As can be seen from the table, among the 78 patients, 53 were male and 25 were female. In the distribution of percentages, people aged 40–59 accounted for 37.2%, including 20 males and 9 females. The patients aged 60–79 accounted for 46.1%, including 27 males and 9 females. It can be seen that this case is more likely to occur in middle-aged people, and the incidence of males is greater than that of females.The distribution of tumor size is shown in Figure9.Figure 9
Tumor size distribution.As shown in Figure9, the rectum is the most common site. Tumors less than 1 cm in the sample patients accounted for 40.1% of the total. Patients with medium-sized tumors accounted for 19.1% of the total, and patients with larger tumors accounted for 40.8% of the total.Routine tumor marker tests were performed, and the results are shown in Table2.Table 2
Routine tumor marker examination.
CEACA125AFPCA199TotalNumber of cases1133658Percentage195.25.210.339.7NET522311NEC611311The results showed that there were 11 CEA positive patients, accounting for 19%. There were 3 cases of CA125 positive patients, accounting for 5.2%. There were 3 AFP positive patients, accounting for 5.2%. There were 6 cases of CA199 positive patients, accounting for 10.3%.The location and age distribution of NEN in the digestive system are shown in Figure10.Figure 10
Location and age distribution of NENs in the digestive system.Figure11 shows the distribution of EUS characteristics in the mucosal layer of neuroendocrine tumors at various sites.Figure 11
Distribution of EUS characteristics in the mucosal layer of neuroendocrine tumors at different sites.Among them, 83.5% (96/115) of the lesions originated from the submucosa, accounting for the vast majority of cases.


### 4.3. Treatment Options

It was examined using GEP-NENs imaging and the results are shown in Table3.Table 3
Imaging examinations of patients with gastroenteropancreatic neuroendocrine tumors.
Imaging examinationUsage (%)Positive rate (%)CT68.558/74 (78.4)B-ultrasonics30.620/33 (60.6)MRI19.420/21 (95.2)Endoscope47.251/51 (100)PET/CT2.82/3 (66.7)SPECT0.91/1 (100%)It performs pNET surgical treatment as shown in Table4.Table 4
Surgical treatment of pNET.
Operation method (including minimally invasive surgery)Number of cases (n)Constituent ratio (%)Whipple surgery2430.7Biopsy1316.6Resection of body and tail of pancreas2734.6Excision of pancreatic lesion1417.9Amount78100Notably, postoperative complications included 1 case of pancreatic fistula with intra-abdominal infection and 1 case of postoperative gastric dysfunction. After active symptomatic treatment, the patient’s condition improved and was discharged. A patient with abdominal bleeding improved after a second operation. All patients who underwent minimally invasive surgery were doing well.It carried out postoperative follow-up and follow-up survey of 28 of them. Univariate survival analysis of all possible related factors of pNET showed that WHO tumor grade (p<0.05) and whether the surgical method is R0 resection (p<0.05) were associated with prognosis. However, factors such as gender, age, functional status is analyzed in Table 5.Table 5
Analysis of factors related to survival of pNET patients.
FactorNumberSurvival rate (%)PGenderMale1083.80.976Female1891.8Age<50121000.139>501681.3Is it functionalYes81000.268No2085.0Is there distant metastasis before operationYes4250.000No24100Chemotherapy or notYes21000.611No2688.5Tumor diameter (CM)≦1.541000.3381.5∼51693.8>5875.0TNM stagingIA111000.002IB8100IIA1100IIB3100III250IV333.3WHO stagingG1181000.002G2785.7G3333.3Lymph node metastasisYes589.30.022No2395.7Operation modeRO2595.50.018Appease333.3


## 4.1. Data Sources

### 4.1.1. Research Object

The medical records of patients with neuroendocrine tumors diagnosed by pathology from July 2010 to January 2018 in the First Affiliated Hospital of X City were collected. The age of onset, gender, initial symptoms, primary tumor site, tumor size, tumor stage, endoscopic characteristics, confirmed disease stage, treatment and follow-up were recorded for retrospective analysis. Inclusion and exclusion criteria must be strictly implemented, and a total of 300 patients were included.


### 4.1.2. Inclusion Criteria

(1)
Age > 18 years old(2)
Patients who received surgical treatment or biopsy, and were diagnosed as pNET by postoperative pathological and immunohistochemical results(3)
Complete case data at the time of definite diagnosis


### 4.1.3. Elimination Criteria

(1)
The pathology department has not made a clear diagnosis of neuroendocrine tumors(2)
Other fatal diseases(3)
The case data is incomplete, which affects the indicators that need to be counted and observedAt present, the most commonly used classification methods at home and abroad are mainly based on histological manifestations and proliferative activity. Tumor proliferative activity was assessed by mitotic figures and/or Ki-67 positivity index (at least 50 high-power fields are counted in the mitotically active area. It uses MIBI antibody to count the positive percentage of 500–2000 cells in the area with the strongest nuclear labeling).


## 4.1.1. Research Object

The medical records of patients with neuroendocrine tumors diagnosed by pathology from July 2010 to January 2018 in the First Affiliated Hospital of X City were collected. The age of onset, gender, initial symptoms, primary tumor site, tumor size, tumor stage, endoscopic characteristics, confirmed disease stage, treatment and follow-up were recorded for retrospective analysis. Inclusion and exclusion criteria must be strictly implemented, and a total of 300 patients were included.


## 4.1.2. Inclusion Criteria

(1)
Age > 18 years old(2)
Patients who received surgical treatment or biopsy, and were diagnosed as pNET by postoperative pathological and immunohistochemical results(3)
Complete case data at the time of definite diagnosis


## 4.1.3. Elimination Criteria

(1)
The pathology department has not made a clear diagnosis of neuroendocrine tumors(2)
Other fatal diseases(3)
The case data is incomplete, which affects the indicators that need to be counted and observedAt present, the most commonly used classification methods at home and abroad are mainly based on histological manifestations and proliferative activity. Tumor proliferative activity was assessed by mitotic figures and/or Ki-67 positivity index (at least 50 high-power fields are counted in the mitotically active area. It uses MIBI antibody to count the positive percentage of 500–2000 cells in the area with the strongest nuclear labeling).


## 4.2. Patient Data

Patients with neuroendocrine tumors diagnosed by pathology from July 2010 to January 2018 in the First Affiliated Hospital of X City were collected, and the patients were arranged according to the year of diagnosis. The result is shown in Figure7.Figure 7
Year distribution of confirmed patients.As shown in Figure5, it can be seen that the distribution of the number of confirmed PNET patients has increased year by year in recent years, with 34 cases in 2016, 51 cases in 2017, and 78 cases in 2018.The comparison between the patient’s brain CT image and the normal person’s brain CT image is shown in Figure8.Figure 8
Comparison of the patient’s brain CT image and the normal person’s brain CT image. (a) PNET patients. (b) Normal person.
(a)(b)Among them, a shadow part can be clearly seen in the ct image of the patient’s brain.It focuses on 78 cases in 2018 and counts the age distribution by gender, as shown in Table1.Table 1
Sex and age distribution of 78 PNET patients in 2018.
AgeNumber of casesGenderComposition percentageMaleFemale<201011.320–39105512.840–592920937.260–793627946.1≧802112.6Total785325100As can be seen from the table, among the 78 patients, 53 were male and 25 were female. In the distribution of percentages, people aged 40–59 accounted for 37.2%, including 20 males and 9 females. The patients aged 60–79 accounted for 46.1%, including 27 males and 9 females. It can be seen that this case is more likely to occur in middle-aged people, and the incidence of males is greater than that of females.The distribution of tumor size is shown in Figure9.Figure 9
Tumor size distribution.As shown in Figure9, the rectum is the most common site. Tumors less than 1 cm in the sample patients accounted for 40.1% of the total. Patients with medium-sized tumors accounted for 19.1% of the total, and patients with larger tumors accounted for 40.8% of the total.Routine tumor marker tests were performed, and the results are shown in Table2.Table 2
Routine tumor marker examination.
CEACA125AFPCA199TotalNumber of cases1133658Percentage195.25.210.339.7NET522311NEC611311The results showed that there were 11 CEA positive patients, accounting for 19%. There were 3 cases of CA125 positive patients, accounting for 5.2%. There were 3 AFP positive patients, accounting for 5.2%. There were 6 cases of CA199 positive patients, accounting for 10.3%.The location and age distribution of NEN in the digestive system are shown in Figure10.Figure 10
Location and age distribution of NENs in the digestive system.Figure11 shows the distribution of EUS characteristics in the mucosal layer of neuroendocrine tumors at various sites.Figure 11
Distribution of EUS characteristics in the mucosal layer of neuroendocrine tumors at different sites.Among them, 83.5% (96/115) of the lesions originated from the submucosa, accounting for the vast majority of cases.


## 4.3. Treatment Options

It was examined using GEP-NENs imaging and the results are shown in Table3.Table 3
Imaging examinations of patients with gastroenteropancreatic neuroendocrine tumors.
Imaging examinationUsage (%)Positive rate (%)CT68.558/74 (78.4)B-ultrasonics30.620/33 (60.6)MRI19.420/21 (95.2)Endoscope47.251/51 (100)PET/CT2.82/3 (66.7)SPECT0.91/1 (100%)It performs pNET surgical treatment as shown in Table4.Table 4
Surgical treatment of pNET.
Operation method (including minimally invasive surgery)Number of cases (n)Constituent ratio (%)Whipple surgery2430.7Biopsy1316.6Resection of body and tail of pancreas2734.6Excision of pancreatic lesion1417.9Amount78100Notably, postoperative complications included 1 case of pancreatic fistula with intra-abdominal infection and 1 case of postoperative gastric dysfunction. After active symptomatic treatment, the patient’s condition improved and was discharged. A patient with abdominal bleeding improved after a second operation. All patients who underwent minimally invasive surgery were doing well.It carried out postoperative follow-up and follow-up survey of 28 of them. Univariate survival analysis of all possible related factors of pNET showed that WHO tumor grade (p<0.05) and whether the surgical method is R0 resection (p<0.05) were associated with prognosis. However, factors such as gender, age, functional status is analyzed in Table 5.Table 5
Analysis of factors related to survival of pNET patients.
FactorNumberSurvival rate (%)PGenderMale1083.80.976Female1891.8Age<50121000.139>501681.3Is it functionalYes81000.268No2085.0Is there distant metastasis before operationYes4250.000No24100Chemotherapy or notYes21000.611No2688.5Tumor diameter (CM)≦1.541000.3381.5∼51693.8>5875.0TNM stagingIA111000.002IB8100IIA1100IIB3100III250IV333.3WHO stagingG1181000.002G2785.7G3333.3Lymph node metastasisYes589.30.022No2395.7Operation modeRO2595.50.018Appease333.3


## 5. Discussion

It takes advantage of the current development of information technology and adopts the nearest patient to see a doctor. The core idea of smart medical care is the way that patient information realizes regional medical codiagnosis. This idea is first used to solve the problem of medical information silos. Medical information islands are a phenomenon in which medical examination information is difficult to flow freely due to the inconsistency of different medical systems. Aiming at this problem, international medical institutions put forward DICOM and HL7 architectures to realize the electronization of medical information and the free exchange of data. The former is a standard for electronic medical information, while the latter is a standard for medical information data interaction. These two standards have greatly promoted the sharing of medical information, but they have not solved the above problems. Thereby, the interoperability and flow of patient information among various medical institutions can be improved. The goal is to provide a collaborative working platform for regional medical care, reduce the cost and time of diagnosis and treatment for patients, and provide patients with a more convenient medical treatment environment. This plan provides relevant ideas for the establishment of the follow-up medical platform. However, since each medical treatment has established its related process and information structure, it is difficult to realize the flow of non-uniform information between different institutions. It is also difficult for each medical institution to afford the cost of building a unified platform, which affects the development of the overall project. Subsequently, some experts proposed to use the Internet-based medical information platform to solve the above problems. The platform converts the patient information in the region into standard HL7 and DICOM forms through the Internet to realize the circulation of information.Compared with the traditional medical system, the great value of smart medical care lies in the fact that it has physiological signal data that is not limited by users around the clock. This information is stored in the data center of the smart medical system. At the same time, taking into account measures such as rapid discovery, rapid disposal, and rapid rescue for sudden diseases, the system collects the user’s physiological information from the portable terminal. There should be no large system delay in the process of completing data storage and display in the data center. The center not only needs to consider the security of data storage, but also the convenience of data storage. Therefore, it should be necessary to complete the relevant function and performance test of the real-time data transmission for the designed smart medical system based on the portable terminal.


## 6. Conclusion

Gradual improvement of the medical system and the medical mechanism to prevent micro-progression have also become the general trend. This paper selects the hardware platform under the premise of conforming to the development trend and market demand of portable medical monitoring terminals. Then a system software platform is built for the terminal on the selected hardware platform. And the device driver of each peripheral hardware is designed and transplanted. And 78 patients with pancreatic neuroendocrine tumors were selected for preoperative analysis and postoperative follow-up survey. GEP-NENs imaging was used for preparation. And the sample patients were subjected to Whipple surgery, biopsy, pancreatic body and tail resection, and pancreatic lesion resection. The study in this paper shows that this case is more likely to occur in middle-aged people, and that men are more likely to have seizures than women. In the statistics of the mucosal layer of neuroendocrine tumors, 83.5% (96/115) of the lesions originated from the submucosa. The rectum is the most common site for pancreatic neuroendocrine tumors. It has successfully completed the subject of surgical strategy and prognosis of pancreatic neuroendocrine tumors based on smart medical image analysis. For the application of this technology, further optimization of the smart medical system platform should be sought, so that the platform can achieve higher memory capacity, more portable carrying method and more general and extensive application at the hardware level.



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*Source: 8752375-2022-06-15.xml*