201
|
Sabater L, Muñoz E, Roselló S, Dorcaratto D, Garcés-Albir M, Huerta M, Roda D, Gómez-Mateo MC, Ferrández-Izquierdo A, Darder A, Cervantes A. Borderline resectable pancreatic cancer. Challenges and controversies. Cancer Treat Rev 2018; 68:124-135. [PMID: 29957372 DOI: 10.1016/j.ctrv.2018.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Pancreatic cancer is a dismal disease with an increasing incidence. Despite the majority of patients are not candidates for curative surgery, a subgroup of patients classified as borderline resectable pancreatic cancer can be selected in whom a sequential strategy of neoadjuvant therapy followed by surgery can provide better outcomes. Multidisciplinary approach and surgical pancreatic expertise are essential for successfully treating these patients. However, the lack of consensual definitions and therapies make the results of studies very difficult to interpret and hard to be implemented in some settings. In this article, we review the challenges of borderline resectable pancreatic cancer, the complexity of its management and controversies and point out where further research and international cooperation for a consensus strategy is urgently needed.
Collapse
Affiliation(s)
- Luis Sabater
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Elena Muñoz
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Susana Roselló
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Dimitri Dorcaratto
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Marisol Huerta
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | - Desamparados Roda
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain
| | | | | | - Antonio Darder
- Department of Surgery, Liver-Biliary and Pancreatic Unit, Biomedical Research Institute INCLIVA, Hospital Clinico University of Valencia, Spain
| | - Andrés Cervantes
- CIBERONC Department of Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
| |
Collapse
|
202
|
Jang DK, Lee SH. The Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Taking Antithrombotic Agents Is Not Negligible. Gut Liver 2018; 12:225-226. [PMID: 29724088 PMCID: PMC5945252 DOI: 10.5009/gnl18103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
203
|
EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions. Gastrointest Endosc 2018; 87:1464-1473. [PMID: 29329992 DOI: 10.1016/j.gie.2017.12.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis-based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. METHODS Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. RESULTS Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P < .001]; wSR, 56.6 vs 15.3 [P < .001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P = .0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ± .01) versus neuroendocrine tumor (D = 2.73 ± .03) and a statistical difference for all 3 channels red, green, and blue (P < .0001). CONCLUSIONS EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.).
Collapse
|
204
|
Cazacu IM, Luzuriaga Chavez AA, Saftoiu A, Vilmann P, Bhutani MS. A quarter century of EUS-FNA: Progress, milestones, and future directions. Endosc Ultrasound 2018; 7:141-160. [PMID: 29941723 PMCID: PMC6032705 DOI: 10.4103/eus.eus_19_18] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open
Abstract
Tissue acquisition using EUS has considerably evolved since the first EUS-FNA was reported 25 years ago. Its introduction was an important breakthrough in the endoscopic field. EUS-FNA has now become a part of the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of the organs in its proximity, including lung diseases. This review aims to present the history of EUS-FNA development and to provide a perspective on the recent developments in procedural techniques and needle technologies that have significantly extended the role of EUS and its clinical applications. There is a bright future ahead for EUS-FNA in the years to come as extensive research is conducted in this field and various technologies are continuously implemented into clinical practice.
Collapse
Affiliation(s)
- Irina Mihaela Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Gastrounit, Division of Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
205
|
Kandel P, Wallace MB. Advanced EUS Guided Tissue Acquisition Methods for Pancreatic Cancer. Cancers (Basel) 2018; 10:cancers10020054. [PMID: 29463004 PMCID: PMC5836086 DOI: 10.3390/cancers10020054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 12/12/2022] Open
Abstract
Pancreas cancer is a lethal cancer as the majority patients are diagnosed at an advanced incurable stage. Despite improvements in diagnostic modalities and management strategies, including surgery and chemotherapies, the outcome of pancreas cancer remains poor. Endoscopic ultrasound (EUS) is an important imaging tool for pancreas cancer. For decades, resected pancreas cancer and other cancer specimens have been used to identify tissue biomarkers or genomics for precision therapy; however, only 20% of patients undergo surgery, and thus, this framework is not useful for unresectable pancreas cancer. With advancements in needle technologies, tumor specimens can be obtained at the time of tissue diagnosis. Tumor tissue can be used for development of personalized cancer treatment, such as performing whole exome sequencing and global genomic profiling of pancreas cancer, development of tissue biomarkers, and targeted mutational assays for precise chemotherapy treatment. In this review, we discuss the recent advances in tissue acquisition of pancreas cancer.
Collapse
Affiliation(s)
- Pujan Kandel
- Department of Gastroenterology and Hepatology Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| |
Collapse
|
206
|
Bhattacharya A, Gandhi NS, Baker ME, Chahal P. Gastroenterology and pancreatic adenocarcinoma: what the radiologist needs to know. Abdom Radiol (NY) 2018; 43:364-373. [PMID: 29116342 DOI: 10.1007/s00261-017-1347-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this article, we review the information that radiologists need to know regarding the endoscopic approach to the diagnosis and management of pancreatic cancer. This includes a review of the indications, techniques, and complications of endoscopic ultrasound. We also review information regarding endoscopic retrograde cholangiopancreatography, including the various biliary drainage techniques and the use of endoscopic palliation for patients with pancreatic cancer.
Collapse
|
207
|
Endoscopic ultrasound-guided tissue acquisition of subepithelial masses. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
208
|
Domínguez-Muñoz E, Veloso-Carmo J, Martín-Presas F, Lariño-Noia J, Abdulkader I, Iglesias-García J. A rare cause of obstructive jaundice: diagnosis by EUS and single-operator per-oral cholangioscopy. VideoGIE 2017; 4:375-378. [PMID: 31388616 PMCID: PMC6669262 DOI: 10.1016/j.vgie.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Enrique Domínguez-Muñoz
- Gastroenterology Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Joana Veloso-Carmo
- Gastroenterology Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Gastroenterology Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Francisco Martín-Presas
- Gastroenterology Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Lariño-Noia
- Gastroenterology Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ihab Abdulkader
- Pathology Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Júlio Iglesias-García
- Gastroenterology Department, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
209
|
Tan Y, Tan L, Lu J, Huo J, Liu D. Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017; 2:115. [PMID: 29354772 DOI: 10.21037/tgh.2017.12.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, and about 60% of them are found in the stomach. With the widespread application of endoscopy and endoscopic ultrasonography (EUS), more and more gastric GISTs are being found in an early stage (with a relative small diameter and no metastasis), giving the chance of complete resection. Endoscopic resection such as endoscopic band ligation (EBL), endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER), is a minimally invasive method compared with the conventional surgical approaches (open or laparoscopic), and has been demonstrated to be safe and effective for treating gastric GISTs. This review summarizes the recent advances on endoscopic resection of gastric GISTs, aiming to provide a rational management strategy for gastric GISTs.
Collapse
Affiliation(s)
- Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Linna Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jiaxi Lu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jirong Huo
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| |
Collapse
|
210
|
Carrara S, Auriemma F, Varadarajulu S. Advances in endoscopic ultrasound-guided tissue acquisition. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
211
|
Iordache S, Albulescu DM, Săftoiu A. The borderline resectable/locally advanced pancreatic ductal adenocarcinoma: EUS oriented. Endosc Ultrasound 2017; 6:S83-S86. [PMID: 29387698 PMCID: PMC5774081 DOI: 10.4103/eus.eus_68_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sevastiţa Iordache
- Department of Gastroenterology, Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Dana-Maria Albulescu
- Department of Imaging, Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Săftoiu
- Department of Gastroenterology, Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| |
Collapse
|