1
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Oppong KW, Nayar MK, Bekkali NLH, Maheshwari P, Haugk B, Darne A, Manas DM, French JJ, White S, Sen G, Pandanaboyana S, Charnley RM, Leeds JS. Impact of prior biliary stenting on diagnostic performance of endoscopic ultrasound for mesenteric vascular staging in patients with head of pancreas and periampullary malignancy. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000864. [PMID: 35301231 PMCID: PMC8932265 DOI: 10.1136/bmjgast-2021-000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The diagnostic performance of endoscopic ultrasound (EUS) for stratification of head of pancreas and periampullary tumours into resectable, borderline resectable and locally advanced tumours is unclear as is the effect of endobiliary stents. The primary aim of the study was to assess the diagnostic performance of EUS for resectability according to stent status. Design A retrospective study was performed. All patients presenting with a solid head of pancreas mass who underwent EUS and surgery with curative intent during an 8-year period were included. Factors with possible impact on diagnostic performance of EUS were analysed using logistic regression. Results Ninety patients met inclusion criteria and formed the study group. A total of 49 (54%) patients had an indwelling biliary stent at the time of EUS, of which 36 were plastic and 13 were self-expanding metal stents (SEMS). Twenty patients underwent venous resection and reconstruction (VRR). Staging was successfully performed in 100% unstented cases, 97% plastic stent and 54% SEMS, p<0.0001. In successfully staged patients, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for classification of resectability were 70%, 70%, 70%, 42% and 88%. For vascular involvement (VI), sensitivity, specificity, accuracy, PPV and NPV were 80%, 68%, 69%, 26% and 96%. Increasing tumour size OR 0.53 (95% CI, 0.30 to 0.95) was associated with a decrease in accuracy of VI classification. Conclusions EUS has modest diagnostic performance for stratification of staging. Staging was less likely to be completed when a SEMS was in situ. Staging EUS should ideally be performed before endoscopic retrograde cholangiopancreatography and biliary drainage.
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Affiliation(s)
- Kofi W Oppong
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Manu K Nayar
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Noor L H Bekkali
- Gastroenterology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | | | - Beate Haugk
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Antony Darne
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Derek M Manas
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Newcastle upon Tyne Hopsitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jeremy J French
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Newcastle upon Tyne Hopsitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steven White
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Newcastle upon Tyne Hopsitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gourab Sen
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Newcastle upon Tyne Hopsitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Newcastle upon Tyne Hopsitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastele upon Tyne, UK
| | - Richard M Charnley
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Newcastle upon Tyne Hopsitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - John S Leeds
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastele upon Tyne, UK
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2
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Zakaria A, Al-Share B, Klapman JB, Dam A. The Role of Endoscopic Ultrasonography in the Diagnosis and Staging of Pancreatic Cancer. Cancers (Basel) 2022; 14:1373. [PMID: 35326524 PMCID: PMC8946253 DOI: 10.3390/cancers14061373] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is the fourth leading cause of cancer-related death and the second gastrointestinal cancer-related death in the United States. Early detection and accurate diagnosis and staging of pancreatic cancer are paramount in guiding treatment plans, as surgical resection can provide the only potential cure for this disease. The overall prognosis of pancreatic cancer is poor even in patients with resectable disease. The 5-year survival after surgical resection is ~10% in node-positive disease compared to ~30% in node-negative disease. The advancement of imaging studies and the multidisciplinary approach involving radiologists, gastroenterologists, advanced endoscopists, medical, radiation, and surgical oncologists have a major impact on the management of pancreatic cancer. Endoscopic ultrasonography is essential in the diagnosis by obtaining tissue (FNA or FNB) and in the loco-regional staging of the disease. The advancement in EUS techniques has made this modality a critical adjunct in the management process of pancreatic cancer. In this review article, we provide an overall description of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer.
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Affiliation(s)
- Ali Zakaria
- Department of Gastroenterology-Advanced Endoscopy, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (J.B.K.); (A.D.)
| | - Bayan Al-Share
- Department of Hematology and Oncology, Karmanos Cancer Center, Wayne State University, Detroit, MI 48201, USA;
| | - Jason B. Klapman
- Department of Gastroenterology-Advanced Endoscopy, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (J.B.K.); (A.D.)
| | - Aamir Dam
- Department of Gastroenterology-Advanced Endoscopy, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (J.B.K.); (A.D.)
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3
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Dietrich CF, Bekkali NL, Burmeister S, Dong Y, Everett SM, Hocke M, Ignee A, On W, Hebbar S, Oppong K, Sun S, Jenssen C, Braden B. Controversies in ERCP: Indications and preparation. Endosc Ultrasound 2021; 11:186-200. [PMID: 34677145 PMCID: PMC9258020 DOI: 10.4103/eus-d-21-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of the series of papers on controversies of biliopancreatic drainage procedures is to discuss the pros and cons of the varying clinical practices and techniques in ERCP and EUS for drainage of biliary and pancreatic ducts. The first part focuses on indications, clinical and imaging prerequisites before ERCP, sedation options, post-ERCP pancreatitis (PEP) prophylaxis, and other related technical topics. In the second part, specific procedural ERCP-techniques including precut techniques and its timing as well as management algorithms are discussed. In addition, controversies in EUS-guided bile duct and pancreatic drainage procedures are under preparation.
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Affiliation(s)
- Christoph F Dietrich
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, China; Johann Wolfgang Goethe University, Frankfurt/Main, Germany; Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Noor L Bekkali
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
| | - Andre Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | - Wei On
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Srisha Hebbar
- University Hospitals of North Midlands, North Midlands, United Kingdom
| | - Kofi Oppong
- HPB Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Markisch-Oderland, Strausberg; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Johann Wolfgang Goethe University, Frankfurt/Main, Germany
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4
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Vascular resections in minimally invasive surgery for pancreatic cancer. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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5
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Grunvald MW, Jacobson RA, Kuzel TM, Pappas SG, Masood A. Current Status of Circulating Tumor DNA Liquid Biopsy in Pancreatic Cancer. Int J Mol Sci 2020; 21:E7651. [PMID: 33081107 PMCID: PMC7589736 DOI: 10.3390/ijms21207651] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is a challenging disease with a low 5-year survival rate. There are areas for improvement in the tools used for screening, diagnosis, prognosis, treatment selection, and assessing treatment response. Liquid biopsy, particularly cell free DNA liquid biopsy, has shown promise as an adjunct to our standard care for pancreatic cancer patients, but has not yet been universally adopted into regular use by clinicians. In this publication, we aim to review cfDNA liquid biopsy in pancreatic cancer with an emphasis on current techniques, clinical utility, and areas of active investigation. We feel that researchers and clinicians alike should be familiar with this exciting modality as it gains increasing importance in the care of cancer patients.
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Affiliation(s)
- Miles W. Grunvald
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (M.W.G.); (R.A.J.); (S.G.P.)
| | - Richard A. Jacobson
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (M.W.G.); (R.A.J.); (S.G.P.)
| | - Timothy M. Kuzel
- Division of Hematology/Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Sam G. Pappas
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA; (M.W.G.); (R.A.J.); (S.G.P.)
| | - Ashiq Masood
- Division of Hematology/Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL 60612, USA;
- Rush Precision Oncology Program, Rush University Medical Center, Chicago, IL 60612, USA
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6
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Abstract
OBJECTIVES We aimed to determine the difference in endoscopic ultrasonography (EUS) images between portal vein (PV) and arterial invasion of pancreatic cancer and to develop criteria for arterial involvement. METHODS We reviewed EUS data of consecutive patients who underwent distal pancreatectomy from December 2010 to May 2017. We categorized the tumor-vessel relationship into 4 and 5 types, respectively, for the PV and arteries: (a) clear separation between tumor and vessel; (b) tumor border at vessel, echo-rich vessel wall uninterrupted; (c) echo-rich vessel wall interrupted; (d) vessel contour irregularity; and (e) arterial wall thickening or echogenic band surrounding the artery. We compared EUS outcomes with surgical and pathological results. RESULTS Overall, 56 patients underwent distal pancreatectomy, of whom 22 received en bloc celiac axis resection. The pathological invasion rates of PVs and arteries were 46.2% and 0% in (c), and 72.5% and 42.4% in (d) (P = 0.046, P = 0.016), respectively. The overall sensitivity and specificity were 92.1% and 83.2%, respectively, for diagnosing venous invasion and 70.0% and 84.4%, respectively, for arterial invasion. CONCLUSIONS Different EUS criteria may be necessary for diagnosing arterial and portal venous invasions. Criterion (d) might be appropriate for diagnosing arterial invasion.
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Clanton J, Oh S, Kaplan SJ, Johnson E, Ross A, Kozarek R, Alseidi A, Biehl T, Picozzi VJ, Helton WS, Coy D, Dorer R, Rocha FG. Does mesenteric venous imaging assessment accurately predict pathologic invasion in localized pancreatic ductal adenocarcinoma? HPB (Oxford) 2018; 20:925-931. [PMID: 29753633 DOI: 10.1016/j.hpb.2018.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 02/28/2018] [Accepted: 03/31/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accurate prediction of mesenteric venous involvement in pancreatic ductal adenocarcinoma (PDAC) is necessary for adequate staging and treatment. METHODS A retrospective cohort study was conducted in PDAC patients at a single institution. All patients with resected PDAC and staging CT and EUS between 2003 and 2014 were included and sub-divided into "upfront resected" and "neoadjuvant chemotherapy (NAC)" groups. Independent imaging re-review was correlated to venous resection and venous invasion. Sensitivity, specificity, positive and negative predictive values were then calculated. RESULTS A total of 109 patients underwent analysis, 60 received upfront resection, and 49 NAC. Venous resection (30%) and vein invasion (13%) was less common in patients resected upfront than those who received NAC (53% and 16%, respectively). Both CT and EUS had poor sensitivity (14-44%) but high specificity (75-95%) for detecting venous resection and vein invasion in patients resected upfront, whereas sensitivity was high (84-100%) and specificity was low (27-44%) after NAC. CONCLUSIONS Preoperative CT and EUS in PDAC have similar efficacy but different predictive capacity in assessing mesenteric venous involvement depending on whether patients are resected upfront or received NAC. Both modalities appear to significantly overestimate true vascular involvement and should be interpreted in the appropriate clinical context.
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Affiliation(s)
- Jesse Clanton
- Sections of General, Thoracic and Vascular Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Stephen Oh
- Hematology and Oncology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Stephen J Kaplan
- Sections of General, Thoracic and Vascular Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Emily Johnson
- Radiology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew Ross
- Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Richard Kozarek
- Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Adnan Alseidi
- Sections of General, Thoracic and Vascular Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Thomas Biehl
- Sections of General, Thoracic and Vascular Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Vincent J Picozzi
- Hematology and Oncology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - William S Helton
- Sections of General, Thoracic and Vascular Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - David Coy
- Radiology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Russell Dorer
- Pathology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Flavio G Rocha
- Sections of General, Thoracic and Vascular Surgery, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
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8
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Gilbert JW, Wolpin B, Clancy T, Wang J, Mamon H, Shinagare AB, Jagannathan J, Rosenthal M. Reply to the letter to the editor 'Borderline resectable pancreatic cancer: an evolving concept' by Petrucciani et al. Ann Oncol 2017; 28:2316. [PMID: 28541392 DOI: 10.1093/annonc/mdx273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J W Gilbert
- Department of Imaging, Dana-Farber Cancer Institute, Boston.,Department of Radiology, Brigham and Women's Hospital, Boston.,Harvard Medical School, Boston
| | - B Wolpin
- Harvard Medical School, Boston.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - T Clancy
- Harvard Medical School, Boston.,Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital and Gastrointestinal Surgical Center, Dana-Farber/Brigham and Women's Cancer Center, Boston
| | - J Wang
- Harvard Medical School, Boston.,Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital and Gastrointestinal Surgical Center, Dana-Farber/Brigham and Women's Cancer Center, Boston
| | - H Mamon
- Harvard Medical School, Boston.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - A B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Boston.,Department of Radiology, Brigham and Women's Hospital, Boston.,Harvard Medical School, Boston
| | - J Jagannathan
- Department of Imaging, Dana-Farber Cancer Institute, Boston.,Department of Radiology, Brigham and Women's Hospital, Boston.,Harvard Medical School, Boston
| | - M Rosenthal
- Department of Imaging, Dana-Farber Cancer Institute, Boston.,Department of Radiology, Brigham and Women's Hospital, Boston.,Harvard Medical School, Boston
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Petrucciani N, Debs T, Nigri G, D'Angelo F, Gugenheim J, Ramacciato G. Borderline resectable pancreatic cancer: an evolving concept. Ann Oncol 2017; 28:2315. [PMID: 28911082 DOI: 10.1093/annonc/mdx255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Petrucciani
- Division of General Surgery, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy.,Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - T Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - G Nigri
- Division of General Surgery, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - F D'Angelo
- Division of General Surgery, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
| | - J Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - G Ramacciato
- Division of General Surgery, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, St Andrea Hospital, Rome, Italy
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