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Zhao CL, Dabiri B, Hanna I, Lee L, Xiaofei Z, Hossein-Zadeh Z, Cao W, Allendorf J, Rodriguez AP, Weng K, Turunbedu S, Boyd A, Gupta M. Improving fine needle aspiration to predict the tumor biological aggressiveness in pancreatic neuroendocrine tumors using Ki-67 proliferation index, phosphorylated histone H3 (PHH3), and BCL-2. Ann Diagn Pathol 2023; 65:152149. [PMID: 37119647 DOI: 10.1016/j.anndiagpath.2023.152149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Surgery is the only known cure for sporadic pancreatic neuroendocrine tumors (PNETs). Therefore, the prediction of the PNETs biological aggressiveness evaluated on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has a significant impact on clinical management. The proliferation rate of Ki-67 in PNETs can help to predict the biological aggressiveness of the tumor. In addition, there is a relatively new proliferation marker called phosphorylated histone H3 (PHH3) that can identify and quantify dividing cells in tissue samples, which is a marker highly specific to mitotic figures. Other markers such as BCL-2 also contribute to tumorigenesis and may be involved in the differentiation of neuroendocrine cells. MATERIALS AND METHODS A retrospective observational study was performed on patients undergoing surveillance for PNETs from January 2010 to May 2021. Data collection included the patients' age, sex, tumor location, tumor size in the surgical specimen, and tumor grade in FNA. The 2019 World Health Organization (WHO) classification guideline was followed to diagnose PNETs, including grade and stage. Immunohistochemical stainings for Ki-67, PHH3 and BCL-2 in PNETs were performed. RESULTS After excluding cell blocks containing fewer than 100 tumor cells, 44 patients with EUS-FNA and surgical resection specimens were included in this study. There were 19 cases of G1 PNETs, 20 cases of G2 PNETs, and 5 cases of G3 PNETs. The grade assigned based on the Ki-67 index was higher and more sensitive than that based on the mitotic count using H&E slides in some cases of G2 and G3 PNETs. However, there was no significant difference between the mitotic count using PHH3-positive tumor cells and the Ki-67 index to grade PNETs. All grade 1 tumors (19 cases) on surgical resection specimens were correctly graded on FNA (100 % concordance rate). Within the 20 G2 PNETs, 15 cases of grade 2 on surgical resection specimens were graded correctly on FNA based on the Ki-67 index only. Five cases of grade 2 PNETs on surgical resection specimens were graded as grade 1 on FNA when using only the Ki-67 index. Three of five grade 3 tumors on surgical resection specimens were graded as grade 2 on FNA based on the Ki-67 index only. Using only FNA Ki-67 to predict PNET tumor grade, the concordance (accuracy) rate was 81.8 % in total. However, all these eight cases (5 cases of G2 PNETs and 3 cases of G3 PNETs) were graded correctly by using the Ki-67 index plus mitotic rate (using PHH3 IHC stains). Four of 18 (22.2 %) patients with PNETs were positive for BCL-2 stain. In these 4 cases positive for BCL-2 stains, 3 cases were G2 PNETs and one case was G3 PNETs. CONCLUSION Grade and the proliferative rate in EUS-FNA can be used to predict the tumor grade in surgical resection specimens. However, when using only FNA Ki-67 to predict PNET tumor grade, about 18 % of cases were downgraded by one level. To solve the problem, immunohistochemical staining for BCL-2 and especially PHH3 would be helpful. Our results demonstrated that the mitotic count using PHH3 IHC stains not only improved the accuracy and precision of PNET grading in the surgical resection specimens, but also could reliably be used in routine scoring of mitotic figures of FNA specimens.
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Affiliation(s)
- Chaohui Lisa Zhao
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America.
| | - Bahram Dabiri
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Iman Hanna
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Lili Lee
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Zhang Xiaofei
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Zarrin Hossein-Zadeh
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Wenqing Cao
- NYU Grossman School of Medicine, NYU Langone Health - TISCH Hospital, Department of Pathology, United States of America
| | - John Allendorf
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Surgery, United States of America
| | - Alex Pipas Rodriguez
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Katherine Weng
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Solomon Turunbedu
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Adrienne Boyd
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America
| | - Mala Gupta
- NYU Long Island School of Medicine, NYU Langone Hospital - Long Island, Department of Pathology, United States of America.
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Boughdad S, Meyer M, Prior JO, Fernandes V, Allenbach G, Kamani C, Jreige M, Albano D, Bertagna F, Nicod-Lalonde M, Schaefer N, Treglia G. Prevalence of physiological uptake in the pancreas on somatostatin receptor-based PET/CT: a systematic review and a meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00432-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Background
Physiological focal radiopharmaceutical uptake in the head and uncinate process of the pancreas may be seen on somatostatin receptor-based PET/CT and might lead to false-positive results for neuroendocrine tumours (NETs). We aimed to perform a systematic review and a meta-analysis about the prevalence of this finding.
Methods
We performed a comprehensive computer literature search across several databases until July 2020. Pooled prevalence of physiological focal uptake on somatostatin receptor-based PET/CT in the pancreas was calculated on a per-examination-based analysis and 95% confidence interval values (95% CI) were reported.
Results
Six studies (684 patients and 829 PET/CT scans) were included. The pooled prevalence of physiological uptake in the head and uncinate process of the pancreas on somatostatin receptor-based PET/CT imaging was 34% (95% CI 19.5–48.7%) with average SUVmax values ranging from 5 to 12.6. Heterogeneity was seen across the selected studies.
Conclusions
High radiopharmaceutical uptake in the head and uncinate process of the pancreas is frequent at somatostatin receptor-based PET/CT and it should be recognized by nuclear medicine physicians to prevent unnecessary additional investigations. In addition, next generation PET/CT tomographs might increase the prevalence of this finding.
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Raoof M, Jutric Z, Melstrom LG, Lee B, Li D, Warner SG, Fong Y, Singh G. Prognostic significance of Chromogranin A in small pancreatic neuroendocrine tumors. Surgery 2018; 165:760-766. [PMID: 30447803 DOI: 10.1016/j.surg.2018.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of nonfunctional pancreatic neuroendocrine tumors ≤2cm is rising. The biologic behavior of these tumors is variable; thus, their management remains controversial. Chromogranin A upregulation is a useful diagnostic biomarker of neuroendocrine tumors; however, the prognostic significance of Chromogranin A is unclear. The objective of this study was to determine whether Chromogranin A levels have prognostic value in pancreatic neuroendocrine tumor patients and may help guide management. METHODS We evaluated the National Cancer Database over a 10-year period (2004-2013). Patients with pancreatic neuroendocrine tumors measuring ≤2cm, without distant metastases, were identified and categorized as Chromogranin A high (>420ng/mL) or Chromogranin A low (≤420ng/mL), and those lacking data on Chromogranin A levels were excluded from the study. Univariate and multivariate analyses were performed using Cox proportional hazards model. Cut-point determination was performed using the Contal and O'Quigley method. RESULTS Of the 445 eligible patients, 352 (79%) were Chromogranin A low and 93 (21%) were Chromogranin A high. Median Chromogranin A level was 71ng/mL (interquartile range, 24-294ng/mL). Chromogranin levels were associated with clinical nodal status and grade. Furthermore, on multivariate analysis, Chromogranin A levels (Chromogranin A high versus Chromogranin A low) independently predicted overall survival after controlling for tumor size, grade, clinical nodal status, and academic status of the facility (hazard ratio: 7.90, 95%CI: 2.34-26.69, P = .001). The greatest benefit of surgical resection was noted in patients in the Chromogranin A high subgroup (log-rank P <.001). CONCLUSION Serum Chromogranin A levels can be incorporated in surgical decision-making for patients with small pancreatic neuroendocrine tumors. Patients in the Chromogranin A low group can be considered for observation, whereas patients in the Chromogranin A high group should be strongly considered for resection.
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Affiliation(s)
- Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Zeljka Jutric
- Department of Surgery, University of California, Irvine, CA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Byrne Lee
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte, CA.
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Tsoukalas N, Triantafyllidis A, Tolia M, Galanopoulos M, Kostakis ID, Demiri S, Toumpanakis C, Koumakis G. Occipital Headache as Initial Manifestation of a Pancreatic Neuroendocrine Tumor. J Gastrointest Cancer 2017; 49:501-503. [PMID: 28283989 DOI: 10.1007/s12029-017-9931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nikolaos Tsoukalas
- Department of Oncology, "401" General Military Hospital of Athens, 138 Mesogeion Avenue and Katechaki Avenue, GR11525, Athens, Greece.
- Department of Medical Oncology, "Agios Savvas" Anticancer Hospital, 171 Alexandras Avenue, GR11522, Athens, Greece.
| | - Agathangelos Triantafyllidis
- Department of Oncology, "401" General Military Hospital of Athens, 138 Mesogeion Avenue and Katechaki Avenue, GR11525, Athens, Greece
| | - Maria Tolia
- Department of Oncology, "401" General Military Hospital of Athens, 138 Mesogeion Avenue and Katechaki Avenue, GR11525, Athens, Greece
| | - Michail Galanopoulos
- Neuroendocrine Tumour Unit, Center of Gastroenterology, Royal Free Hospital NHS Foundation Trust, London, NW3 2QG, UK
| | - Ioannis D Kostakis
- Department of Oncology, "401" General Military Hospital of Athens, 138 Mesogeion Avenue and Katechaki Avenue, GR11525, Athens, Greece
| | - Stamatina Demiri
- Department of Medical Oncology, "Agios Savvas" Anticancer Hospital, 171 Alexandras Avenue, GR11522, Athens, Greece
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Center of Gastroenterology, Royal Free Hospital NHS Foundation Trust, London, NW3 2QG, UK
| | - Georgios Koumakis
- Department of Medical Oncology, "Agios Savvas" Anticancer Hospital, 171 Alexandras Avenue, GR11522, Athens, Greece
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Sakuma Y, Yasuda Y, Sata N, Hosoya Y, Shimizu A, Fujii H, Matsubara D, Fukushima N, Miki A, Maeno M, Lefor AK. Pancreatic neuroendocrine tumor with metastasis to the spleen: a case report. BMC Cancer 2017; 17:37. [PMID: 28068959 PMCID: PMC5223534 DOI: 10.1186/s12885-016-3020-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background Long-term term survival in patients with pancreatic neuroendocrine tumors has been reported, even in patients with metastatic disease. Metastases to the spleen are extremely rare, but have been reported from a number of primary malignancies, such as breast cancer, lung cancer, melanoma and ovarian cancer. This is the first report of a splenic metastasis from a primary pancreatic neuroendocrine tumor. Case presentation The patient presented as a 53 years old white male with anemia and fatigue. Physical examination revealed a left upper quadrant fullness and computed tomography showed a 24 cm left upper quadrant mass with multiple liver metastases, splenomegaly and a 1 cm mass in the spleen. Resection of the primary pancreatic tumor (T4N0M1) was accompanied by gastrectomy, splenectomy and resection of adherent bowel. The spleen contained a metastatic lesion 1.0 cm in diameter, consistent with a primary neuroendocrine tumor of the pancreas. This operation was followed 8 months later, by delayed resection of liver metastases. The patient receives monthly administration of somatostatin long-acting analogue and has undergone several ablations of liver lesions with percutaneous radiofrequency ablation as well as a second liver resection. The patient is alive seven years after initial presentation, with no evidence of disease on imaging studies. Conclusions This is the first report of a splenic metastasis from a primary pancreatic neuroendocrine tumor. The patient initially presented with synchronous multiple liver metastases and a single splenic metastasis. After resection of the primary tumor and spleen, the patient has undergone aggressive cytoreductive surgery/ablation of liver lesions and somatostatin therapy with resulting long-term survival.
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Affiliation(s)
- Yasunaru Sakuma
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | | | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | | | - Atsushi Shimizu
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hirofumi Fujii
- Department of Oncology, Jichi Medical University, Tochigi, Japan
| | | | | | - Atsushi Miki
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Misato Maeno
- Department of Surgery, Jichi Medical University, Tochigi, Japan
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Papamichail M, Ali A, Pizanias M, Peddu P, Karani J, Heaton N. Irreversible electroporation for the treatment of pancreatic neuroendocrine tumors. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2016; 20:116-20. [PMID: 27621748 PMCID: PMC5018952 DOI: 10.14701/kjhbps.2016.20.3.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/30/2016] [Accepted: 06/19/2016] [Indexed: 12/18/2022]
Abstract
Backgrounds/Aims Resection or enucleation is currently the treatment of choice for small pancreatic neuroendocrine tumors (NETs). Irreversible electroporation is a novel ablative method that is used for locally advanced pancreatic adenocarcinoma, but little data exists for its use for pancreatic NETs. We report an early experience of IRE for early pancreatic NETs. Methods Between April 2014 and March 2015, 3 patients with small (<2 cm) pancreatic NETs were treated with percutaneous IRE. Results There were no adverse effects during the procedure. Mean hospital stay was 2.6 days. All patients remained disease free on 12-19 months follow up. One patient developed recurrent pancreatitis with pseudocyst formation. Conclusions IRE for small tumors of the pancreas is practical and may offer advantages over other thermal ablative techniques, since it preserves vital structures such as blood vessels, bile and pancreatic ducts. Further data regarding the long term disease free interval is required to establish efficacy.
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Affiliation(s)
- Michail Papamichail
- Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, United Kingdom
| | - Amir Ali
- Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, United Kingdom
| | - Michail Pizanias
- Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, United Kingdom
| | - Praveen Peddu
- Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, United Kingdom
| | - John Karani
- Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, United Kingdom
| | - Nigel Heaton
- Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London, United Kingdom
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Sharma P, Arora S, Dhull VS, Naswa N, Kumar R, Ammini AC, Bal C. Evaluation of (68)Ga-DOTANOC PET/CT imaging in a large exclusive population of pancreatic neuroendocrine tumors. ACTA ACUST UNITED AC 2015; 40:299-309. [PMID: 25134801 DOI: 10.1007/s00261-014-0219-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of (68)Ga-DOTANOC PET/CT imaging in a large exclusive population of pancreatic neuroendocrine tumors (NETs). METHODS Data of 141 (mean age 46.2 ± 15.2 years) patients who underwent 178 (68)Ga-DOTANOC PET/CT studies for diagnosis/staging (n = 88) and restaging (n = 90) of pancreatic NET were retrospectively analyzed. PET/CT results were compared to conventional imaging (CIM) when available (n = 86). Histopathology and/or clinical/imaging follow-up (minimum 6 months) were used as reference standard. RESULTS The overall sensitivity, specificity, and accuracy of (68)Ga-DOTANOC PET/CT were 85.7%, 79.1%, and 84.8%. The corresponding values were 73%, 50%, and 70.4% for diagnosis/staging groups and 98.6%, 100%, and 98.8% for restaging groups. The accuracy was significantly higher for restaging as compared to diagnosis/staging (P < 0.0001) and in non-insulinoma tumors than insulinomas (P < 0.0001). The SUVmax of primary tumors was significantly higher than metastatic lesions overall (P = 0.001), as well as in diagnosis/staging (P = 0.041) and restaging (P = 0.0003) subgroups. When available, CIM was less specific than (68)Ga-DOTANOC PET/CT (P < 0.001) and showed fewer lesions. CONCLUSIONS (68)Ga-DOTANOC PET/CT is useful for diagnosis/staging and restaging of patients with pancreatic NET. It demonstrates more lesions compared to CIM and is more specific.
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine and PET/CT, Eastern Diagnostics India Ltd., Kolkata, India,
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Abstract
OBJECTIVE The purpose of this article is to present our experience in treating patients with hepatic metastases from a neuroendocrine primary malignancy. CONCLUSION The tumor and patient characteristics, vascular access, and features of treatment all play a role in the long-term management of patients with metatastic neuroendocrine tumors. Routine prophylactic measures are recommended to reduce the frequency and severity of crisis events related to hormone release in patients with neuroendocrine tumors.
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Abstract
Pancreatic neuroendocrine tumors are a group of rare, heterogeneous neoplasms that have been increasing in incidence the past few decades largely because of the diagnosis of pancreatic incidentalomas on cross-sectional imaging. Although these tumors are classically associated with clinical syndromes that result from excess secretion of particular hormones, most pancreatic neuroendocrine tumors are nonfunctional tumors presenting with symptoms secondary to mass effect, metastatic disease, or as incidental findings. This article reviews the diagnostic algorithm, surgical management, and available systemic therapies for nonfunctional pancreatic neuroendocrine tumors.
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Affiliation(s)
- Jennifer H Kuo
- Division of GI/Endocrine Surgery, Columbia University, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032, USA
| | - James A Lee
- COACH Education, Endocrine Surgery, Adrenal Center, New York Thyroid/Parathyroid Center, Simulation Center, Columbia University, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032, USA.
| | - John A Chabot
- Division of GI/Endocrine Surgery, Columbia University, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032, USA
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Abstract
Pancreatic neuroendocrine tumors (PanNETs) have increased in incidence in the USA over the last 20 years. Although PanNETs are often misconceived as being indolent tumors as they have a far more favorable prognosis over pancreatic adenocarcinoma, roughly 60-70% of patients have metastatic disease at the time of diagnosis due to presentation late in the disease process. While improvements in imaging modalities allow for early detection and better tumor localization, recent advancements in basic science, as well as surgical and medical management of PanNETs have further improved the prognosis. The mainstay of therapy for localized PanNETs is surgical intervention, which has become safer and is slowly shifting towards a more minimally invasive approach. However, the prognosis still remains relatively bleak for patients with unresectable disease. Fortunately, novel molecular targeted therapies, such as everolimus and sunitinib, have recently come into the limelight and have shown significant promise for the treatment of locally advanced and metastatic disease.
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Affiliation(s)
- Miral R Sadaria
- Department of Surgery, University of Colorado Anschutz Medical Campus, Division of GI, Tumor and Endocrine Surgery, Academic Office One, 12631 East 17th Avenue, C311, Aurora, CO 80045, USA
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Abstract
OBJECTIVE Pancreatic cancer continues to have a poor prognosis despite impressive improvements in the outcomes of many other types of cancer, often because most pancreatic neoplasms are found to be unresectable at diagnosis. The purpose of this review is to provide an overview of pancreatic cancer and the role of modern imaging in its diagnosis and management with an emphasis on (18)F-FDG PET/CT fusion imaging. CONCLUSION Multimodality imaging is critical in the diagnosis and management of pancreatic cancer. PET/CT is increasingly viewed as a useful, accurate, and cost-effective modality in diagnosing and managing pancreatic cancer, but further studies are warranted. Early data suggest that contrast-enhanced PET/CT performed with modern PET/CT scanners yields high-resolution anatomic information for surgical and radiotherapeutic planning and functional information for whole-body staging in the care of patients with this disease.
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Support for a postresection prognostic score for pancreatic endocrine tumors. Am J Surg 2011; 201:406-10; discussion 410. [PMID: 21367388 DOI: 10.1016/j.amjsurg.2010.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/13/2010] [Accepted: 09/15/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prognostic scores predicting long-term survival of patients with pancreatic neuroendocrine tumors (PNETs) have been created. The purpose of this study was to validate a prognostic scoring scheme at a single institution. METHODS We reviewed all resections for PNETs from 1996 to 2004. Prognostic scores based on patient age, tumor grade, and distant metastasis were calculated. Survival was compared with an established postresection prognostic score for PNETs. RESULTS A total of 34 PNETs were identified. Predicted 5-year survival for prognostic scores of 1, 2, and 3 were 76.7%, 50.9%, and 35.7%, respectively. Final prognostic scores of 1, 2, and 3 were observed in 13 (38%), 18 (53%), and 3 (9%) patients, with observed actual 5-year survivals of 92.3%, 72.2%, and 66.7%, respectively. CONCLUSIONS PNET prognostic scores were found to be inversely related to survival. PNET postresection prognostic score categories may be useful tools in predicting long-term survival.
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Ruf J, Schiefer J, Furth C, Kosiek O, Kropf S, Heuck F, Denecke T, Pavel M, Pascher A, Wiedenmann B, Amthauer H. 68Ga-DOTATOC PET/CT of Neuroendocrine Tumors: Spotlight on the CT Phases of a Triple-Phase Protocol. J Nucl Med 2011; 52:697-704. [DOI: 10.2967/jnumed.110.083741] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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DiNorcia J, Lee MK, Reavey PL, Genkinger JM, Lee JA, Schrope BA, Chabot JA, Allendorf JD. One hundred thirty resections for pancreatic neuroendocrine tumor: evaluating the impact of minimally invasive and parenchyma-sparing techniques. J Gastrointest Surg 2010; 14:1536-46. [PMID: 20824378 DOI: 10.1007/s11605-010-1319-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 08/09/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasingly, surgeons apply minimally invasive and parenchyma-sparing techniques to the management of pancreatic neuroendocrine tumor (PNET). The aim of this study was to evaluate the impact of these approaches on patient outcomes. METHODS We retrospectively collected data on patients with PNET and compared perioperative and pathologic variables. Survival was analyzed using the Kaplan-Meier method. Factors influencing survival were evaluated using a Cox proportional hazards model. RESULTS One hundred thirty patients underwent resection for PNET. Traditional resections included 43 pancreaticoduodenectomies (PD), 38 open distal pancreatectomies (DP), and four total pancreatectomies. Minimally invasive and parenchyma-sparing resections included 25 laparoscopic DP, 11 central pancreatectomies, five enucleations, three partial pancreatectomies, and one laparoscopic-assisted PD. Compared to traditional resections, the minimally invasive and parenchyma-sparing resections had shorter hospital stays. By univariate analysis of neuroendocrine carcinoma, liver metastases and positive resection margins correlated with poor survival. There was an increase in minimally invasive or parenchyma-sparing resections over the study period with no differences in morbidity, mortality, or survival. CONCLUSION In this series, there has been a significant increase in minimally invasive and parenchyma-sparing techniques for PNET. This shift did not increase morbidity or compromise survival. In addition, minimally invasive and parenchyma-sparing operations yielded shorter hospital stays.
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Affiliation(s)
- Joseph DiNorcia
- College of Physicians and Surgeons, Department of Surgery, Columbia University, 161 Fort Washington Avenue, Suite 820, New York, NY 10032, USA
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