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Litjens G, Gerges C, Shastri YM, Somani P, Beyna T, Neuhaus H, van Laarhoven CJHM, Prokop M, Siersema PD, Hermans JJ, van Geenen EJM. EUS-Guided Biopsy with a Novel Puncture Biopsy Forceps Needle-Feasibility Study. Diagnostics (Basel) 2021; 11:diagnostics11091638. [PMID: 34573978 PMCID: PMC8466864 DOI: 10.3390/diagnostics11091638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) or biopsy (FNB) to diagnose lesions in the gastrointestinal tract is common. Demand for histology sampling to identify treatment-specific targets is increasing. Various core biopsy FNB needles to obtain tissue for histology are currently available, however, with variable (37-97%) histology yields. In this multicenter study, we evaluated performance, safety, and user experience of a novel device (the puncture biopsy forceps (PBF) needle). Twenty-four procedures with the PBF needle were performed in 24 patients with a suspected pancreatic lesion (n = 10), subepithelial lesion (n = 10), lymph node (n = 3), or pararectal mass (n = 1). In 20/24 (83%) procedures, the PBF needle yielded sufficient material for interpretation (sample adequacy). In 17/24 (71%), a correct diagnosis was made with the material from the PBF needle (diagnostic accuracy). All participating endoscopists experienced a learning curve. (Per)procedural technical issues occurred in four cases (17%), but there were no adverse events. The PBF needle is a safe and potentially useful device to obtain an EUS-guided biopsy specimen. As the design of the PBF needle is different to core biopsy FNB needles, specific training will likely further improve the performance of the PBF needle. Furthermore, the design of the needle needs further improvement to make it more robust in clinical practice.
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Affiliation(s)
- Geke Litjens
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (G.L.); (M.P.); (J.J.H.)
| | - Christian Gerges
- Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, 40217 Düsseldorf, Germany; (C.G.); (T.B.); (H.N.)
| | - Yogesh M. Shastri
- Department of Gastroenterology and Hepatology, NMC Specialty Hospital, Abu Dhabi 6222, United Arab Emirates;
| | - Piyush Somani
- Department of Gastroenterology, NMC Royal Hospital Sharjah, Sharjah 3499, United Arab Emirates;
- Department of Gastroenterology, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
| | - Torsten Beyna
- Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, 40217 Düsseldorf, Germany; (C.G.); (T.B.); (H.N.)
| | - Horst Neuhaus
- Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, 40217 Düsseldorf, Germany; (C.G.); (T.B.); (H.N.)
| | - Cornelis J. H. M. van Laarhoven
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Mathias Prokop
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (G.L.); (M.P.); (J.J.H.)
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - John J. Hermans
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (G.L.); (M.P.); (J.J.H.)
| | - Erwin J. M. van Geenen
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Correspondence:
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Funamizu N, Omura K, Takada Y, Ozaki T, Mishima K, Igarashi K, Wakabayashi G. Geriatric Nutritional Risk Index Less Than 92 Is a Predictor for Late Postpancreatectomy Hemorrhage Following Pancreatoduodenectomy: A Retrospective Cohort Study. Cancers (Basel) 2020; 12:cancers12102779. [PMID: 32998260 PMCID: PMC7600944 DOI: 10.3390/cancers12102779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 01/06/2023] Open
Abstract
Simple Summary The definite risk factor of postpancreatectomy hemorrhage (PPH) is still unknown in spite of a lethal complication of pancreatoduodenectomy (PD). In this study, we evaluated whether GNRI is a reliable marker for PPH following PD. The present study retrospectively evaluated 121 patients treated with PD at Ageo Central General Hospital in Japan. Ten patients had developed PPH. Among them, the patients were divided into bleeding group (n = 10) and non-bleeding group (n = 111). The bleeding group had significantly low geriatric nutritional risk index (GNRI) values compared to those in the non-bleeding group (p = 0.001). The cut-off value of GNRI was determined by 92 accounting for a sensitivity 80.0%, specificity 82.9% using receiver operating characteristic curve analysis. A GNRI of <92 was statistically identified as an independently risk factor of PPH risk following PD. Abstract Postpancreatectomy hemorrhage (PPH) is the most lethal complication of pancreatoduodenectomy (PD). The main risk factor for PPH is the development of a postoperative pancreatic fistula (POPF). Recent evidence shows that the geriatric nutritional risk index (GNRI) may be predictive indicator for POPF. In this study, we aimed to evaluate whether GNRI is a reliable predictive marker for PPH following PD. The present study retrospectively evaluated 121 patients treated with PD at Ageo Central General Hospital in Japan between January 2015 and March 2020. We investigated the potential of age, gender, body mass index, serum albumin, American Society of Anesthesiologists classification (ASA), diabetes mellitus and smoking status, time taken for the operation, estimated blood loss, and postoperative complications (POPF, bile leak, and surgical site infections) to predict the risk of PPH following PD using univariate and multivariate analyses. Ten patients had developed PPH with an incidence of 8.3%. Among them, the patients were divided into bleeding group (n = 10) and non-bleeding group (n = 111). The bleeding group had significantly lower GNRI values than those in the non-bleeding group (p = 0.001). We determined that the cut-off value of GNRI was 92 accounting for a sensitivity 80.0%, specificity 82.9%, and likelihood ratio of 4.6 using receiver operating characteristic curve analysis. A GNRI of <92 was statistically associated with PPH in both univariate (p < 0.001) and multivariate analysis (p = 0.01). Therefore, we could identify that a GNRI < 92 was an independently potential predictor of PPH risk following PD. We should alert surgeons if patients have low level GNRI before PD.
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Affiliation(s)
- Naotake Funamizu
- Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Ageo, Saitama 362-8588, Japan; (K.O.); (T.O.); (K.M.); (K.I.); (G.W.)
- Department of HBP Surgery, Ehime University, Ehime Prefecture, Matsuyama 791-0295, Japan;
- Correspondence: ; Tel.: +81-48-773-1111 (ext. 8625)
| | - Kenji Omura
- Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Ageo, Saitama 362-8588, Japan; (K.O.); (T.O.); (K.M.); (K.I.); (G.W.)
| | - Yasutsugu Takada
- Department of HBP Surgery, Ehime University, Ehime Prefecture, Matsuyama 791-0295, Japan;
| | - Takahiro Ozaki
- Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Ageo, Saitama 362-8588, Japan; (K.O.); (T.O.); (K.M.); (K.I.); (G.W.)
| | - Kohei Mishima
- Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Ageo, Saitama 362-8588, Japan; (K.O.); (T.O.); (K.M.); (K.I.); (G.W.)
| | - Kazuharu Igarashi
- Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Ageo, Saitama 362-8588, Japan; (K.O.); (T.O.); (K.M.); (K.I.); (G.W.)
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Ageo, Saitama 362-8588, Japan; (K.O.); (T.O.); (K.M.); (K.I.); (G.W.)
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Verbeke C, Häberle L, Lenggenhager D, Esposito I. Pathology assessment of pancreatic cancer following neoadjuvant treatment: Time to move on. Pancreatology 2018; 18:467-476. [PMID: 29843972 DOI: 10.1016/j.pan.2018.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023]
Abstract
Neoadjuvant treatment has increasingly become an integral part of the multimodal management of patients with pancreatic cancer. In patients who are able to undergo surgery following preoperative therapy, tumour regression grading remains the diagnostic gold standard for the histomorphological assessment of the effect of neoadjuvant treatment. In recent years, however, there has been growing concern about inherent flaws of tumour regression grading systems as well as their imprecise and impractical criteria that result in divergence of practice and lack of interobserver agreement. Furthermore, existing tumour regression systems differ in their defining criteria and thresholds, leading to incomparability of data. In this review, the principles and limitations of the main existing tumour regression systems are discussed, and potential alternative assessment approaches and novel markers are presented.
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Affiliation(s)
- Caroline Verbeke
- Dept of Pathology, Institute of Clinical Medicine, University of Oslo, Norway; Dept of Pathology, Oslo University Hospital, Norway.
| | - Lena Häberle
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Germany
| | - Daniela Lenggenhager
- Dept of Pathology, Institute of Clinical Medicine, University of Oslo, Norway; Dept of Pharmacology, Institute of Clinical Medicine, University of Oslo, Norway; Institute of Pathology and Molecular Pathology, University of Zürich and University Hospital Zürich, Switzerland
| | - Irene Esposito
- Institute of Pathology, Heinrich-Heine University and University Hospital of Düsseldorf, Germany.
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Abstract
Pancreatic cancer is a deadly and aggressive disease. Less than 1% of diagnosed patients survive 5 years with an average survival time of only 4–8 months. The only option for metastatic pancreatic cancer is chemotherapy where only the antimetabolites gemcitabine and 5-fluorouracil are used clinically. Unfortunately, efforts to improve chemotherapy regimens by combining, 5-fluorouracil or gemcitabine with other drugs, such as cisplatin or oxaliplatin, have not increased cell killing or improved patient survival. The novel antimetabolite zebularine shows promise, inducing apoptosis and arresting cellular growth in various pancreatic cancer cell lines. However, resistance to these antimetabolites remains a problem highlighting the need to discover and develop new antimetabolites that will improve a patient’s overall survival.
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Affiliation(s)
- Malyn May Asuncion Valenzuela
- Center for Health Disparities Research and Molecular Medicine, Loma Linda University, Loma Linda, California, USA ; Department of Basic Sciences, Division of Biochemistry, Loma Linda University, Loma Linda, California, USA
| | - Jonathan W Neidigh
- Department of Basic Sciences, Division of Biochemistry, Loma Linda University, Loma Linda, California, USA
| | - Nathan R Wall
- Center for Health Disparities Research and Molecular Medicine, Loma Linda University, Loma Linda, California, USA ; Department of Basic Sciences, Division of Biochemistry, Loma Linda University, Loma Linda, California, USA
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Tumour-stroma interactions in pancreatic ductal adenocarcinoma: rationale and current evidence for new therapeutic strategies. Cancer Treat Rev 2013; 40:118-28. [PMID: 23849556 DOI: 10.1016/j.ctrv.2013.04.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 12/16/2022]
Abstract
Most patients with pancreatic cancer present with advanced/metastatic disease and have a dismal prognosis. Despite the proven albeit modest benefits of gemcitabine demonstrated over a decade ago, subsequent advances have been slow, suggesting it may be time to take a different approach. It is thought that some key characteristics of pancreatic cancer, such as the desmoplasia, restricted vasculature and hypoxic environment, may prevent the delivery of chemotherapy to the tumour thereby explaining the limited benefits observed to-date. Moreover, there is evidence to suggest that the stroma is not only a mechanical barrier but also constitutes a dynamic compartment of pancreatic tumours that is critically involved in tumour formation, progression and metastasis. Thus, targeting the stroma and the tumour represents a promising therapeutic strategy. Currently, several stroma-targeting agents are entering clinical development. Among these, nab-paclitaxel appears promising since it combines cytotoxic therapy with targeted delivery via its proposed ability to bind SPARC on tumour and stromal cells. Preclinical data indicate that co-treatment with nab-paclitaxel and gemcitabine results in stromal depletion, increased tumour vascularization and intratumoural gemcitabine concentration, and increased tumour regression compared with either agent alone. Phase I/II study data also suggest that a high level of antitumor activity can be achieved with this combination in pancreatic cancer. This was recently confirmed in a Phase III study which showed that nab-paclitaxel plus gemcitabine significantly improved overall survival (HR 0.72) and progression-free survival (HR 0.69) versus gemcitabine alone for the first-line treatment of patients with metastatic pancreatic cancer.
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Gooden HM, White KJ. Pancreatic cancer and supportive care--pancreatic exocrine insufficiency negatively impacts on quality of life. Support Care Cancer 2013; 21:1835-41. [PMID: 23397095 DOI: 10.1007/s00520-013-1729-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/28/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Pancreatic cancer is a fatal cancer with a median survival from diagnosis of around 5 months Speer et al. (Med J Aust 196(8):511-515, 2012). Given the short survival time for people with pancreatic cancer, effective supportive care is imperative to enable best quality of life. This article presents an unexpected finding from research into the psychosocial supportive care needs of people affected by pancreatic cancer that management of pancreatic exocrine insufficiency is an area of unmet need that severely impacts on quality of life and increases carer burden in people affected by pancreatic cancer. METHODS A qualitative inquiry framework was used to explore participants' perspectives and experience. Two groups of participants (N = 35) were recruited across Australia from people accessing the Cancer Helpline or direct referral from clinicians/nurses: patients diagnosed with pancreatic cancer (N = 12) and carers/family (N = 23) including a subgroup of bereaved participants (N = 14). Sampling continued until saturation. A thematic content analysis was conducted. RESULTS The findings revealed that the major quality of life theme was difficulty in managing gut symptoms and complex dietary issues. Issues were related to lack of information about malabsorption and managing symptoms of pancreatic exocrine insufficiency. This was compounded by a lack of routine dietary consultation: perceived reluctance of clinicians to prescribe enzyme supplements and poor understanding of dose to diet guidelines. CONCLUSION Participants expressed distress relating to the effects of pancreatic exocrine insufficiency. Pancreatic enzyme supplement therapy with clear dosage guidelines and associated dietary advice could resolve symptoms of malabsorption and markedly improve quality of life. For people affected by pancreatic cancer, this is an essential supportive care.
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Affiliation(s)
- H M Gooden
- Cancer Nursing Research Unit, Sydney Nursing School, University of Sydney, Camperdown, Australia.
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Van Laethem JL, Verslype C, Iovanna JL, Michl P, Conroy T, Louvet C, Hammel P, Mitry E, Ducreux M, Maraculla T, Uhl W, Van Tienhoven G, Bachet JB, Maréchal R, Hendlisz A, Bali M, Demetter P, Ulrich F, Aust D, Luttges J, Peeters M, Mauer M, Roth A, Neoptolemos JP, Lutz M. New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel. Ann Oncol 2012; 23:570-576. [PMID: 21810728 DOI: 10.1093/annonc/mdr351] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although the treatment of pancreatic ductal adenocarcinoma (PDAC) remains a huge challenge, it is entering a new era with the development of new strategies and trial designs. Because there is an increasing number of novel therapeutic agents and potential combinations available to test in patients with PDAC, the identification of robust prognostic and predictive markers and of new targets and relevant pathways is a top priority as well as the design of adequate trials incorporating molecular-driven hypothesis. We presently report a consensus strategy for research in pancreatic cancer that was developed by a multidisciplinary panel of experts from different European institutions and collaborative groups involved in pancreatic cancer. The expert panel embraces the concept of exploratory early proof of concept studies, based on the prediction of response to novel agents and combinations, and randomised phase II studies permitting the selection of the best therapeutic approach to go forward into phase III, where the recommended primary end point remains overall survival. Trials should contain as many translational components as possible, relying on standardised tissue and blood processing and robust biobanking, and including dynamic imaging. Attention should not only be paid to the pancreatic cancer cells but also to microenvironmental factors and stem/stellate cells.
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Affiliation(s)
- J-L Van Laethem
- Gastrointestinal Cancer Unit, Hôpital Erasme, Université Libre de Bruxelles, Brussels.
| | - C Verslype
- Department of Hepatology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - J L Iovanna
- Institut National de la Santé et de la Recherche Médicale, Marseille, France
| | - P Michl
- Department of Gastroenterology and Endocrinology, University of Marburg, Marburg, Germany
| | - T Conroy
- Nancy University and Department of Medical Oncology, Centre Alexis Vautrin, Nancy
| | - C Louvet
- Digestive Surgery Department, Institut Mutualiste Montsouris, Paris
| | - P Hammel
- Gastroenterology Department, Hôpital Beaujon, Clichy
| | - E Mitry
- Medical Oncology Department, Institut Curie, Hôpital René-Huguenin, Saint-Cloud
| | - M Ducreux
- Digestive Oncology Department, Institut G. Roussy, Villejuif, France
| | - T Maraculla
- Medical Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - W Uhl
- Department of Surgery, St Josef-Hospital, Ruhr-University, Bochum, Germany
| | - G Van Tienhoven
- Department of Radiation Oncology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J B Bachet
- Department of Gastroenterology, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Maréchal
- Department of Gastroenterology and Hepato-Pancreatology, Gastrointestinal Cancer Unit, Hôpital Universitaire Erasme, Brussels
| | - A Hendlisz
- Department of Gastroenterology, Institut J. Bordet, Brussels
| | - M Bali
- Department of Medical Imaging, Hôpital Erasme, Brussels, Belgium
| | - P Demetter
- Gastrointestinal Cancer Unit, Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - F Ulrich
- Department of General and Visceral Surgery, J. W. Goethe University Medical Center, Frankfurt
| | - D Aust
- Institute of Pathology, University Hospital Carl Gustav Carus, Dresden
| | - J Luttges
- Caritasklinik St Theresia, Saarbrücken, Germany
| | - M Peeters
- Department of Oncology, Universitair Ziekenhuis Antwerpen, Edegem
| | - M Mauer
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - A Roth
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, Hôpital Universitaire de Genève, Geneva, Switzerland
| | - J P Neoptolemos
- Department of Surgery, University of Liverpool, Liverpool, UK
| | - M Lutz
- Caritasklinik St Theresia, Saarbrücken, Germany
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