Publications by authors named "Riccardo De Robertis"

60 Publications

Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe.

Insights Imaging 2021 Jun 10;12(1):76. Epub 2021 Jun 10.

IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.

Newer biologic drugs and immunomodulatory agents, as well as more tolerated and effective radiation therapy schemes, have reduced treatment toxicity in oncology patients. However, although imaging assessment of tumor response is adapting to atypical responses like tumor flare, expected changes and complications of chemo/radiotherapy are still routinely encountered in post-treatment imaging examinations. Radiologists must be aware of old and newer therapeutic options and related side effects or complications to avoid a misinterpretation of imaging findings. Further, advancements in oncology research have increased life expectancy of patients as well as the frequency of long-term therapy-related side effects that once could not be observed. This pictorial will help radiologists tasked to detect therapy-related complications and to differentiate expected changes of normal tissues from tumor relapse.
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http://dx.doi.org/10.1186/s13244-021-01017-2DOI Listing
June 2021

An Overview of Artificial Intelligence Applications in Liver and Pancreatic Imaging.

Cancers (Basel) 2021 Apr 30;13(9). Epub 2021 Apr 30.

Department of Radiology, G.B. Rossi University Hospital, University of Verona, 37129 Verona, Italy.

Artificial intelligence (AI) is one of the most promising fields of research in medical imaging so far. By means of specific algorithms, it can be used to help radiologists in their routine workflow. There are several papers that describe AI approaches to solve different problems in liver and pancreatic imaging. These problems may be summarized in four different categories: segmentation, quantification, characterization and image quality improvement. Segmentation is usually the first step of successive elaborations. If done manually, it is a time-consuming process. Therefore, the semi-automatic and automatic creation of a liver or a pancreatic mask may save time for other evaluations, such as quantification of various parameters, from organs volume to their textural features. The alterations of normal liver and pancreas structure may give a clue to the presence of a diffuse or focal pathology. AI can be trained to recognize these alterations and propose a diagnosis, which may then be confirmed or not by radiologists. Finally, AI may be applied in medical image reconstruction in order to increase image quality, decrease dose administration (referring to computed tomography) and reduce scan times. In this article, we report the state of the art of AI applications in these four main categories.
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http://dx.doi.org/10.3390/cancers13092162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124771PMC
April 2021

CT Simplified Radiomic Approach to Assess the Metastatic Ductal Adenocarcinoma of the Pancreas.

Cancers (Basel) 2021 Apr 13;13(8). Epub 2021 Apr 13.

Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona, 37129 Verona, Italy.

The aim of this study was to perform a simplified radiomic analysis of pancreatic ductal adenocarcinoma based on qualitative and quantitative tumor features and to compare the results between metastatic and non-metastatic patients. A search of our radiological, surgical, and pathological databases identified 1218 patients with a newly diagnosed pancreatic ductal adenocarcinoma who were referred to our Institution between January 2014 and December 2018. Computed Tomography (CT) examinations were reviewed analyzing qualitative and quantitative features. Two hundred eighty-eight patients fulfilled the inclusion criteria and were included in this study. Overall, metastases were present at diagnosis in 86/288 patients, while no metastases were identified in 202/288 patients. Ill-defined margins and a hypodense appearance on portal-phase images were significantly more common among patients with metastases compared to non-metastatic patients ( < 0.05). Metastatic tumors showed a significantly larger size and significantly lower arterial index, perfusion index, and permeability index compared to non-metastatic tumors ( < 0.05). In the management of pancreatic ductal adenocarcinoma, early detection and correct staging are key elements. The study of computerized tomography characteristics of pancreatic ductal adenocarcinoma showed substantial differences, both qualitative and quantitative, between metastatic and non-metastatic disease.
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http://dx.doi.org/10.3390/cancers13081843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069159PMC
April 2021

Dosimetric Feasibility Study of Dose Escalated Stereotactic Body Radiation Therapy (SBRT) in Locally Advanced Pancreatic Cancer (LAPC) Patients: It Is Time to Raise the Bar.

Front Oncol 2020 17;10:600940. Epub 2020 Dec 17.

Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy.

Background And Objective: To assess the dosimetric feasibility of a stereotactic body radiotherapy (SBRT) dose escalated protocol, with a simultaneous integrated boost (SIB) and a simultaneous integrated protection (SIP) approach, in patients with locally advanced pancreatic cancer (LAPC).

Material And Methods: Twenty LAPC lesions, previously treated with SBRT at our Institution, were re-planned. The original prescribed and administered dose was 50/30/25 Gy in five fractions to PTV (tumor-vessel interface [TVI])/PTV (tumor volume)/PTV (overlap area between PTV and planning organs at risk volume [PRV]), respectively. At re-planning, the prescribed dose was escalated up to 60/40/33 Gy in five fractions to PTV/PTV/PTV, respectively. All plans were performed using an inspiration breath hold (IBH) technique and generated with volumetric modulated arc therapy (VMAT). Well-established and accepted OAR dose constraints were used (D < 33 Gy for luminal OARs and D < 38 Gy for corresponding PRV). The primary end-point was to achieve a median dose equal to the prescription dose for the PTV with D≥ 95% (95% of prescription dose is the minimum dose), and a coverage for PTV and PTV of D≥95%, with minor deviations in OAR dose constraints in < 10% of the plans.

Results: PTV median (± SD) dose/D/conformity index (CI) were 60.54 (± 0.85) Gy/58.96 (± 0.86) Gy/0.99 (± 0.01), respectively; whilst PTV median (± SD) dose/D were 44.51 (± 2.69) Gy/38.44 (± 0.82) Gy, and PTV median (± SD) dose/D were 35.18 (± 1.42) Gy/33.01 (± 0.84) Gy, respectively. With regard to OARs, median (± SD) maximum dose (D) to duodenum/stomach/bowel was 29.31 (± 5.72) Gy/25.29 (± 6.90) Gy/27.03 (± 5.67) Gy, respectively. A minor acceptable deviation was found for a single plan (bowel and duodenum D=34.8 Gy). V38 < 0.5 cc was achieved for all PRV luminal OARs.

Conclusions: In LAPC patients SBRT, with a SIB/SIP dose escalation approach up to 60/40/33 Gy in five fractions to PTV/PTV/PTV, respectively, is dosimetrically feasible with adequate PTVs coverage and respect for OAR dose constraints.
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http://dx.doi.org/10.3389/fonc.2020.600940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773844PMC
December 2020

Magnetic resonance (MR) for mural nodule detection studying Intraductal papillary mucinous neoplasms (IPMN) of pancreas: Imaging-pathologic correlation.

Pancreatology 2021 Jan 3;21(1):180-187. Epub 2020 Dec 3.

Department of Surgery, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Purpose: Magnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic MR with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of pancreatic IPMN by using pathological analysis as gold standard.

Materials And Methods: Ninety-one preoperative MR with histopathological diagnosis of IPMN were reviewed by two radiologists. Presence, number and size of mural nodule, signal intensity of the nodule on T1-weighted imaging (T1-WI) after contrast medium administration and on DWI. Inter-observer agreement was evaluated.

Results: Significant correlation (p < 0.0001) were found for presence of nodules > 5 mm on MR and pathological specimen, size and number of mural nodules evaluated on pathological review and degree of dysplasia, size and number of mural nodules evaluated on MR and tumoral dysplasia, presence of nodule > 5 mm with enhancement after contrast medium administration and hyperintensity on DWI and degree of dysplasia. Interobserver agreement was moderate for the presence of mural nodule (K = 0.56), for the presence of high signal intensity on DWI (K = 0.57) and enhancement of mural nodule (K = 0.58). Apparent Diffusion Coefficient (ADC) map histogram analysis showed a correlation between Entropy of the entire cystic lesion and the degree of dysplasia (p < 0.034).

Conclusions: MR with dynamic and DWI sequences was an accurate method for the identification of ≥ 5 mm solid nodules of the IPMNs and correlate with the lesion malignancy. Entropy, calculated from the histogram analysis of the IPMN ADC map, correlated with the lesion dysplasia.
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http://dx.doi.org/10.1016/j.pan.2020.11.024DOI Listing
January 2021

US-Guided Percutaneous Radiofrequency Ablation of Locally Advanced Pancreatic Adenocarcinoma: A 5-Year High-Volume Center Experience.

Ultraschall Med 2020 Aug 14. Epub 2020 Aug 14.

Surgery, University of Verona, Italy.

Purpose:  The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up.

Materials And Methods:  Patients with unresectable LAPC after failed chemoradiotherapy for at least six months were retrospectively included. Percutaneous RFA was performed after a preliminary ultrasound (US) feasibility evaluation. Contrast-enhanced computed tomography (CT) and CA 19.9 sampling were performed before and 24 hours and 30 days after the procedure to evaluate the effects of the ablation. Patients were followed-up after discharge considering the two main endpoints: procedure-related complications and death.

Results:  35 patients were included, 5 were excluded. All patients underwent RFA with no procedure-related complications reported. The mean size of tumors was 49 mm before treatment. The mean dimension of the ablated necrotic zone was 32 mm, with a mean extension of 65 % compared to the whole tumor size. Tumor density was statistically reduced one day after the procedure (p < 0.001). The mean CA 19.9 levels before and 24 hours and 30 days after the procedure were 285.8 U/mL, 635.2 U/mL, and 336.0 U/mL, respectively, with a decrease or stability at the 30-day evaluation in 80 % of cases. The mean survival was 310 (65-718) days.

Conclusion:  Percutaneous RFA of LAPC is a feasible technique in patients who cannot undergo surgery, with great debulking effects and a very low complication rate.
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http://dx.doi.org/10.1055/a-1178-0474DOI Listing
August 2020

Impact of coronavirus disease 2019 (COVID-19) emergency on Italian radiologists: a national survey.

Eur Radiol 2020 Dec 14;30(12):6635-6644. Epub 2020 Jul 14.

IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.

Objectives: To perform an online survey aimed at evaluating the impact of COVID-19 on Italian radiology departments.

Methods: We launched a survey composed of 25 questions about how COVID-19 has changed the safety and organization of daily activity in Italian radiology units.

Results: A total of 2136/10,564 (20.2%) radiologists of the Italian Society of Medical and Interventional Radiology participated. Two-thirds performed at least one diagnostic/interventional procedure on COVID-19 patients. The 88.1% reported a reduction in the elective imaging volumes, with US, mammography, and MRI having shown the greater decrease (41.1%, 23.9%, and 21.1%, respectively). In 69.6% of cases, institutions had trouble getting personal protective equipment (PPE), especially public hospitals and southern institutions. Less than 30% of participants were subjected to RT-PCR swab test, although 81.5% believed that it should be done on all health workers and 70% suggested it as the most important measure to improve safety at work. Slightly more than half of participants declared to work safely and felt to be adequately protected by their institutions. Up to 20% of northern participants were redeployed to clinical services. The first imaging examination performed by admitted COVID-19 patients was chest radiography in 76.3% of cases. Almost half of participants reported that less than 30% of health workers were infected in their radiology department, with higher rates in northern regions and public institutions.

Conclusions: This snapshot of the current situation in Italian radiology departments could be used to harmonize the organization of working activity in order to safely and effectively face this pandemic.

Key Points: • More than two-thirds of institutions had trouble getting PPE for health workers, with public hospitals and southern institutions that presented more procurement problems • A substantial drop of imaging volumes was observed in the vast majority of Italian radiology departments, mostly due to the decrease of ultrasound, mammography, and MRI, especially in private practice were working activity was stopped in 13.3% of institutions • RT-PCR swab to health workers was reported as the most suggested measure by Italian radiologists to improve safety at work, as more than 80% of them believed that it should be performed to all health workers, although less than 30% were subjected to this test.
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http://dx.doi.org/10.1007/s00330-020-07046-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358329PMC
December 2020

Diffusion-Weighted Imaging in Oncology: An Update.

Cancers (Basel) 2020 Jun 8;12(6). Epub 2020 Jun 8.

IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy.

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the "functional" information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.
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http://dx.doi.org/10.3390/cancers12061493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352852PMC
June 2020

Liver Tumor Burden in Pancreatic Neuroendocrine Tumors: CT Features and Texture Analysis in the Prediction of Tumor Grade and F-FDG Uptake.

Cancers (Basel) 2020 Jun 7;12(6). Epub 2020 Jun 7.

Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy.

Pancreatic neuroendocrine tumors (p-NETs) are a rare group of neoplasms that often present with liver metastases. Histological characteristics, metabolic behavior, and liver tumor burden (LTB) are important prognostic factors. In this study, the usefulness of texture analysis of liver metastases in evaluating the biological aggressiveness of p-NETs was assessed. Fifty-six patients with liver metastases from p-NET were retrospectively enrolled. Qualitative and quantitative CT features of LTB were evaluated. Histogram-derived parameters of liver metastases were calculated and correlated with the tumor grade (G) and F-fluorodeoxyglucose (F-FDG) standardized uptake value (SUV). Arterial relative enhancement was inversely related with G (-0.37, = 0.006). Different metastatic spread patterns of LTB were not associated with histological grade. Arterial was significantly correlated to G (-0.368, = 0.038) and to Ki67 percentage (-0.421, = 0.018). The ROC curve for the Arterial reported an area under the curve (AUC) of 0.736 (95% confidence interval 0.545-0.928, = 0.035) in the identification of G1-2 tumors. Arterial values were correlated to G (0.346, = 0.005) and Ki67 levels (0.383, = 0.033). Arterial values were directly correlated with the SUV (0.449, = 0.047) which was inversely correlated with Arterial (-0.499, = 0.025). Skewness and kurtosis reported no significant correlations. In conclusion, histogram-derived parameters may predict adverse histological features and metabolic behavior of p-NET liver metastases.
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http://dx.doi.org/10.3390/cancers12061486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352332PMC
June 2020

Diagnosis and Management of Iatrogenic Hemobilia Secondary to Transjugular Intrahepatic Portosystemic Shunt Procedure.

Cureus 2020 Apr 10;12(4):e7629. Epub 2020 Apr 10.

Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, ITA.

A patient with end-stage liver disease and subsequent refractory ascites was treated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The procedure was complicated by massive gastrointestinal hemorrhage with associated rettorragia. Computed tomography angiography (CT-A) was performed and revealed haemobilia due to an artero-biliary fistula between the right hepatic artery and an intrahepatic biliary branch. The patient underwent an attempt at percutaneous embolization. Bleeding was successfully stopped by the embolization of the fistula with coils. Hemobilia is a rare cause of upper gastrointestinal bleeding with an increasing incidence due to the widespread use of invasive hepatobiliary procedures. Hemobilia is an uncommon complication of TIPS procedures. Nowadays, transcatheter embolization is the gold standard in the management of hemobilia.
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http://dx.doi.org/10.7759/cureus.7629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213657PMC
April 2020

Correlation of MR features and histogram-derived parameters with aggressiveness and outcomes after resection in pancreatic ductal adenocarcinoma.

Abdom Radiol (NY) 2020 11;45(11):3809-3818

Department of Radiology, Ospedale G.B. Rossi - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Purpose: To evaluate MR-derived histogram parameters in predicting aggressiveness and surgical outcomes in patients with PDAC, by correlating them to pathological features, recurrence-free survival (RFS), and overall survival (OS).

Methods: Pre-operative MR examinations of 103 patients with PDAC between July 2014 and September 2018 were retrospectively analyzed. Morphologic features and whole-tumor histogram-derived parameters were correlated to pathological features using Fisher's exact or Mann-Whitney U tests and receiver operating characteristic (ROC) curves were constructed for significant parameters. Cox regression analysis and Kaplan-Meier curves were used to determine the association of clinical-pathological variables, morphological features, and histogram-derived parameters with RFS and OS.

Results: T1, ADC, T2, and ADC had the highest area under the curve (AUC) for prediction of vascular infiltration, nodal metastases, microscopic vascular invasion, and peripancreatic fat invasion (.657, .742, .760, and .818, respectively). Poor tumor differentiation (P = 0.002, hazard ratio-HR = 4.08), nodal ratio (P = 0.034, HR 6.95), and ADC (P = 0.021, HR 1.01) were significant predictors of RFS. Poor tumor differentiation (P = 0.05, HR 2.82), ADC (P = 0.02, HR 3.32), and arterial (P = 0.02, HR 6.84) were the only significant predictors of death; patients with higher arterial had significantly shorter OS than patients who did not meet this criterion (P = 0.02; median OS 24 vs 31 months).

Conclusion: Histogram-derived parameters may predict adverse pathological features in PDACs. High arterial seems to be associated with short OS after surgery in patients with PDAC.
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http://dx.doi.org/10.1007/s00261-020-02509-3DOI Listing
November 2020

Solid Pseudopapillary Neoplasms of the Pancreas: Clinicopathologic and Radiologic Features According to Size.

AJR Am J Roentgenol 2019 11 16;213(5):1073-1080. Epub 2019 Jul 16.

Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy.

The purpose of this study was to retrospectively analyze and correlate clinicopathologic and radiologic features of resected solid pseudopapillary neoplasms of the pancreas according to their size. Clinicopathologic and radiologic features of 106 resected solid pseudopapillary neoplasms of the pancreas over a 20-year period were retrospectively analyzed. Tumors were divided into three groups according to their size (≤ 30 mm, 31-50 mm, and ≥ 51 mm). Clinicopathologic and radiologic features were compared among groups using Kruskal-Wallis and Fisher exact tests. Forty-one tumors that were 30 mm or smaller, 30 tumors between 31 and 50 mm, and 35 tumors that were 51 mm or larger were included. Preoperative MRI of 76 patients and CT of 40 patients were examined. Patients with tumors that were 30 mm or smaller were significantly older than the other groups of patients ( = 0.038). Large tumors (31-50 and ≥ 51 mm) were more frequently located in the pancreatic body or tail ( = 0.008). Most tumors had well-defined margins (87.7%) and a mixed solid and cystic appearance (54.7%) at imaging; tumors that were 30 mm or smaller were more frequently entirely solid ( = 0.028). At histologic analysis, 13 tumors had at least one feature of malignancy; nodal and liver metastases were found in one patient (0.9%). No significant differences between groups were found regarding the presence of malignant histologic features ( = 0.932). The rate of incorrect preoperative diagnosis was higher in tumors 30 mm or smaller, albeit without significant differences between groups ( = 0.561). Malignancy in solid pseudopapillary neoplasms is not correlated with tumor size; tumors that are 30 mm or smaller may present atypical imaging features, which may overlap those of other solid tumors of the pancreas.
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http://dx.doi.org/10.2214/AJR.18.20715DOI Listing
November 2019

From fine-needle aspiration cytology to fluorescent in-situ hybridization in an unusual case of pharyngeal synovial sarcoma.

Diagn Cytopathol 2019 Oct 10;47(10):1067-1071. Epub 2019 Jul 10.

Pathology Unit, Department of Pathology and Diagnostics, Integrated University Hospital of Verona, Verona, Italy.

Synovial sarcoma arising in the pharynx is a rare entity, with very few cases described in literature, mainly as surgical-oriented case reports. We report the case of a healthy 20-year old man who presented with a painless right neck mass, clinically suspicious for a thyroid nodule. Ultrasound scan and fine-needle aspiration cytology failed to provide a definitive result, although suggesting a mesenchymal proliferation, in accordance with magnetic resonance imaging findings. Therefore, the lesion was removed with a minimally invasive surgical intervention. Definitive histologic and immunohistochemical examination of the surgical specimen revealed a biphasic synovial sarcoma, further validated by the detection of SS18 gene rearrangement on fluorescent in-situ hybridization examination. Although rarely, synovial sarcoma may arise in the pharynx. Radiological, cytological, histological and molecular findings are needed along each step of the diagnostic process.
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http://dx.doi.org/10.1002/dc.24274DOI Listing
October 2019

Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study.

Eur J Surg Oncol 2019 Sep 8;45(9):1668-1673. Epub 2019 Apr 8.

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy. Electronic address:

Background: The Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking.

Methods: Multicenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients without regular follow-up were interviewed about symptoms and complications.

Results: In total, 164 patients were enrolled, 55 WT (33.5%) and 109 kT (66.5%), of which 95 (57.9%) MI. There was no 30-day mortality (0%).The only significant difference in short-term outcome was more delayed gastric emptying (DGE) after WT (9.1% vs 1.8%, p = 0.043). MI-SPDP was associated with less blood loss (median 150 vs 250 ml, respectively, p < 0.001), less DGE (0% vs 10%, p = 0.002), less abdominal abscesses (8.4% vs 18.4%, p = 0.03) and less splenic infarctions (3.2% vs. 13%, p = 0.042), than open SPDP. Long-term follow-up (median 41 months) was available for 111 patients (67.7%) of whom 18 (16.2%) had an SPDP-related long-term sequela, mostly perigastric varices (n = 11, 9%) but without differences between WT and KT. Less long-term sequelae were reported after MI as compared to open SPDP (12.5% vs 21.2%, p = 0.032).

Conclusions: In this international retrospective study, the WT and KT had comparable short- and long-term outcomes. If a KT does not seem feasible during SPDP, a WT is recommended, rather than performing a splenectomy. MI-SPDP was associated with less short- and long term complications as compared to an open SPDP.
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http://dx.doi.org/10.1016/j.ejso.2019.04.004DOI Listing
September 2019

Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study.

Cancers (Basel) 2019 Feb 25;11(2). Epub 2019 Feb 25.

Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy.

Introduction: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to computed tomography (CT) overestimation of tumor extension and residual vascular involvement, limiting access to surgery to some patients with potentially resectable tumors. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging in the evaluation of PDAC after chemoradiotherapy in order to achieve complete resection.

Methods: We retrospectively enrolled 71 patients with locally advanced and borderline resectable PDAC who underwent neoadjuvant chemoradiotherapy. Pre-operative CT or magnetic resonance (MR) have been evaluated by three radiologists to assess major qualitative and quantitative parameters of lesions. Accuracy, sensitivity, and specificity compared to anatomopathological results were evaluated for each parameter. Cohen's K-coefficient has been calculated to evaluate the inter-observer agreement (IOA). Both single and consensus lecture have been tested. Different dimensional cut-offs were tested to categorize tumors according to their major axis and to compare with anatomopathological diameter, tumor persistence, and margin infiltration.

Results: A 25 mm cut-off was 67% sensitive, 90% specific, and 77% accurate in assessing real tumor dimension. 25 mm cut-off reported a 64% sensitivity, 78% specificity, and 69% accuracy in assessing R0 resection. Each 5 mm increment of major axis dimension there is an odds ratio (OR) 1.79 (95% CI 1.13⁻2.80, = 0.012) for R+ resection. Imaging presence of the perivascular cuff is not associated with tumor persistence and resection margin infiltration ( = 0.362). Lesion enhancement and pattern homogeneity were not accurate in determining tumor persistence. IOA was generally poor to fair, except for >25 mm cut-off classification where IOA was moderate. Diagnostic accuracy is superior in consensus lecture rather than single lecture.

Conclusion: Imaging methods tend to underestimate PDAC resectability after neoadjuvant-CRT. IOA is poor to fair in evaluating most of the qualitative parameters of downstaged pancreatic adenocarcinoma. Surgery should be considered for downstaged borderline resectable PDACs, independently from perivascular cuff presence, especially for tumors smaller than 25 mm.
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http://dx.doi.org/10.3390/cancers11020267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406608PMC
February 2019

CT Enhancement and 3D Texture Analysis of Pancreatic Neuroendocrine Neoplasms.

Sci Rep 2019 02 18;9(1):2176. Epub 2019 Feb 18.

Department of Pathology, Pancreas Institute, G.B. Rossi Hospital - University of Verona, Verona, Italy.

To evaluate pancreatic neuroendocrine neoplasms (panNENs) grade prediction by means of qualitative and quantitative CT evaluation, and 3D CT-texture analysis. Patients with histopathologically-proven panNEN, availability of Ki67% values and pre-treatment CT were included. CT images were retrospectively reviewed, and qualitative and quantitative images analysis were done; for quantitative analysis four enhancement-ratios and three permeability-ratios were created. 3D CT-texture imaging analysis was done (Mean Value; Variance; Skewness; Kurtosis; Entropy). Subsequently, these features were compared among the three grading (G) groups. 304 patients affected by panNENs were considered, and 100 patients were included. At qualitative evaluation, frequency of irregular margins was significantly different between tumor G groups. At quantitative evaluation, for all ratios, comparisons resulted statistical significant different between G1 and G3 groups and between G2 and G3 groups. At 3D CT-texture analysis, Kurtosis resulted statistical significant different among three G groups and Entropy resulted statistical significant different between G1 and G3 and between G2 and G3 groups. Quantitative CT evaluation of panNENs can predict tumor grade, discerning G1 from G3 and G2 from G3 tumors. CT-texture analysis can predict panNENs tumor grade, distinguishing G1 from G3 and G2 from G3, and G1 from G2 tumors.
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http://dx.doi.org/10.1038/s41598-018-38459-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379382PMC
February 2019

Ultrasound-guided percutaneous procedures in pancreatic diseases: new techniques and applications.

Eur Radiol Exp 2019 Jan 22;3(1). Epub 2019 Jan 22.

PhD Programme in Inflammation, Immunity and Cancer, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Ultrasound (US) is not only an important diagnostic tool for the evaluation of the pancreas, but is also a fundamental imaging technique to guide percutaneous interventions for several pancreatic diseases (fluid aspiration and drainage; invasive diagnosis by means fine-needle aspiration and core-needle biopsy; tumour ablation by radiofrequency, microwaves, irreversible electroporation, cryoablation, and high-intensity focused US). Technical improvements, such as contrast media and fusion imaging, have recently increased precision and safety and reduced procedure-related complications. New treatment US techniques for the ablation of pancreatic tumours, such as contrast-enhanced US and multimodality fusion imaging, have been recently developed and have elicited a growing interest worldwide. The purpose of this article was to review the most up-to-date role of US in percutaneous procedures for pancreatic diseases.
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http://dx.doi.org/10.1186/s41747-018-0081-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342746PMC
January 2019

Palliative therapy in pancreatic cancer-interventional treatment with radiofrequency ablation/irreversible electroporation.

Transl Gastroenterol Hepatol 2018 26;3:80. Epub 2018 Oct 26.

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, Verona, Italy.

Pancreatic cancer (PC) is a solid tumor with still a dismal prognosis. Diagnosis is usually late, when the disease is metastatic or locally advanced (LAPC). Only 20% of PC are amenable to surgery at the time of diagnosis and the vast majority of them, despite radically resected will unavoidably recur. The treatment of LAPC is a challenge. Current guidelines suggest to adopt systemic therapies upfront, based on multi-drugs chemotherapy regimens. However, the vast majority of patients will never experience conversion to surgical exploration and radical resection. Thus, there a large subgroup of LAPC patients where the only therapeutic chance is to offer palliative treatments, such as interventional ablative treatments, in order to obtain a cytoreduction of the tumor, trying to delay its growth and spread. Radiofrequency ablation (RFA) and irreversible electroporation (IRE) demonstrated to be safe and effective in obtaining a local control of the disease with some promising oncological results in terms of overall survival (OS). However, they should be adopted as a treatment strategy to adopt in parallel with other systemic therapies, within multidisciplinary choices. They are not free from complications, even serious, thus they should applied only in specialized centers of pancreatology. This review depicts the state of the art of the two techniques.
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http://dx.doi.org/10.21037/tgh.2018.10.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232064PMC
October 2018

Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where?

Neuroendocrinology 2019 27;108(3):161-171. Epub 2018 Nov 27.

Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.

Background/aims: Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up.

Methods: We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods.

Results: The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases.

Conclusions: Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.
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http://dx.doi.org/10.1159/000495774DOI Listing
December 2019

Pancreatic cystic neoplasm diagnosis: Role of imaging.

Endosc Ultrasound 2018 Sep-Oct;7(5):297-300

Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy.

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http://dx.doi.org/10.4103/eus.eus_38_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199913PMC
October 2018

Imaging presentation of pancreatic neuroendocrine neoplasms.

Insights Imaging 2018 Dec 9;9(6):943-953. Epub 2018 Oct 9.

Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy.

Pancreatic neuroendocrine neoplasms (P-NENs) are the second most common solid pancreatic neoplasms. P-NENs have a wide range of imaging features presentations and they can be detected with typical and atypical imaging presentations. Typical and atypical appearances can be explained by pathologic correlations. P-NENs are generally hypervascular lesions, showing a typical enhancement behavior after contrast media injection during imaging methods, but they could also have different imaging features, creating some difficulty in differential diagnosis. For this reason, radiologists should be aware of different imaging presentations of these neoplasms. Radiological evaluation has a critical role in P-NENs identification, characterization, and staging of these neoplasms, especially in those cases in which surgery is the treatment of choice. The present paper shows, indicating the underlying pathologic correlations, typical and atypical presentations of NENs. KEY POINTS: • P-NENs have a wide range of imaging features presentations, typical and atypical. • Pathology could help in better understanding the typical P-NENs appearance at imaging. • P-NENs are generally hypervascular lesions. • Radiological evaluation has a critical role in P-NENs identification and management. • Radiologists should know every type of different imaging presentation of P-NENs to better diagnose these kinds of lesions.
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http://dx.doi.org/10.1007/s13244-018-0658-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6269331PMC
December 2018

CT Texture Analysis of Ductal Adenocarcinoma Downstaged After Chemotherapy.

Anticancer Res 2018 Aug;38(8):4889-4895

Department of Radiology, G.B. Rossi Hospital - University of Verona, Verona, Italy

Background/aim: Re-staging of ductal adenocarcinoma using computed tomography (CT) scan can be problematic so new imaging techniques and evaluation parameters are required. The aim of the study was to evaluate the added value of CT texture analysis in estimation of tissue changes in ductal adenocarcinoma downsized and resected after chemotherapy.

Materials And Methods: Patients with ductal adenocarcinoma downstaged after neoadjuvant treatment, and resected, were included. A pre- and post-treatment CT was obtained. In comparison, patients with disease progression were included for texture analysis evaluation at CT pre- and post-treatment. CT texture analysis results were compared.

Results: A total of 17 patients affected by un-resectable or borderline ductal adenocarcinoma reached the resectable stage after treatment. The comparison between Kurtosis pre- and Kurtosis post-treatment showed a statistically significant difference. On the contrary, in the comparison group composed of 14 patients with disease progression there was no statistical difference regarding this parameter.

Conclusion: This evaluation may represent an added value in tumor tissue changes judgment and can be extremely useful to diagnose downstaging in those cases with no evident downsizing after chemotherapy.
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http://dx.doi.org/10.21873/anticanres.12803DOI Listing
August 2018

Intravoxel incoherent motion diffusion-weighted MR imaging of solid pancreatic masses: reliability and usefulness for characterization.

Abdom Radiol (NY) 2019 01;44(1):131-139

Department of Radiology, Ospedale P. Pederzoli, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy.

Purpose: IVIM-DW imaging has shown potential usefulness in the study of pancreatic lesions. Controversial results are available regarding the reliability of the measurements of IVIM-derived parameters. The aim of this study was to evaluate the reliability and the diagnostic potential of IVIM-derived parameters in differentiation among focal solid pancreatic lesions and normal pancreas (NP).

Methods: Fifty-seven patients (34 carcinomas-PDACs, 18 neuroendocrine neoplasms-panNENs, and 5 autoimmune pancreatitis-AIP) and 50 subjects with NP underwent 1.5-T MR imaging including IVIM-DWI. Images were analyzed by two independent readers. Apparent diffusion coefficient (ADC), slow component of diffusion (D), incoherent microcirculation (Dp), and perfusion fraction (f) were calculated. Interobserver reliability was assessed with intraclass correlation coefficient (ICC). A Kruskal-Wallis H test with Steel-Dwass post hoc test was used for comparison. The diagnostic performance of each parameter was evaluated through receiver operating characteristic (ROC) curve analysis.

Results: Overall interobserver agreement was excellent (ICC = 0.860, 0.937, 0.968, and 0.983 for ADC, D, Dp, and f). D, Dp, and f significantly differed among PDACs and panNENs (p = 0.002, < 0.001, and < 0.001), albeit without significant difference at the pairwise comparison of ROC curves (p = 0.08-0.74). Perfusion fraction was higher in AIP compared with PDACs (p = 0.024; AUC = 0.735). Dp and f were higher in panNENs compared with AIP (p = 0.029 and 0.023), without differences at ROC analysis (p = 0.07).

Conclusions: IVIM-derived parameters have excellent reliability and could help in differentiation among solid pancreatic lesions and NP.
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http://dx.doi.org/10.1007/s00261-018-1684-zDOI Listing
January 2019

Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: A systematic review and proportion meta-analysis of screening results.

Pancreatology 2018 Jun 10;18(4):420-428. Epub 2018 Apr 10.

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.

Background/objectives: Screening/surveillance programs for pancreatic cancer (PC) in familial high-risk individuals (FPC-HRI) have been widely reported, but their merits remain unclear. The data reported so far are heterogeneous-especially in terms of screening yield. We performed a systematic review and meta-analysis of currently available data coming from screening/surveillance programs to evaluate the proportion of screening goal achievement (SGA), overall surgery and unnecessary surgery.

Methods: We searched MEDLINE, Embase, PubMed and the Cochrane Library database from January 2000 to December 2016to identify studies reporting results of screening/surveillance programs including cohorts of FPC-HRI. The main outcome measures were weighted proportion of SGA, overall surgery, and unnecessary surgery among the FPC-HRI cohort, using a random effects model. SGA was defined as any diagnosis of resectable PC, PanIN3, or high-grade dysplasia intraductal papillary mucinous neoplasm (HGD-IPMN). Unnecessary surgery was defined as any other final pathology.

Results: In a meta-analysis of 16 studies reporting on 1551 FPC-HRI cases, 30 subjects (1.82%), received a diagnosis of PC, PanIN3 or HGD-IPMNs. The pooled proportion of SGA was 1.4%(95% CI 0.8-2, p < 0.001, I = 0%). The pooled proportion of overall surgery was 6%(95% CI 4.1-7.9, p < 0.001, I = 60.91%). The pooled proportion of unnecessary surgery was 68.1%(95% CI 59.5-76.7, p < 0.001, I = 4.05%); 105 subjects (6.3%) received surgery, and the overall number of diagnoses from non-malignant specimens was 156 (1.5 lesion/subject).

Conclusions: The weighted proportion of SGA of screening/surveillance programs published thus far is excellent. However, the probability of receiving surgery during the screening/surveillance program is non-negligible, and unnecessary surgery is a potential negative outcome.
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http://dx.doi.org/10.1016/j.pan.2018.04.002DOI Listing
June 2018

Can histogram analysis of MR images predict aggressiveness in pancreatic neuroendocrine tumors?

Eur Radiol 2018 Jun 19;28(6):2582-2591. Epub 2018 Jan 19.

Department of Radiology, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Objectives: To evaluate MRI derived whole-tumour histogram analysis parameters in predicting pancreatic neuroendocrine neoplasm (panNEN) grade and aggressiveness.

Methods: Pre-operative MR of 42 consecutive patients with panNEN >1 cm were retrospectively analysed. T1-/T2-weighted images and ADC maps were analysed. Histogram-derived parameters were compared to histopathological features using the Mann-Whitney U test. Diagnostic accuracy was assessed by ROC-AUC analysis; sensitivity and specificity were assessed for each histogram parameter.

Results: ADC was significantly higher in G2-3 tumours with ROC-AUC 0.757; sensitivity and specificity were 83.3 % (95 % CI: 61.2-94.5) and 61.1 % (95 % CI: 36.1-81.7). ADC was higher in panNENs with vascular involvement, nodal and hepatic metastases (p= .008, .021 and .008; ROC-AUC= 0.820, 0.709 and 0.820); sensitivity and specificity were: 85.7/74.3 % (95 % CI: 42-99.2 /56.4-86.9), 36.8/96.5 % (95 % CI: 17.2-61.4 /76-99.8) and 100/62.8 % (95 % CI: 56.1-100/44.9-78.1). No significant differences between groups were found for other histogram-derived parameters (p >.05).

Conclusions: Whole-tumour histogram analysis of ADC maps may be helpful in predicting tumour grade, vascular involvement, nodal and liver metastases in panNENs. ADC and ADC are the most accurate parameters for identification of panNENs with malignant behaviour.

Key Points: • Whole-tumour ADC histogram analysis can predict aggressiveness in pancreatic neuroendocrine neoplasms. • ADC entropy and kurtosis are higher in aggressive tumours. • ADC histogram analysis can quantify tumour diffusion heterogeneity. • Non-invasive quantification of tumour heterogeneity can provide adjunctive information for prognostication.
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http://dx.doi.org/10.1007/s00330-017-5236-7DOI Listing
June 2018

Vanishing Pancreatic Cysts during Follow-Up: Another Step Towards De-Emphasizing Cyst Size as a Major Clinical Predictor of Malignancy.

Dig Surg 2018 12;35(6):508-513. Epub 2017 Dec 12.

Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.

Introduction: In the management of pancreatic cystic neoplasms (PCN), size plays a crucial role as the expression of disease progression. While many evidences regarding the natural history of growing pancreatic cysts exist, almost no data are available regarding cysts with a reduction in size.

Methods: Radiological and clinical data from patients of the dedicated pancreatic cysts outpatient clinic of the Department of General and Pancreatic Surgery, University of Verona Hospital were retrospectively reviewed. Patients diagnosed with PCNs reducing in size during follow-up were reviewed.

Results: From a total of 3,146 patients, we identified 12 (0.38%) vanishing/reducing cysts without a history of pancreatitis. Most of them were presumed IPMN (66.6%). The median follow-up was 69 months and the median cyst's size 30 mm (range 10-49). Most of the patients (75%) experienced a reduction in cyst size (median reduction of 8 mm, range 6-22) after a median time of 12 months (range 6-63), 3 patients experienced a complete disappearance of the cyst.

Conclusion: Cyst size reduction during follow-up is a rare phenomenon of unknown explanation. It adds to the debate regarding the role of size as a clinical predictor whenever a definite diagnosis of a PCN cannot be reached.
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http://dx.doi.org/10.1159/000485199DOI Listing
January 2019

The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs): Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution.

Ann Surg 2019 04;269(4):725-732

General and Pancreatic Surgery Department, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy.

Objective: The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome.

Background: Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection.

Methods: From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses.

Results: Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years.

Conclusions: Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.
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http://dx.doi.org/10.1097/SLA.0000000000002594DOI Listing
April 2019

Tumor thrombosis: a peculiar finding associated with pancreatic neuroendocrine neoplasms. A pictorial essay.

Abdom Radiol (NY) 2018 03;43(3):613-619

Department of Radiology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.

While abutment, encasement or vessel occlusion are identified in most patients with a pancreatic tumor, tumor thrombosis is an uncommon finding. In particular, there are no description in the literature of tumor thrombosis associated with ductal adenocarcinoma, the most common pancreatic tumor. On the other hand, surgical series reveal that tumor thrombosis is associated with about 5% of pancreatic neuroendocrine neoplasms (PanNENs), and literature data suggest that this finding is frequently underreported on pre-operative imaging examinations. Tumor thrombosis may be clinically relevant, causing splenoportomesenteric hypertension, possibly responsible for life-threatening upper gastrointestinal bleeding. Bland thrombosis caused by direct infiltration of peri-pancreatic vessels frequently determines surgical unresectability, even in neuroendocrine tumors; on the opposite, tumor thrombosis associated with PanNENs do not exclude surgery per se, even though both morbidity and mortality can be increased by such condition. Considering the favorable prognosis of PanNENs and the frequent need to treat tumor thrombosis in order to prevent complications or to relieve symptoms, it is of paramount importance for radiologists the knowledge of the variety of findings associated with tumor thrombosis in PanNENs.
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http://dx.doi.org/10.1007/s00261-017-1243-zDOI Listing
March 2018

Are Cystic Pancreatic Neuroendocrine Tumors an Indolent Entity Results from a Single-Center Surgical Series.

Neuroendocrinology 2018 7;106(3):234-241. Epub 2017 Jun 7.

Introduction: Cystic pancreatic neuroendocrine tumors (CPanNETs) represent an uncommon variant of pancreatic neuroendocrine tumors (PanNETs). Due to their rarity, there is a lack of knowledge with regard to clinical features and postoperative outcome.

Methods: The prospectively maintained surgical database of a high-volume institution was queried, and 46 resected CPanNETs were detected from 1988 to 2015. Clinical, demographic, and pathological features and survival outcomes of CPanNETs were described and matched with a population of 92 solid PanNETs (SPanNETs) for comparison.

Results: CPanNETs accounted for 7.8% of the overall number of resected PanNETs (46/587). CPanNETs were mostly sporadic (n = 42, 91%) and nonfunctioning (39%). Two functioning CPanNETs were detected (4.3%), and they were 2 gastrinomas. The median tumor diameter was 30 mm (range 10-120). All tumors were well differentiated, with 38 (82.6%) G1 and 8 (17.4%) G2 tumors. Overall, no CPanNET showed a Ki-67 >5%. A correct preoperative diagnosis of a CPanNET was made in half of the cases. After a median follow-up of >70 months, the 5- and 10-year overall survival of resected CPanNETs was 93.8 and 62.5%, respectively, compared to 92.7 and 84.6% for SPanNETs (p > 0.05). The 5- and 10-year disease-free survival rates were 94.5 and 88.2% for CPanNETs and 81.8 and 78.9% for SPanNETs, respectively (p > 0.05).

Conclusion: In the setting of a surgical cohort, CPanNETs are rare, nonfunctional, and well-differentiated neoplasms. After surgical resection, they share the excellent outcome of their well-differentiated solid counterparts for both survival and recurrence.
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http://dx.doi.org/10.1159/000477849DOI Listing
January 2019