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Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer. Fam Cancer 2024; 23:323-339. [PMID: 38619782 PMCID: PMC11255004 DOI: 10.1007/s10689-024-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/16/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths and is associated with a poor prognosis. The majority of these cancers are detected at a late stage, contributing to the bad prognosis. This underscores the need for novel, enhanced early detection strategies to improve the outcomes. While population-based screening is not recommended due to the relatively low incidence of PDAC, surveillance is recommended for individuals at high risk for PDAC due to their increased incidence of the disease. However, the outcomes of pancreatic cancer surveillance in high-risk individuals are not sorted out yet. In this review, we will address the identification of individuals at high risk for PDAC, discuss the objectives and targets of surveillance, outline how surveillance programs are organized, summarize the outcomes of high-risk individuals undergoing pancreatic cancer surveillance, and conclude with a future perspective on pancreatic cancer surveillance and novel developments.
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Affiliation(s)
- Aleksander M Bogdanski
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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2
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Ohno E, Kuzuya T, Kawabe N, Nakaoka K, Tanaka H, Nakano T, Miyachi Y, Hashimoto S, Hirooka Y. Contributions of endoscopic ultrasonography-guided tissue acquisition (EUS-TA) to the diagnostics of biliary stricture and gallbladder lesions. J Med Ultrason (2001) 2024; 51:227-233. [PMID: 38700561 DOI: 10.1007/s10396-024-01458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/04/2024] [Indexed: 05/21/2024]
Abstract
Endoscopic ultrasonography (EUS) provides high spatial resolution and more detailed images than other diagnostic modalities. Furthermore, EUS-guided tissue acquisition (EUS-TA), such as EUS-guided fine needle aspiration or biopsy (EUS-FNA/FNB), is an indispensable tool in pancreaticobiliary disease diagnostics, supporting a conclusive pathological diagnosis. In this review, we evaluate the current status and the usefulness of EUS-TA for the diagnostics of the following biliary tract diseases: (A) biliary stricture diagnostics, (B) biliary tract cancer (BTC) itself, and (C) staging of advanced BTC. Previous reports have shown that EUS-FNA for biliary lesions is a safe procedure that is useful in differentiating biliary cancer from benign lesions and in the staging of BTC. On the other hand, the diagnostic performance of EUS-TA for bile duct lesions is reported to be similar to that of transpapillary biopsy. Overall, EUS-TA for biliary lesions may be a safe and effective method, but it should be performed with an understanding of the risk of serious adverse events such as bile leakage and peritoneal dissemination of cancer. It is recommended for distal biliary stricture lesions for which endoscopic retrograde cholangiopancreatography cannot confirm the diagnosis or gallbladder lesions if they do not require the needle to pass through the biliary lumen.
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Affiliation(s)
- Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naoto Kawabe
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazunori Nakaoka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroyuki Tanaka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuji Nakano
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yohei Miyachi
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Senju Hashimoto
- Department of Gastroenterology and Hepatology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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El Menabawey T, McCrudden R, Shetty D, Hopper AD, Huggett MT, Bekkali N, Carroll NR, Henry E, Johnson GJ, Keane MG, Love M, McKay CJ, Norton S, Oppong K, Penman I, Ramesh J, Ryan B, Siau K, Nayar M. UK and Ireland Joint Advisory Group (JAG) consensus statements for training and certification in diagnostic endoscopic ultrasound (EUS). Gut 2023; 73:118-130. [PMID: 37739777 PMCID: PMC10715553 DOI: 10.1136/gutjnl-2023-329800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS International endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation. In 2019, the Joint Advisory Group on GI Endoscopy (JAG) commissioned a working group to examine the evidence relating to this process for EUS. The aim of this was to develop evidence-based recommendations for EUS training and certification in the UK. METHODS Under the oversight of the JAG quality assurance team, a modified Delphi process was conducted which included major stakeholders from the UK and Ireland. A formal literature review was made, initial questions for study were proposed and recommendations for training and certification in EUS were formulated after a rigorous assessment using the Grading of Recommendation Assessment, Development and Evaluation tool and subjected to electronic voting to identify accepted statements. These were peer reviewed by JAG and relevant stakeholder societies before consensus on the final EUS certification pathway was achieved. RESULTS 39 initial questions were proposed of which 33 were deemed worthy of assessment and finally formed the key recommendations. The statements covered four key domains, such as: definition of competence (13 statements), acquisition of competence (10), assessment of competence (5) and postcertification mentorship (5). Key recommendations include: (1) minimum of 250 hands-on cases before an assessment for competency can be made, (2) attendance at the JAG basic EUS course, (3) completing a minimum of one formative direct observation of procedural skills (DOPS) every 10 cases to allow the learning curve in EUS training to be adequately studied, (4) competent performance in summative DOPS assessments and (5) a period of mentorship over a 12-month period is recommended as minimum to support and mentor new service providers. CONCLUSIONS An evidence-based certification pathway has been commissioned by JAG to support and quality assure EUS training. This will form the basis to improve quality of training and safety standards in EUS in the UK and Ireland.
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Affiliation(s)
- Tareq El Menabawey
- Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Gastroenterology, Homerton University Hospital, London, UK
| | - Raymond McCrudden
- Department of Gastroenterology, University Hospitals Dorset NHS Trust, Bournemouth, UK
| | - Dushyant Shetty
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Andrew D Hopper
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Noor Bekkali
- Department of Gastroenterology and Hepatology, University of Oxford, Translational Gastroenterology Unit, Oxford, UK
| | - Nicholas R Carroll
- Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elaine Henry
- Department of Gastroenterology, NHS Tayside, Dundee, UK
| | - Gavin J Johnson
- Pancreatobiliary Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Margaret G Keane
- Gastroenterology and Hepatology, Johns Hopkins, Baltimore, Maryland, USA
| | - Mark Love
- Radiology, Belfast City Hospital, Belfast, UK
| | - Colin J McKay
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Sally Norton
- Upper Gastrointestinal Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Kofi Oppong
- HPB Unit & Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Ian Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Jayapal Ramesh
- Department of Gastroenterology, Royal Liverpool Hospital NHS Trust, Liverpool, UK
| | - Barbara Ryan
- Department of Gastroenterology, Trinity College Dublin, Dublin, Ireland
| | - Keith Siau
- Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
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Qu W, Yang J, Li J, Yuan G, Li S, Chu Q, Xie Q, Zhang Q, Cheng B, Li Z. Avoid non-diagnostic EUS-FNA: a DNN model as a possible gatekeeper to distinguish pancreatic lesions prone to inconclusive biopsy. Br J Radiol 2023; 96:20221112. [PMID: 37195026 PMCID: PMC10607397 DOI: 10.1259/bjr.20221112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE This work aimed to explore the utility of CT radiomics with machine learning for distinguishing the pancreatic lesions prone to non-diagnostic ultrasound-guided fine-needle aspiration (EUS-FNA). METHODS 498 patients with pancreatic EUS-FNA were retrospectively reviewed [Development cohort: 147 pancreatic ductal adenocarcinoma (PDAC); Validation cohort: 37 PDAC]. Pancreatic lesions not PDAC were also tested exploratively. Radiomics extracted from contrast-enhanced CT was integrated with deep neural networks (DNN) after dimension reduction. The receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were performed for model evaluation. And, the explainability of the DNN model was analyzed by integrated gradients. RESULTS The DNN model was effective in distinguishing PDAC lesions prone to non-diagnostic EUS-FNA (Development cohort: AUC = 0.821, 95% CI: 0.742-0.900; Validation cohort: AUC = 0.745, 95% CI: 0.534-0.956). In all cohorts, the DNN model showed better utility than the logistic model based on traditional lesion characteristics with NRI >0 (p < 0.05). And, the DNN model had net benefits of 21.6% at the risk threshold of 0.60 in the validation cohort. As for the model explainability, gray-level co-occurrence matrix (GLCM) features contributed the most averagely and the first-order features were the most important in the sum attribution. CONCLUSION The CT radiomics-based DNN model can be a useful auxiliary tool for distinguishing the pancreatic lesions prone to nondiagnostic EUS-FNA and provide alerts for endoscopists preoperatively to reduce unnecessary EUS-FNA. ADVANCES IN KNOWLEDGE This is the first investigation into the utility of CT radiomics-based machine learning in avoiding non-diagnostic EUS-FNA for patients with pancreatic masses and providing potential pre-operative assistance for endoscopists.
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Affiliation(s)
- Weinuo Qu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiannan Yang
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingguo Xie
- Biomedical Engineering Department, College of Life Sciences and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Bin Cheng
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Technical Performance, Overall Accuracy and Complications of EUS-Guided Interventional Procedures: A Dynamic Landscape. Diagnostics (Basel) 2022; 12:diagnostics12071641. [PMID: 35885546 PMCID: PMC9324484 DOI: 10.3390/diagnostics12071641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022] Open
Abstract
Endoscopic ultrasound (EUS) gained wide acceptance as the diagnostic and minimally invasive therapeutic approach for intra-luminal and extraluminal gastrointestinal, as well as various non-gastrointestinal lesions. Since its introduction, EUS has undergone substantial technological advances. This multi-centric study is a retrospective analysis of a prospectively maintained database of patients who underwent EUS for the evaluation of lesions located within the gastrointestinal tract and the proximal organs. It aimed to extensively assess in dynamic the dual-center EUS experience over the course of the past 20 years. Hence, we performed a population study and an overall assessment of the EUS procedures. The performance of EUS-FNA/FNB in diagnosing pancreatic neoplasms was evaluated. We also investigated the contribution of associating contrast-enhanced ultrasound imaging (CE-EUS) with EUS-FNA/FNB for differentiating solid pancreatic lesions or cystic pancreatic lesions. A total of 2935 patients undergoing EUS between 2002–2021 were included, out of which 1880 were diagnostic EUS and 1052 EUS-FNA/FNB (80% FNA and 20% FNB). Therapeutic procedures performed included endoscopic transmural drainage of pancreatic fluid collections, celiac plexus block and neurolysis, while diagnostic EUS-like CE-EUS (20%) and real-time elastography (12%) were also conducted. Most complications occurred during the first 7 days after EUS-FNA/FNB or pseudocyst drainage. EUS and the additional tools have high technical success rates and low rates of complications. The EUS methods are safe, cost effective and indispensable for the diagnostic or therapeutic management in gastroenterological everyday practice.
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Endoscopic Ultrasound Plus Endoscopic Retrograde Cholangiopancreatography Based Tissue Sampling for Diagnosis of Proximal and Distal Biliary Stenosis Due to Cholangiocarcinoma: Results from a Retrospective Single-Center Study. Cancers (Basel) 2022; 14:cancers14071730. [PMID: 35406502 PMCID: PMC8997048 DOI: 10.3390/cancers14071730] [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: 02/23/2022] [Revised: 03/23/2022] [Accepted: 03/27/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary The diagnosis of cholangiocarcinoma depends on several factors, including growth pattern and location. Previous studies have evaluated the diagnostic accuracy of endoscopic retrograde cholangiopancreatography based tissue sampling and endoscopic ultrasound with either fine-needle aspiration or fine-needle biopsy, reporting values < 80% for each procedure. Here, we describe the performance of both methods in a group of patients with a stricture of the biliary tract suspicious for cholangiocarcinoma. Our analysis confirms the high diagnostic accuracy of the procedures when performed together in distinguishing between a primary malignant or benign biliary stenosis. Abstract Differentiating between benign and malignant biliary stenosis (BS) is challenging, where tissue diagnosis plays a crucial role. Endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or biopsy (FNB) are used to obtain tissue specimens from BS. The aim of this retrospective study was to evaluate the diagnostic yield of EUS-FNA/B plus ERCP with brushing or forceps biopsy in BS. All endoscopic procedures performed in patients with BS at our gastroenterology unit were reviewed. The gold standard for diagnosis was histopathology of surgical specimens or the progression of the malignancy at radiological or clinical follow-up. A total of 70 endoscopic procedures were performed in 51 patients with BS. Final endoscopic diagnosis was reached in 96% of the patients and was malignant in 61.7% and benign in 38.3% of cases. Sensitivity, specificity, and diagnostic accuracy were 73.9%, 100%, and 80%, respectively, for EUS-FNA/B; 66.7%, 100%, and 82.5% for ERCP; and 83.3%, 100%, and 87.5% for both procedures carried out in the same session. The combination of EUS and ERCP tissue sampling seems to increase diagnostic accuracy in defining the etiology of BS. Performing both procedures in a single session reduces the time required for diagnostic work-up and optimizes resources.
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