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Pancreatic Neoplasms: HELP
Articles by Rosalie A. Carr
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, R. A. Carr wrote the following 10 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Article Performance of candidate urinary biomarkers for pancreatic cancer - Correlation with pancreatic cyst malignant progression? 2019

Yip-Schneider, Michele T / Soufi, Mazhar / Carr, Rosalie A / Flick, Katelyn F / Wu, Huangbing / Colgate, Cameron L / Schmidt, C Max. ·Departments of Surgery, USA; Departments of Walther Oncology Center, USA; Departments of Indiana University Simon Cancer Center, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA. · Departments of Surgery, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA. · Departments of Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. · Departments of Surgery, USA; Departments of Biochemistry/Molecular Biology, USA; Departments of Walther Oncology Center, USA; Departments of Indiana University Simon Cancer Center, USA; Departments of Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA. Electronic address: maxschmi@iupui.edu. ·Am J Surg · Pubmed #31554598.

ABSTRACT: BACKGROUND: Intraductal papillary mucinous neoplasms (IPMN) are precursors of pancreatic cancer. Potential biomarkers of IPMN progression have not been identified in urine. A few urinary biomarkers were reported to be predictive of pancreatic ductal adenocarcinoma (PDAC). Here, we seek to assess their ability to detect high-risk IPMN. METHODS: Urine was collected from patients undergoing pancreatic resection and healthy controls. TIMP-1(Tissue Inhibitor of Metalloproteinase-1), LYVE-1(Lymphatic Vessel Endothelial Receptor 1), and PGEM(Prostaglandin E Metabolite) levels were determined by ELISA and analyzed by Kruskal-Wallis. RESULTS: Median urinary TIMP-1 levels were significantly lower in healthy controls (n = 9; 0.32 ng/mg creatinine) compared to PDAC (n = 13; 1.95) but not significantly different between low/moderate-grade (n = 20; 0.71) and high-grade/invasive IPMN (n = 20; 1.12). No significant difference in urinary LYVE-1 was detected between IPMN low/moderate (n = 16; 0.37 ng/mg creatinine) and high/invasive grades (n = 21; 0.09). Urinary PGEM levels were not significantly different between groups. CONCLUSIONS: Urinary TIMP-1, LYVE-1, and PGEM do not correlate with malignant potential of pancreatic cysts.

2 Article Cystic pancreatic neuroendocrine tumors: A more favorable lesion? 2019

Carr, Rosalie A / Bletsis, Panagiotis / Roch, Alexandra M / House, Michael G / Zyromski, Nicholas J / Nakeeb, Attila / Schmidt, C Max / Ceppa, Eugene P. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: eceppa@iupui.edu. ·Pancreatology · Pubmed #30704851.

ABSTRACT: BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) are predominantly solid lesions with malignant potential. Cystic PNETs are a small subset in which data are scarce. The aim of this study was to compare clinical and biologic differences between cystic and solid PNETs. METHODS: Patients with PNETs undergoing pancreatectomy between 1988 and 2016 at a high-volume center were reviewed retrospectively. Demographic, clinical, and histopathologic data were collected and analyzed. RESULTS: 347 patients with PNETs were identified; 27% (n = 91) were cystic. Patients with cystic PNETs were generally older (59 vs. 55 years, p = 0.05). Cystic PNETs were more commonly non-functional (95% vs. 82%, p = 0.004), asymptomatic (44% vs. 28%, p = 0.009), and located in the pancreatic body/tail (81% vs. 60%, p < 0.001) than solid PNETs. Although cystic and solid PNETs had similar sizes and pathologic stage at the time of resection, Ki-67 proliferation index (Ki-67 ≤ 9%: 98% vs. 85%; p = 0.007), and histologic grade (grade I: 84% vs. 59%; p = 0.009) had less aggressive features in cystic PNETs. CONCLUSION: In addition to reporting a higher than previously published incidence of cystic PNET (27%), this study found significant differences in multiple clinicopathologic variables between cystic and solid PNETs. Cystic PNET may be a distinct and possibly less aggressive subtype of PNET yet have similar pathologic stage, recurrence, and survival to solid PNETs. Cystic PNETs require further attention to better understand the true natural history.

3 Article Are BRCA1 and BRCA2 gene mutation patients underscreened for pancreatic adenocarcinoma? 2019

Roch, Alexandra M / Schneider, Justine / Carr, Rosalie A / Lancaster, William P / House, Michael G / Zyromski, Nicholas J / Nakeeb, Attila / Schmidt, C Max / Ceppa, Eugene P. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. ·J Surg Oncol · Pubmed #30636051.

ABSTRACT: BACKGROUND: Breast cancer (BRCA) mutations account for the highest proportion of hereditary causes of pancreatic ductal adenocarcinoma (PDAC). Screening is currently recommended only for patients with one first-degree relative or two family members with PDAC. We hypothesized that screening all BRCA1/2 patients would identify a higher rate of pancreatic abnormalities. METHODS: All BRCA1/2 patients at a single academic center were retrospectively reviewed (2005-2015). Pancreatic abnormalities were defined on cross-sectional imaging as pancreatic neoplasm (cystic/solid) or main-duct dilation. RESULTS: Two hundred and four patients were identified with BRCA mutations. Forty-seven (40%) had abdominal imaging (20 computerized tomography and 27 magnetic resonance imaging). Twenty-one percent had pancreatic abnormalities (PDAC [n = 2] and intraductal papillary mucinous neoplasm [IPMN; n = 8]). The prevalence of pancreatic abnormalities and IPMN was higher in BRCA2 patients than in the general population (21% vs 8% and 17% vs 1%; P = 0.0007 and P < 0.0001, respectively), with no influence of family history. Similarly, BRCA1 patients had an increased prevalence of IPMN (8.3% vs 1%; P < 0.0001). CONCLUSIONS: In this series, 4% and 17% of BRCA2 patients developed PDAC and IPMN, respectively. Eight percent of BRCA1 patients developed IPMN. Under current recommended screening, 60% of BRCA1/2 patients had incompletely pancreatic assessment. With no influence of family history, this study suggests all BRCA1/2 patients should undergo a high-risk screening protocol that will identify a higher rate of precancerous pancreatic neoplasms amenable to curative resection.

4 Article Pancreatic cyst fluid glucose: rapid, inexpensive, and accurate diagnosis of mucinous pancreatic cysts. 2018

Carr, Rosalie A / Yip-Schneider, Michele T / Simpson, Rachel E / Dolejs, Scott / Schneider, Justine G / Wu, Huangbing / Ceppa, Eugene P / Park, Walter / Schmidt, C Max. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN; Walther Oncology Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN. Electronic address: myipschn@iupui.edu. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN. · Department of Medicine, Stanford University, Stanford, CA. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN; Walther Oncology Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN; Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, IN. Electronic address: maxschmi@iupui.edu. ·Surgery · Pubmed #29241991.

ABSTRACT: BACKGROUND: The most widely accepted biochemical test for preoperative differentiation of mucinous from benign, nonmucinous pancreatic cysts is cyst fluid carcinoembryonic antigen. However, the diagnostic accuracy of carcinoembryonic antigen ranges from 70% to 86%. Based on previous work, we hypothesize that pancreatic cyst fluid glucose may be an attractive alternative to carcinoembryonic antigen. METHODS: Pancreatic cyst fluid was collected during endoscopic or operative intervention. Diagnoses were pathologically confirmed. Glucose and carcinoembryonic antigen were measured using a patient glucometer and automated analyzer/enzyme-linked immunosorbent assay. Sensitivity, specificity, accuracy, and receiver operator characteristic analyses were performed. RESULTS: Cyst fluid samples from 153 patients were evaluated (mucinous: 25 mucinous cystic neoplasms, 77 intraductal papillary mucinous neoplasms, 4 ductal adenocarcinomas; nonmucinous: 21 serous cystic neoplasms, 9 cystic neuroendocrine tumors, 14 pseudocysts, 3 solid pseudopapillary neoplasms). Median cyst fluid glucose was lower in mucinous versus nonmucinous cysts (19 vs 96 mg/dL; P < .0001). With a threshold of ≤ 50 mg/dL, cyst fluid glucose was 92% sensitive, 87% specific, and 90% accurate in diagnosing mucinous pancreatic cysts. In comparison, cyst fluid carcinoembryonic antigen with a threshold of >192 ng/mL was 58% sensitive, 96% specific, and 69% accurate. Area under the curve for glucose and CEA were similar at 0.91 and 0.92. CONCLUSION: Cyst fluid glucose has significant advantages over carcinoembryonic antigen and should be considered for use as a routine diagnostic test for pancreatic mucinous cysts.

5 Article Cancer history: A predictor of IPMN subtype and dysplastic status? 2018

Carr, Rosalie A / Kiel, Brandon A / Roch, Alexandra M / Ceppa, Eugene P / House, Michael G / Zyromski, Nicholas J / Nakeeb, Attila / Schmidt, C Max. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: maxschmi@iupui.edu. ·Am J Surg · Pubmed #29174163.

ABSTRACT: INTRODUCTION: The aim of this study was to determine the association of PMH and FH of pancreatic (PDAC) and non-pancreatic cancers with IPMN malignant risk. METHODS: A retrospective review of a prospective database of IPMN patients undergoing resection was performed to assess FH and PMH. RESULTS: FH of PDAC was present in 13% of 362 included patients. Of these, 8% had at least one first degree relative (FDR) with PDAC. The rate of PDAC positive FH in non-invasive versus invasive IPMN patients was 14% and 8%, respectively (p = 0.3). In main duct IPMN patients, FH (44%) and PMH of non-pancreatic cancer (16%) was higher than that seen in branch duct IPMN (FH 29%; PMH 6%; p = 0.004 and 0.008). CONCLUSIONS: FH of PDAC is not associated with IPMN malignant progression. FH and PMH of non-pancreatic cancer is associated with main duct IPMN, the subtype with the highest rate of invasive transformation.

6 Article Prospective Evaluation of Associations between Cancer-Related Pain and Perineural Invasion in Patients with Resectable Pancreatic Adenocarcinoma. 2017

Carr, Rosalie A / Roch, Alexandra M / Zhong, Xin / Ceppa, Eugene P / Zyromski, Nicholas J / Nakeeb, Attila / Schmidt, C Max / House, Michael G. ·Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA. · Department of General Surgery, Indiana University School of Medicine, 515 Barnhill Drive, Indianapolis, IN, 46202, USA. michouse@iupui.edu. ·J Gastrointest Surg · Pubmed #28785934.

ABSTRACT: INTRODUCTION: Perineural invasion is a unique characteristic of pancreatic adenocarcinoma biology and is present in the majority of resected pathologic specimens. The purpose of this study was to understand the relationships between preoperative pain and perineural invasion in patients with pancreatic adenocarcinoma. METHODS: Fifty-two chemotherapy naive patients undergoing resection for pancreatic adenocarcinoma from 2012 to 2014 completed a previously validated Brief Pain Inventory survey for preoperative clinical pain scoring. Preoperative pain was correlated with multiple clinicopathologic features. RESULTS: Preoperative pain was not associated with pathologic cancer stage, lymph node status, lymph node positivity ratio, resection margin status, or tumor location within the pancreas. In the subgroup of pancreatic head cancers, pain interference with affect was associated with the absence of perineural invasion (p = 0.02). Patients with stage I cancer had higher pain interference scores than those with stage II cancer (p = 0.02). CONCLUSIONS: Preoperative pain does not predict the presence of perineural invasion or other pathologic prognostic factors in patients with resectable pancreatic adenocarcinoma. Higher pain scores in pancreatic head cancers correlated with absence of perineural invasion and early cancer stage. The effects of preoperative pain on quality and interference of daily life deserve further investigation in larger prospective studies involving patients with pancreatic cancer.

7 Article Prostaglandin E 2017

Yip-Schneider, Michele T / Carr, Rosalie A / Wu, Huangbing / Schmidt, C Max. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Walther Oncology Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN; Indiana University Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN; Walther Oncology Center, Indianapolis, IN; Indiana University Cancer Center, Indianapolis, IN; Indiana University Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. Electronic address: maxschmi@iupui.edu. ·J Am Coll Surg · Pubmed #28739154.

ABSTRACT: BACKGROUND: With the increased frequency of diagnostic imaging, pancreatic cysts are now detected in >3% of American adults. Most of these are intraductal papillary mucinous neoplasms (IPMNs) with well-established but variable malignant potential. A biomarker that predicts malignant potential or dysplastic grade would help determine which IPMNs require removal and which can be observed safely. We previously reported that pancreatic fluid prostaglandin E STUDY DESIGN: Pancreatic cyst/duct fluid was prospectively collected from 100 patients with IPMN undergoing pancreatic resection. Surgical pathology revealed 47 low-/moderate-grade, 34 high-grade, and 20 invasive IPMNs. The PGE RESULTS: Mean pancreatic cyst fluid PGE CONCLUSIONS: Our results validate pancreatic cyst fluid PGE

8 Article Pancreatic Cyst Fluid Vascular Endothelial Growth Factor A and Carcinoembryonic Antigen: A Highly Accurate Test for the Diagnosis of Serous Cystic Neoplasm. 2017

Carr, Rosalie A / Yip-Schneider, Michele T / Dolejs, Scott / Hancock, Bradley A / Wu, Huangbing / Radovich, Milan / Schmidt, C Max. ·Department of Surgery, Indiana University School of Medicine; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine; Department of Walther Oncology Center; Indiana University Cancer Center; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine. · Department of Surgery, Indiana University School of Medicine; Department of Walther Oncology Center; Indiana University Cancer Center. · Department of Surgery, Indiana University School of Medicine; Department of Biochemistry/Molecular Biology, Indiana University School of Medicine; Department of Walther Oncology Center; Indiana University Cancer Center; Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN. Electronic address: maxschmi@iupui.edu. ·J Am Coll Surg · Pubmed #28633941.

ABSTRACT: BACKGROUND: Accurate differentiation of pancreatic cystic lesions is important for pancreatic cancer early detection and prevention as well as avoidance of unnecessary surgical intervention. Serous cystic neoplasms (SCN) have no malignant potential, but may mimic premalignant mucinous cystic lesions: mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN). We recently identified vascular endothelial growth factor (VEGF)-A as a novel pancreatic fluid biomarker for SCN. We hypothesize that combining cyst fluid carcinoembryonic antigen (CEA) with VEGF-A will improve the diagnostic accuracy of VEGF-A. METHODS: Pancreatic cyst/duct fluid was collected from consenting patients undergoing surgical cyst resection with corresponding pathologic diagnoses. Pancreatic fluid VEGF-A and CEA levels were detected by ELISA. RESULTS: One hundred forty-nine patients with pancreatic cystic lesions met inclusion criteria. Pathologic diagnoses included pseudocyst (n=14), SCN (n=26), MCN (n=40), low/moderate grade IPMN (n=34), high grade IPMN (n=20), invasive IPMN (n=10) and solid pseudopapillary neoplasm (n=5). VEGF-A was significantly elevated in SCN cyst fluid compared to all other diagnoses (p<0.001). With a threshold of >5,000 pg/ml, VEGF-A alone has 100% sensitivity and 83.7% specificity to distinguish SCN from other cystic lesions. With a threshold of ≤10ng/ml, CEA alone identifies SCN with 95.5% sensitivity and 81.5% specificity. Sensitivity and specificity of the VEGF-A/CEA combination are 95.5% and 100% respectively. The c-statistic increased from 0.98 to 0.99 when CEA was added to VEGF-A alone in the ROC analysis. CONCLUSIONS: Although VEGF-A alone is a highly accurate test for SCN, the combination of VEGF-A with CEA approaches the gold-standard of pathologic diagnosis, thus importantly avoiding false positives. Patients with a positive test indicating benign SCN can be spared a high risk surgical pancreatic resection.

9 Article Smoking and IPMN malignant progression. 2017

Carr, R A / Roch, A M / Shaffer, K / Aboudi, S / Schmidt, C M / DeWitt, J / Ceppa, E P / House, M G / Zyromski, N J / Nakeeb, A / Schmidt, C M. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. · Department of Medicine, Division of Gastroenterology, Indiana University Hospital, Indianapolis, IN, USA. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: maxschmi@iupui.edu. ·Am J Surg · Pubmed #28129918.

ABSTRACT: BACKGROUND: Patients with intraductal papillary mucinous neoplasm (IPMN) are at risk for invasive pancreatic cancer. We aim to characterize the impact of smoking on IPMN malignant progression. METHODS: Patients undergoing pancreatic resection for IPMN (1991-2015) were retrospectively reviewed using a prospectively collected database. RESULTS: Of 422 patients identified, 324 had complete data for analysis; 55% were smokers. Smoking status did not impact IPMN malignant progression (smokers/non-smokers: 22%/18% invasive grade; p = 0.5). Smokers were younger than non-smokers at the time of IPMN diagnosis (63 versus 68 years; p = 0.001). This association also held in the invasive IPMN subgroup (65 versus 72 years, p = 0.01). Despite this observation, rate of symptoms at diagnosis, cancer stage, and median survival were the same between smokers and non-smokers. CONCLUSION: Although smoking is not associated with IPMN malignant progression, invasive IPMN is diagnosed at a younger age in smokers. These data suggest tobacco exposure may accelerate IPMN malignant progression.

10 Article Management of Undifferentiated Solitary Mucinous Cystic Lesion of the Pancreas: A Clinical Dilemma. 2017

Roch, Alexandra M / Bigelow, Katherine / Schmidt, Christian M / Carr, Rosalie A / Jester, Andrea L / Ceppa, Eugene P / House, Michael G / Zyromski, Nicholas J / Nakeeb, Attila / Schmidt, C Max. ·Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. · Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Electronic address: maxschmi@iupui.edu. ·J Am Coll Surg · Pubmed #28126546.

ABSTRACT: BACKGROUND: Management of solitary mucinous cystic lesions of the pancreas (MCLs) relies on correct differentiation between branch duct intraductal papillary mucinous neoplasm (BD-IPMN) and mucinous cystic neoplasm (MCN). Current international consensus guidelines recommend resection for MCN, and unifocal BD-IPMN can be followed in the absence of worrisome features/high-risk stigmata. We hypothesized that preoperative differentiation of solitary MCLs is suboptimal, and that all solitary MCLs should be treated similarly. STUDY DESIGN: A retrospective review of an institutional database (2003 to 2016) identified 711 patients who underwent resection for pancreatic cyst. Only lesions that met cytologic or biochemical criteria for diagnosis of MCLs were included. Mucinous cystic neoplasms were defined by presence of ovarian stroma on pathology. Patients with formal preoperative diagnosis of BD-IPMN (multifocality, GNAS mutation) were excluded. RESULTS: One hundred and eighty solitary MCLs were identified on preoperative imaging (mean age 54 years, 24% men). On surgical pathology, 108 were MCNs and 72 BD-IPMNs. There was no difference in invasive rate (7 of 108 [6.5%] MCNs vs 4 of 72 [5.6%] BD-IPMN; p ≈ 1). Pancreatic ductal connectivity was reported on imaging/endoscopy in 10 of 108 (9%) MCNs and 22 of 72 (31%) BD-IPMNs, representing 67% accuracy in differentiating MCNs from BD-IPMNs. On multivariate analysis, typical risk factors failed to predict invasiveness in either MCNs or BD-IPMNs. When all undifferentiated solitary MCLs were analyzed together, older age (p = 0.03) and cyst size (p = 0.04) were associated with increased invasive rate in multivariate analysis. CONCLUSIONS: Unreliable differentiation and limited ability to predict invasiveness make solitary MCLs clinically challenging. With similar invasive rates, MCN and unifocal BD-IPMNs should be merged into one new entity for management, the undifferentiated solitary MCL.