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Pancreatic Neoplasms: HELP
Articles by Mirko D'Onofrio
Based on 59 articles published since 2010
(Why 59 articles?)
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Between 2010 and 2020, M. D'Onofrio wrote the following 59 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. 2014

Anonymous4770793 / Anonymous4780793 / Buscarini, Elisabetta / Pezzilli, Raffaele / Cannizzaro, Renato / De Angelis, Claudio / Gion, Massimo / Morana, Giovanni / Zamboni, Giuseppe / Arcidiacono, Paolo / Balzano, Gianpaolo / Barresi, Luca / Basso, Daniela / Bocus, Paolo / Calculli, Lucia / Capurso, Gabriele / Canzonieri, Vincenzo / Casadei, Riccardo / Crippa, Stefano / D'Onofrio, Mirko / Frulloni, Luca / Fusaroli, Pietro / Manfredi, Guido / Pacchioni, Donatella / Pasquali, Claudio / Rocca, Rodolfo / Ventrucci, Maurizio / Venturini, Silvia / Villanacci, Vincenzo / Zerbi, Alessandro / Falconi, Massimo / Anonymous4790793. ·Gastroenterology Unit, Maggiore Hospital, Crema, Italy. Electronic address: ebuscarini@rim.it. · Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy. · Gastroenterology Unit, CRO-National Cancer Institute, Aviano, Italy. · Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy. · Department of Clinical Pathology, AULSS 12, Venice, Italy. · Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy. · Department of Pathology, University of Verona, Verona, Italy. · Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy. · Department of Surgery, San Raffaele Scientific Institute, Milan, Italy. · Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy. · Department of Laboratory Medicine, University Hospital, Padua, Italy. · Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy. · Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy. · Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy. · Division of Pathology, CRO-National Cancer Institute, IRCCS, Aviano, Italy. · Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy. · Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy. · Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy. · Department of Clinical Medicine, University of Bologna, Bologna, Italy. · Gastroenterology Unit, Maggiore Hospital, Crema, Italy. · Pathology Unit, A.O. San Giovanni Battista/Molinette, Turin, Italy. · Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy. · Gastroenterology Unit, Mauriziano Hospital, Turin, Italy. · Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy. · 2nd Pathology Section, Spedali Civili, Brescia, Brescia, Italy. · Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy. ·Dig Liver Dis · Pubmed #24809235.

ABSTRACT: This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.

2 Editorial Percutaneous ablation of pancreatic cancer. 2016

D'Onofrio, Mirko / Ciaravino, Valentina / De Robertis, Riccardo / Barbi, Emilio / Salvia, Roberto / Girelli, Roberto / Paiella, Salvatore / Gasparini, Camilla / Cardobi, Nicolò / Bassi, Claudio. ·Mirko D'Onofrio, Valentina Ciaravino, Riccardo De Robertis, Camilla Gasparini, Nicolò Cardobi, Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. ·World J Gastroenterol · Pubmed #27956791.

ABSTRACT: Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

3 Editorial Prognostication and response assessment in liver and pancreatic tumors: The new imaging. 2015

De Robertis, Riccardo / Tinazzi Martini, Paolo / Demozzi, Emanuele / Puntel, Gino / Ortolani, Silvia / Cingarlini, Sara / Ruzzenente, Andrea / Guglielmi, Alfredo / Tortora, Giampaolo / Bassi, Claudio / Pederzoli, Paolo / D'Onofrio, Mirko. ·Riccardo De Robertis, Emanuele Demozzi, Gino Puntel, Mirko D'Onofrio, Department of Radiology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. ·World J Gastroenterol · Pubmed #26078555.

ABSTRACT: Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.

4 Editorial Radiofrequency ablation of locally advanced pancreatic adenocarcinoma: an overview. 2010

D'Onofrio, Mirko / Barbi, Emilio / Girelli, Roberto / Martone, Enrico / Gallotti, Anna / Salvia, Roberto / Martini, Paolo-Tinazzi / Bassi, Claudio / Pederzoli, Paolo / Pozzi Mucelli, Roberto. ·Department of Radiology, University Hospital G.B. Rossi, University of Verona, Piazzale L.A. Scuro 10, Verona 37134, Italy. mirko.donofrio@univr.it ·World J Gastroenterol · Pubmed #20653055.

ABSTRACT: Radiofrequency ablation (RFA) of pancreatic neoplasms is restricted to locally advanced, non-resectable but non-metastatic tumors. RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery. Intraoperative ultrasound covers the mandatory role of staging, evaluation of feasibility, guidance and monitoring of the procedure. Different types of needle can be used. The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma, in order of evaluation but not of importance, is to determine the feasibility of the procedure. The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis and cytoreduction. The most important aim, third in order of evaluation, is the potential improvement of quality of life and survival rate. Nowadays, only a few studies assess the feasibility of the procedure. The present paper is an overview of RFA for pancreatic adenocarcinoma.

5 Review Ablation treatments in unresectable pancreatic cancer. 2019

Paiella, Salvatore / De Pastena, Matteo / Romeo, Francesco / D'onofrio, Mirko / Fontana, Martina / Pea, Antonio / De Marchi, Giulia / Crinò, Stefano F / Bassi, Claudio / Salvia, Roberto. ·Unit of General and Pancreatic Surgery, Pancreas Institute, Policlinico GB Rossi, University of Verona, Verona, Italy - Salvatore.paiella@univr.it. · Unit of General and Pancreatic Surgery, Pancreas Institute, Policlinico GB Rossi, University of Verona, Verona, Italy. · Unit of Radiology, Pancreas Institute, Policlinico GB Rossi, University of Verona, Verona, Italy. · Unit of Gastroenterology B, Pancreas Institute, Policliclino GB Rossi, University of Verona, Verona, Italy. · Unit of Gastroenterology and Digestive Endoscopy, Pancreas Institute, Policliclino GB Rossi, University of Verona, Verona, Italy. ·Minerva Chir · Pubmed #30600963.

ABSTRACT: Ablation treatments have been increasingly applied as an alternative treatment for unresectable locally advanced pancreatic cancer (LAPC). The goal of LAPC therapy is surgical resection with negative margins (R0); however, that can be achieved only in a minority of patients and only following neoadjuvant treatment. Ablation might be useful for those patients with unresectable LAPC that do not progress towards metastatic stage and do not experience a true downstaging. Indeed, some LAPC that tend to grow locally, might be the subgroup of tumors that could benefit from ablation. Experience is necessary to select patients and the technique to adopt, since serious or fatal complications can occur. This review aims to discuss the role of ablation treatments in LAPC, with a unique focus on radiofrequency ablation and irreversible electroporation.

6 Review Palliative therapy in pancreatic cancer-interventional treatment with radiofrequency ablation/irreversible electroporation. 2018

Paiella, Salvatore / De Pastena, Matteo / D'Onofrio, Mirko / Crinò, Stefano Francesco / Pan, Teresa Lucia / De Robertis, Riccardo / Elio, Giovanni / Martone, Enrico / Bassi, Claudio / Salvia, Roberto. ·General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, Verona, Italy. · Radiology Unit, Pancreas Institute, University of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, Verona, Italy. · Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, Verona, Italy. · Radiology Unit, Ospedale Pederzoli, Peschiera del Garda, Verona, Italy. ·Transl Gastroenterol Hepatol · Pubmed #30505967.

ABSTRACT: 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.

7 Review Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: A systematic review and proportion meta-analysis of screening results. 2018

Paiella, Salvatore / Salvia, Roberto / De Pastena, Matteo / Pollini, Tommaso / Casetti, Luca / Landoni, Luca / Esposito, Alessandro / Marchegiani, Giovanni / Malleo, Giuseppe / De Marchi, Giulia / Scarpa, Aldo / D'Onofrio, Mirko / De Robertis, Riccardo / Pan, Teresa Lucia / Maggino, Laura / Andrianello, Stefano / Secchettin, Erica / Bonamini, Deborah / Melisi, Davide / Tuveri, Massimiliano / Bassi, Claudio. ·General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. Electronic address: salvatore.paiella@univr.it. · General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. · Gastroenterology B Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. · Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy; ARC-NET Research Center, University and Hospital Trust of Verona, Verona, Italy. · Department of Radiology, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. · Department of Radiology, Casa di Cura Pederzoli Hospital, Peschiera del Garda, Italy. · Oncology Unit, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. ·Pancreatology · Pubmed #29709409.

ABSTRACT: 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 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.

8 Review Systematic review, meta-analysis, and a high-volume center experience supporting the new role of mural nodules proposed by the updated 2017 international guidelines on IPMN of the pancreas. 2018

Marchegiani, Giovanni / Andrianello, Stefano / Borin, Alex / Dal Borgo, Chiara / Perri, Giampaolo / Pollini, Tommaso / Romanò, Giorgia / D'Onofrio, Mirko / Gabbrielli, Armando / Scarpa, Aldo / Malleo, Giuseppe / Bassi, Claudio / Salvia, Roberto. ·General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Radiology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Gastroenterology and Digestive Endoscopy, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Pathology, ARCNet Research Center, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. Electronic address: roberto.salvia@univr.it. ·Surgery · Pubmed #29454468.

ABSTRACT: BACKGROUND: Mural nodules (MNs) have a predominant role in the 2016 revision of the international guidelines on intraductal papillary mucinous neoplasms (IPMN) of the pancreas. The aim of this study was to evaluate MNs as predictors of invasive cancer (iCa) or high-grade dysplasia (HGD) in IPMNs and to investigate the role of MN size in risk prediction. METHODS: A PRISMA-compliant systematic review of the literature and meta-analysis on selected studies were conducted. The random effect model was adopted, and the pooled SMD (standardized mean difference) obtained. The surgical series of IPMNs at a single high-volume institution was reviewed. RESULTS: This review included 70 studies and 2297 resected IPMNs. MNs have a positive predictive value for malignancy of 62.2%. The meta-analysis suggested that MN size has a considerable effect on predicting IPMNs with both iCa or HGD with a mean SMD of 0.79. All studies included in the meta-analysis used contrast-enhanced endosonography (CE-EUS) to assess MNs. Due to the heterogeneity of the proposed thresholds, no reliable MN size cut-off was identified. Of 317 IPMNs resected at our institution, 102 (32.1%) had a preoperative diagnosis of MN. Multivariate analysis showed that MN is the only independent predictor of iCa and HGD for all types of IPMNs. CONCLUSION: MNs are reliable predictors of iCa and HGD in IPMNs as proposed by the 2016 IAP guidelines. CE-EUS seems to be the best tool for characterizing size and has the best accuracy for predicting malignancy. Further studies should determine potential MN dimensional cut-offs.

9 Review Tumor thrombosis: a peculiar finding associated with pancreatic neuroendocrine neoplasms. A pictorial essay. 2018

De Robertis, Riccardo / Paiella, Salvatore / Cardobi, Nicolò / Landoni, Luca / Tinazzi Martini, Paolo / Ortolani, Silvia / De Marchi, Giulia / Gobbo, Stefano / Giardino, Alessandro / Butturini, Giovanni / Tortora, Giampaolo / Bassi, Claudio / D'Onofrio, Mirko. ·Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. riccardo.derobertis@hotmail.it. · Department of General and Pancreatic Surgery, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. · Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Oncology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Gastroenterology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. · Department of Pathology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Pancreatic Surgery, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Medical Oncology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. · Department of Radiology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. ·Abdom Radiol (NY) · Pubmed #28677005.

ABSTRACT: 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.

10 Review Serous pancreatic neoplasia, data and review. 2017

Dietrich, Christoph F / Dong, Yi / Jenssen, Christian / Ciaravino, Valentina / Hocke, Michael / Wang, Wen-Ping / Burmester, Eike / Moeller, Kathleen / Atkinson, Nathan Ss / Capelli, Paola / D'Onofrio, Mirko. ·Christoph F Dietrich, Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, 97980 Bad Mergentheim, Germany. ·World J Gastroenterol · Pubmed #28852316.

ABSTRACT: AIM: To describe the imaging features of serous neoplasms of the pancreas using ultrasound, endoscopic ultrasound, computed tomography and magnetic resonance imaging. METHODS: This multicenter international collaboration enhances a literature review to date, reporting features of 287 histologically confirmed cases of serous pancreatic cystic neoplasms (SPNs). RESULTS: Female predominance is seen with most SPNs presenting asymptomatically in the 5 CONCLUSION: The described ultrasound features can aid differentiation of SPN from other neoplastic lesions under most circumstances.

11 Review Role of local ablative techniques (Radiofrequency ablation and Irreversible Electroporation) in the treatment of pancreatic cancer. 2016

Paiella, Salvatore / Salvia, Roberto / Girelli, Roberto / Frigerio, Isabella / Giardino, Alessandro / D'Onofrio, Mirko / De Marchi, Giulia / Bassi, Claudio. ·General and Pancreatic Surgery Department, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro 10, 37134, Verona, Italy. · Pancreatic Surgical Unit, Casa di Cura Pederzoli, Peschiera Del Garda, Verona, Italy. · Radiology Department, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Gastroenterology B Department, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · General and Pancreatic Surgery Department, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro 10, 37134, Verona, Italy. Claudio.bassi@univr.it. ·Updates Surg · Pubmed #27535401.

ABSTRACT: Thanks to continuous research and investment in technology, the ablation of tumors has become common. Through the application of different types of energy is possible to induce cellular injury of the neoplastic tissue, leading to cellular death. Radiofrequency ablation (RFA) and irreversible electroporation (IRE) represent the most applied ablative techniques on pancreatic cancer. RFA and IRE, causing necrosis and apoptosis of neoplastic cells, are able to destroy neoplastic tissue, to drastically modify the neoplastic microenvironment and, possibly, to stimulate both directly and indirectly the anti-tumor immune system. This article provides part of our experience with the application of RFA and IRE on pancreatic adenocarcinoma (PDAC).

12 Review Ultrasound-guided percutaneous fine-needle aspiration of solid pancreatic neoplasms: 10-year experience with more than 2,000 cases and a review of the literature. 2016

D'Onofrio, Mirko / De Robertis, Riccardo / Barbi, Emilio / Martone, Enrico / Manfrin, Erminia / Gobbo, Stefano / Puntel, Gino / Bonetti, Franco / Pozzi Mucelli, Roberto. ·Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. · Department of Radiology, Casa di cura Pederzoli, Peschiera del Garda, Italy. riccardo.derobertis@hotmail.it. · Department of Radiology, Casa di cura Pederzoli, Peschiera del Garda, Italy. · Department of Pathology, G.B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Pathology, Casa di cura Pederzoli, Peschiera del Garda, Italy. ·Eur Radiol · Pubmed #26373764.

ABSTRACT: OBJECTIVES: To evaluate the diagnostic accuracy and complication rate of percutaneous ultrasound-guided fine-needle aspiration (US-FNA) of solid pancreatic neoplasms through the analysis of 10-year experiences of two centres. METHODS: Clinical, radiological and pathologic data of 2,024 patients with solid pancreatic masses who underwent US-FNAs were retrospectively evaluated. Indications for aspiration were: unresectable lesions before neo-adjuvant therapy; doubtful imaging findings; and suspicion of uncommon neoplasms with prognostic or therapeutic implications such as metastases or lymphoma. US-FNAs were performed using aspiration needles with a cytopathologist present in centre 1. In centre 2, cytologic samples were collected with Chiba needles and separately evaluated by a cytopathologist. RESULTS: US-FNA had a diagnostic sample rate of 92.2 % (centre 1: 95.9 %; centre 2: 87.2 %). US-FNA repetition after non-diagnostic samples provided a diagnosis in 86.3 % of cases. Sensitivity, specificity, positive and negative predictive values, and accuracy were 98.7 %, 100 %, 100 %, 75.5 %, and 98.7 %, respectively. The complication rate was 0.8 %. CONCLUSIONS: Percutaneous US-FNA is a sensitive, accurate and safe method for the invasive diagnosis of solid pancreatic neoplasms. The use of aspiration needles and the on-site presence of a cytopathologist may lead to a high rate of diagnostic samples, thus reducing the need for US-FNA repetition. KEY POINTS: • Percutaneous ultrasound-guided fine-needle aspiration of pancreatic neoplasms is sensitive and accurate. • The short-term complication rate of percutaneous ultrasound-guided fine-needle aspiration is low. • Technical aspects may influence the rate of diagnostic samples.

13 Review Diffusion-weighted imaging of pancreatic cancer. 2015

De Robertis, Riccardo / Tinazzi Martini, Paolo / Demozzi, Emanuele / Dal Corso, Flavia / Bassi, Claudio / Pederzoli, Paolo / D'Onofrio, Mirko. ·Riccardo De Robertis, Paolo Tinazzi Martini, Department of Radiology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy. ·World J Radiol · Pubmed #26516428.

ABSTRACT: Magnetic resonance imaging (MRI) is a reliable and accurate imaging method for the evaluation of patients with pancreatic ductal adenocarcinoma (PDAC). Diffusion-weighted imaging (DWI) is a relatively recent technological improvement that expanded MRI capabilities, having brought functional aspects into conventional morphologic MRI evaluation. DWI can depict the random diffusion of water molecules within tissues (the so-called Brownian motions). Modifications of water diffusion induced by different factors acting on the extracellular and intracellular spaces, as increased cell density, edema, fibrosis, or altered functionality of cell membranes, can be detected using this MR sequence. The intravoxel incoherent motion (IVIM) model is an advanced DWI technique that consent a separate quantitative evaluation of all the microscopic random motions that contribute to DWI, which are essentially represented by molecular diffusion and blood microcirculation (perfusion). Technological improvements have made possible the routine use of DWI during abdominal MRI study. Several authors have reported that the addition of DWI sequence can be of value for the evaluation of patients with PDAC, especially improving the staging; nevertheless, it is still unclear whether and how DWI could be helpful for identification, characterization, prognostic stratification and follow-up during treatment. The aim of this paper is to review up-to-date literature data regarding the applications of DWI and IVIM to PDACs.

14 Review CEUS of the pancreas: Still research or the standard of care. 2015

D'Onofrio, Mirko / Canestrini, Stefano / De Robertis, Riccardo / Crosara, Stefano / Demozzi, Emanuele / Ciaravino, Valentina / Pozzi Mucelli, Roberto. ·Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy. Electronic address: mirko.donforio@univr.it. · Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy. ·Eur J Radiol · Pubmed #25796427.

ABSTRACT: Contrast-enhanced ultrasonography (CEUS) improves the characterization of pancreatic masses. CEUS is in fact a safe and accurate imaging method to evaluate the vascularity of pancreatic lesions. CEUS should be performed when possible immediately after the ultrasound (US) detection of a pancreatic mass. CEUS is accurate in the characterization of ductal adenocarcinoma. The use of CEUS in studying pancreatic lesions found at US, especially in the same session of ultrasound examination, is therefore recommendable to promote faster diagnosis mainly of pancreatic ductal adenocarcinoma.

15 Review Uncommon presentations of common pancreatic neoplasms: a pictorial essay. 2015

D'Onofrio, Mirko / De Robertis, Riccardo / Capelli, Paola / Tinazzi Martini, Paolo / Crosara, Stefano / Gobbo, Stefano / Butturini, Giovanni / Salvia, Roberto / Barbi, Emilio / Girelli, Roberto / Bassi, Claudio / Pederzoli, Paolo. ·Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy, mirko.donofrio@univr.it. ·Abdom Imaging · Pubmed #25772002.

ABSTRACT: Pancreatic neoplasms are a wide group of solid and cystic lesions with different and often characteristic imaging features, clinical presentations, and management. Among solid tumors, ductal adenocarcinoma is the most common: it arises from exocrine pancreas, comprises about 90% of all pancreatic neoplasms, and generally has a bad prognosis; its therapeutic management must be multidisciplinary, involving surgeons, oncologists, gastroenterologists, radiologists, and radiotherapists. The second most common solid pancreatic neoplasms are neuroendocrine tumors: they can be divided into functioning or non-functioning and present different degrees of malignancy. Cystic pancreatic neoplasms comprise serous neoplasms, which are almost always benign, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, which can vary from benign to frankly malignant lesions, and solid pseudopapillary tumors. Other pancreatic neoplasms, such as lymphoma, metastases, or pancreatoblastoma, are rarely seen in clinical practice and have different and sometimes controversial managements. Rare clinical presentations and imaging appearance of the most common pancreatic neoplasms, both solid and cystic, are more frequently seen and clinically relevant than rare pancreatic tumors; their pathologic and radiologic appearances must be known to improve their management. The purpose of this paper is to present some rare or uncommon clinical and radiological presentations of common pancreatic neoplasms providing examples of multi-modality imaging approach with pathologic correlations, thus describing the histopathological bases that can explain the peculiar imaging features, in order to avoid relevant misdiagnosis and to improve lesion management.

16 Review Diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced endoscopic ultrasound (ECEUS) for the differentiation of pancreatic lesions: a systematic review and meta-analysis. 2014

D'Onofrio, M / Biagioli, E / Gerardi, C / Canestrini, S / Rulli, E / Crosara, S / De Robertis, R / Floriani, I. ·Department of Oncology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy. · Department of Radiology, G.B. Rossi University Hospital, Verona, Italy. ·Ultraschall Med · Pubmed #25226455.

ABSTRACT: PURPOSE: To evaluate CEUS for the diagnosis of pancreatic diseases and its application in the clinical routine with a focus on the value of CEUS in ductal pancreatic carcinoma and its use for the differentiation of neoplastic and non-neoplastic lesions. MATERIALS AND METHODS: All prospective and retrospective studies published in any language by March 6, 2014 were included based on the following criteria: use of contrast-enhanced ultrasound (CEUS) and contrast-enhanced endoscopic ultrasound (ECEUS) as the imaging methods, use of histology as the reference method and availability of a complete translation. Two authors analyzed the titles and abstracts of the search results to identify all relevant publications. Two independent readers then analyzed the full articles to identify those meeting the inclusion criteria. Details regarding study design, patient characteristics, interventions, and results were then independently extracted by two radiologists and one reviewer with methodological expertise. Sensitivity, specificity and diagnostic odds ratio (DOR) were used to obtain overall estimates. RESULTS: 1293 articles were initially identified. 27 studies met the inclusion criteria. CEUS was the index test in 23 studies while ECEUS was the index test in 4 studies. The primary study objective was met by 20 studies with respect to ductal adenocarcinoma. CEUS sensitivity was evaluated in all studies. The pooled estimate of CEUS sensitivity for the diagnosis of ductal adenocarcinoma was 0.89 (95 % CI, 0.85 - 0.92). 15 out of 20 studies examined CEUS specificity. The average specificity was 0.84 (95 % CI, 0.77 - 0.89). The pooled estimate for DOR was 61.12 (95 % CI, 34.81 - 107.32). With regard to the secondary study objective, the pooled sensitivity and specificity were 0.95 (95 % CI, 0.93 - 0.96) from 14 studies and 0.72 (95 % CI, 0.58 - 0.83) from 13 studies, respectively. The pooled DOR was 57.63 (95 % CI, 33.62 - 98.78). CONCLUSION: The sensitivity, specificity, and DOR results show the high value of CEUS for the characterization and differentiation of ductal adenocarinomas from other pancreatic diseases and for cystic pancreatic lesions. For this reason and due to their noninvasive nature, CEUS and ECEUS should be used as the first methods for characterizing neoplastic pancreatic lesions, especially since these are often incidental findings. The methods improve the quality of ultrasound diagnostics and result in faster diagnosis and better disease management.

17 Review Ultrasonography of the pancreas. 2012

Zamboni, Giulia A / Ambrosetti, Maria Chiara / D'Onofrio, Mirko / Pozzi Mucelli, Roberto. ·Istituto di Radiologia, Policlinico GB Rossi, Azienda Ospedaliera Universitaria Integrata Verona, P.le LA Scuro 10, 37134 Verona, Italy. gzamboni@hotmail.com ·Radiol Clin North Am · Pubmed #22560688.

ABSTRACT: Although the pancreas is often thought of as an organ that is difficult to explore using ultrasound (US), because of its deep retroperitoneal location, with the appropriate technique it can be studied successfully in most patients. In this article, the authors discuss the use of available US techniques in the diagnosis of the most common pancreatic diseases, the use of US intraoperatively, and the use of sonographic guidance for diagnostic and therapeutic procedures. The authors also briefly discuss the potential use of elastosonography techniques in the evaluation of pancreatic disease.

18 Review Aggressive approach to acinar cell carcinoma of the pancreas: a single-institution experience and a literature review. 2011

Butturini, Giovanni / Pisano, Michele / Scarpa, Aldo / D'Onofrio, Mirko / Auriemma, Alessandra / Bassi, Claudio. ·Surgical Department, Verona University Hospital, Piazzale La Scuro 10, Verona, Italy. giovanni.butturini@ospedaleuniverona.it ·Langenbecks Arch Surg · Pubmed #20803029.

ABSTRACT: PURPOSE: Acinar cell carcinomas (ACCs) are a rare pancreatic tumor group with no standardized treatment. The aim of the study is to analyze the clinical and pathologic characteristics of our series and to review the current literature. METHODS: Retrospective review of prospectively collected data from 1990 to 2007 included patients who underwent pancreatic resection for histologically proven ACCs. All specimens of ACC were rereviewed by an expert pathologist. Follow-up was updated to October 2009. A literature search was performed by Pubmed and COCHRANE library. RESULTS: Among 1,210 patients who underwent pancreatic resection, we identified nine ACCs. R0 resection was possible for all but one R1. We had no major complications and no mortality. All nine cases were diagnosed as pure ACCs. Five patients received adjuvant chemotherapy. Median overall survival was 31 months, while median disease-free survival was 18 months. All patients developed liver metastases, requiring modification of chemotherapeutic schema, radiofrequency ablation techniques, or reiterate surgery. Currently, only one patient is alive without evidence of disease 85 months after pancreatic resection. One patient is alive 52 months after operation, with evidence of recurrent disease. CONCLUSIONS: ACC represents a rare solid tumor of the pancreas. Prognosis is dismal, although, compared to the more common ductal adenocarcinoma, survival appears to be longer. Patients with metastatic disease might benefit from aggressive multimodality treatments.

19 Review Clinicopathological features of adenosquamous pancreatic cancer. 2011

Regi, Paolo / Butturini, Giovanni / Malleo, Giuseppe / Pedica, Federica / D'Onofrio, Mirko / Bassi, Claudio. ·Surgical and Gastroenterological Department, University of Verona, Policlinico Borgo Roma, Piazzale LA Scuro #10, 37134 Verona, Italy. paoloregi@tiscali.it ·Langenbecks Arch Surg · Pubmed #20617336.

ABSTRACT: PURPOSE: Adenosquamous pancreatic cancer represents 0.9-4.4% of exocrine pancreatic neoplasms and is generally thought to be associated with a worse prognosis than the more common ductal adenocarcinoma. The aim of the current study is to describe the outcome of patients with adenosquamous pancreatic cancer in our institution who were managed in a multidisciplinary environment. METHODS: In a retrospective analysis between February 1990 and February 2010, we identified from our database of 890 pancreatic lesions resected for malignancy six cases (0.67%) of adenosquamous cancer. We assessed the demographics, clinical and radiological features, surgical approach, histological details and follow-up data. RESULTS: All patients underwent pylorus-preserving pancreatoduodenectomy. Two patients, one male and one female, died in the preoperative period due to sepsis and myocardial infarction, respectively. The remaining four patients received adjuvant chemotherapy. One male patient died with local recurrence after 13 months; however, one female and two male patients are still alive with Karnofsky status of 80-90% at 15, 14 and 39 months after the operation, respectively. CONCLUSIONS: The prognosis of adenosquamous pancreatic cancer remains very poor, apparently worse than ductal pancreatic cancer. Nevertheless, our report and the review of literature seem to show that "curative" surgical resection associated with adjuvant treatment may offer the best results with a similar survival rate than ductal pancreatic cancer.

20 Review Imaging techniques in pancreatic tumors. 2010

D'Onofrio, Mirko / Gallotti, Anna / Pozzi Mucelli, Roberto. ·Department of Radiology, GB Rossi University Hospital, University of Verona, Verona, Italy. mirko.donofrio@univr.it ·Expert Rev Med Devices · Pubmed #20214430.

ABSTRACT: Conventional ultrasonography represents the first diagnostic imaging modality for the study of pancreatic tumors. Contrast-enhanced ultrasound has significantly improved the accuracy of first-line examination and may influence the choice of second-line investigations: multidetector computed tomography is considered the gold standard for studying pancreatic solid lesions and tumor staging, while MRI with magnetic resonance cholangiopancreatography allows better study of pancreatic cystic lesions and the ductal system. To definitely diagnose a pancreatic lesion, image-guided fine-needle-aspiration or biopsy are very often required. PET with 18-fluorodeoxyglucose, endoscopic ultrasound and intraoperative ultrasonography remain techniques often employed in the third line. This article reviews the imaging techniques generally used for diagnosing the main pancreatic tumors, and a work-up algorithm is finally proposed.

21 Clinical Trial Is there a role for near-infrared technology in laparoscopic resection of pancreatic neuroendocrine tumors? Results of the COLPAN "colour-and-resect the pancreas" study. 2017

Paiella, Salvatore / De Pastena, Matteo / Landoni, Luca / Esposito, Alessandro / Casetti, Luca / Miotto, Marco / Ramera, Marco / Salvia, Roberto / Secchettin, Erica / Bonamini, Deborah / Manzini, Gessica / D'Onofrio, Mirko / Marchegiani, Giovanni / Bassi, Claudio. ·General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. salvatore.paiella@univr.it. · General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. · Radiology Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. ·Surg Endosc · Pubmed #28374260.

ABSTRACT: BACKGROUND: The intraoperative identification of pancreatic neuroendocrine tumors (PanNETs) is of utmost importance to drive their laparoscopic resection. Near-infrared (NIR) surgery has emerged as a new technique for localizing tumors or neoplastic tissue. This study aimed to explore the results of the application of NIR in the laparoscopic resection of PanNETs. METHODS: Per protocol we enrolled ten subjects undergoing laparoscopic pancreatic surgery for PanNET from March 2016 to October 2016. During surgery, the patients were injected with indocyanine green dye (ICG, 25 mg given in 5 boli of 5 mg each). The switch-activation of NIR was performed to identify PanNETs. An ex-post analysis of the images was realized using ImageJ Software® to calculate the fluorescence signal. RESULTS: NIR imaging identified all ten PanNETs. Nine (90%) laparoscopic distal pancreatectomy with splenectomy and one (10%) laparoscopic enucleation were performed. The mean maximum tumor dimension was 2.4 cm (range 1-4 cm). Eight non-functioning PanNETs (80%) and two insulinomas (20%) were found at the final pathology. Nine out of ten (90%) PanNETs were detected after the second ICG bolus. The mean latency time was 80 s and the mean visibility time was 220 s. The peak of tumor visualization was reached 20 min after the last bolus. This finding was confirmed by the ex-post analysis of the fluorescence signal (mean signal-to-background ratio of 7.7, p = 0.001). NIR identified two additional lesions, which turned out to be normal lymph nodes at final pathology. A fluorescent signal was identified at the bed of the enucleation, and thus, a further exeresis was performed and final pathology revealed that is was residual neoplastic tissue. CONCLUSIONS: This explorative study shows that NIR with ICG can have a role in laparoscopic pancreatic resection of PanNETs. Further studies are needed to assess the proper setting and role of this new and promising technology.

22 Clinical Trial Safety and feasibility of Irreversible Electroporation (IRE) in patients with locally advanced pancreatic cancer: results of a prospective study. 2015

Paiella, Salvatore / Butturini, Giovanni / Frigerio, Isabella / Salvia, Roberto / Armatura, Giulia / Bacchion, Matilde / Fontana, Martina / D'Onofrio, Mirko / Martone, Enrico / Bassi, Claudio. ·Unit of Pancreatic and General Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy. ·Dig Surg · Pubmed #25765775.

ABSTRACT: PURPOSE: To evaluate the safety of the NanoKnife Low Energy Direct Current (LEDC) System (Irreversible Electroporation, IRE) in order to treat patients with unresectable pancreatic adenocarcinoma. METHODS: Prospective, nonrandomized, single-center clinical evaluation of ten patients with a cytohystological diagnosis of unresectable locally advanced pancreatic cancer (LAPC) that was no further responsive to standard treatments. The primary outcome was the rate of procedure-related abdominal complications. The secondary endpoints included the evaluation of the short-term efficacy of IRE through the evaluation of tumor reduction at imaging and biological tumor response as shown by CA 19-9, clinical assessments and patient quality of life. RESULTS: Ten patients (5 males, 5 females) were enrolled, with a median age of 66 and median tumor size of 30 mm. All patients were treated successfully with a median procedure time of 79.5 min. Two procedure-related complications were described in one patient (10%): a pancreatic abscess with a pancreoduodenal fistula. Three patients had early progression of disease: one patient developed pulmonary metastases 30 days post-IRE and two patients had liver metastases 60 days after the procedure. We registered an overall survival of 7.5 months (range: 2.9-15.9). CONCLUSIONS: IRE is a safe procedure in patients with LAPC and may represent a new technological option in the treatment and multimodality management of this disease.

23 Article Solid Pseudopapillary Neoplasms of the Pancreas: Clinicopathologic and Radiologic Features According to Size. 2019

De Robertis, Riccardo / Marchegiani, Giovanni / Catania, Matteo / Ambrosetti, Maria Chiara / Capelli, Paola / Salvia, Roberto / D'Onofrio, Mirko. ·Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale A. Stefani 1, 37126 Verona, Italy. · Department of Pancreatic Surgery, G. B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Radiology, G. B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Pathology, G. B. Rossi Hospital, University of Verona, Verona, Italy. ·AJR Am J Roentgenol · Pubmed #31310181.

ABSTRACT:

24 Article Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study. 2019

Beleù, Alessandro / Calabrese, Angela / Rizzo, Giulio / Capelli, Paola / Bellini, Nicolò / Caloggero, Simona / Calbi, Roberto / Tinazzi Martini, Paolo / De Robertis, Riccardo / Carbognin, Giovanni / Marchegiani, Giovanni / Scarpa, Aldo / Salvia, Roberto / Bassi, Claudio / D'Onofrio, Mirko. ·Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. ale.beleu@gmail.com. · Department of Radiology, Istituto Oncologico Giovanni Paolo II, 70124 Bari, Italy. acalabrese22@gmail.com. · Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. giulioriz11@gmail.com. · Department of Pathology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. paolacapelli@hotmail.com. · Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. bellini.nico@live.it. · Department of Radiology, G. Martino Hospital, University of Messina, 98125 Messina, Italy. simona.caloggero@hotmail.it. · Department of Radiology, Ospedale Generale Regionale "F. Miulli", 70021 Acquaviva della Fonti, Italy. calbi.roberto@gmail.com. · Department of Radiology, Ospedale P. Pederzoli, 37019 Peschiera del Garda, Italy. paolo.tinazzimartini@univr.it. · Department of Radiology, Ospedale Civile Maggiore Borgo Trento, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy. riccardo.derobertislombardi@univr.it. · Department of Radiology, Ospedale "Sacro Cuore, Don Calabria", 37024 Negrar, Italy. giovanni.carbogni@univr.it. · Department of Surgery, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. giovanni.marchegiani@aovr.veneto.it. · Department of Pathology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. aldo.scarpa@univr.it. · Department of Surgery, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. roberto.salvia@univr.it. · Department of Surgery, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. claudio.bassi@univr.it. · Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy. mirko.donofrio@univr.it. ·Cancers (Basel) · Pubmed #30823544.

ABSTRACT: 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, 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.

25 Article The Actual Prevalence of Symptoms in Pancreatic Cystic Neoplasms: A Prospective Propensity Matched Cohort Analysis. 2019

Marchegiani, Giovanni / Andrianello, Stefano / Miatello, Chiara / Pollini, Tommaso / Secchettin, Erica / Tedesco, Giorgia / D'Onofrio, Mirko / Malleo, Giuseppe / Bassi, Claudio / Salvia, Roberto. ·Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Radiology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy, roberto.salvia@univr.it. ·Dig Surg · Pubmed #30541002.

ABSTRACT: BACKGROUND: The prevalence of symptoms in pancreatic cystic neoplasms (PCNs) is mainly based on retrospective surgical series. The aim of this study is to describe the actual prevalence of symptoms in PCNs under surveillance. METHODS: Patients with PCNs under surveillance observed from 2015 to 2017 were submitted to magnetic resonance imaging (MRI) and a specific interview. An identical survey was carried out on a control population matched for age, sex, and comorbidities in which any pancreatic disease was excluded by MRI. RESULTS: Two groups of 184 individuals were compared. Patients with PCNs have a similar prevalence of abdominal pain when compared to controls (35.2 vs. 28.8, p = 0.2). PCNs in the distal pancreas experienced a significantly increased prevalence of abdominal pain (42.3 vs. 28.8%, p = 0.04), whereas size and presumed connection with the ductal system did not affect the prevalence of abdominal pain. PCNs associated with abdominal pain did not differ in terms of clinical and radiological features from asymptomatic ones. CONCLUSION: Patients with PCNs under surveillance have a similar prevalence of abdominal pain when compared to a matched population of controls. Abdominal pain might not correlate with radiological signs of malignancy.

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