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Pancreatic Neoplasms: HELP
Articles by Riccardo DE Robertis
Based on 34 articles published since 2010
(Why 34 articles?)
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Between 2010 and 2020, R. De Robertis wrote the following 34 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 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.

2 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.

3 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.

4 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.

5 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.

6 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.

7 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.

8 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.

9 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.

10 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.

11 Review Pancreatic intraductal papillary mucinous neoplasm invading the duodenum: a case report and a review of the literature. 2014

DʼOnofrio, Mirko / Tinazzi Martini, Paolo / De Robertis, Riccardo / Pregarz, Massimo / Girelli, Roberto / Pederzoli, Paolo / Pozzi Mucelli, Roberto. ·Department of Radiology G.B. Rossi Hospital University of Verona Verona, Italy mirko.donofrio@univr.it Department of Radiology Casa di Cura Pederzoli Peschiera del Garda Verona, Italy Department of Radiology G.B. Rossi Hospital University of Verona Verona, Italy Department of Radiology Casa di Cura Pederzoli Peschiera del Garda Verona, Italy Department of Surgery Casa di Cura Pederzoli Peschiera del GardaVerona, Italy Department of Radiology G.B. Rossi Hospital University of Verona Verona, Italy. ·Pancreas · Pubmed #24622089.

ABSTRACT: -- No abstract --

12 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:

13 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.

14 Article Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where? 2019

Marchegiani, Giovanni / Landoni, Luca / Andrianello, Stefano / Masini, Gaia / Cingarlini, Sara / D'Onofrio, Mirko / De Robertis, Riccardo / Davì, Mariavittoria / Capelli, Paola / Manfrin, Erminia / Amodio, Antonio / Paiella, Salvatore / Malleo, Giuseppe / Damoli, Isacco / Miotto, Marco / Bianchi, Beatrice / Nessi, Chiara / Vivani, Elena / Scarpa, Aldo / Salvia, Roberto / Bassi, Claudio. ·Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Oncology, 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 Medicine, University of Verona Hospital Trust, Verona, Italy. · Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Gastroenterology, 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. ·Neuroendocrinology · Pubmed #30481765.

ABSTRACT: BACKGROUND/AIMS: Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up. METHODS: We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods. RESULTS: The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases. CONCLUSIONS: Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.

15 Article Intravoxel incoherent motion diffusion-weighted MR imaging of solid pancreatic masses: reliability and usefulness for characterization. 2019

De Robertis, Riccardo / Cardobi, Nicolò / Ortolani, Silvia / Tinazzi Martini, Paolo / Stemmer, Alto / Grimm, Robert / Gobbo, Stefano / Butturini, Giovanni / D'Onofrio, Mirko. ·Department of Radiology, Ospedale P. Pederzoli, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy. riccardo.derobertis@hotmail.it. · Department of Radiology, Ospedale P. Pederzoli, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy. · Department of Oncology, Ospedale P. Pederzoli, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy. · Siemens Healthcare, Allee am Roethelheimpark, 2, 91052, Erlangen, Germany. · Department of Pathology, Ospedale P. Pederzoli, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy. · Department of Pancreatic Surgery, Ospedale P. Pederzoli, Via Monte Baldo, 24, 37019, Peschiera del Garda, Italy. ·Abdom Radiol (NY) · Pubmed #29951899.

ABSTRACT: PURPOSE: IVIM-DW imaging has shown potential usefulness in the study of pancreatic lesions. Controversial results are available regarding the reliability of the measurements of IVIM-derived parameters. The aim of this study was to evaluate the reliability and the diagnostic potential of IVIM-derived parameters in differentiation among focal solid pancreatic lesions and normal pancreas (NP). METHODS: Fifty-seven patients (34 carcinomas-PDACs, 18 neuroendocrine neoplasms-panNENs, and 5 autoimmune pancreatitis-AIP) and 50 subjects with NP underwent 1.5-T MR imaging including IVIM-DWI. Images were analyzed by two independent readers. Apparent diffusion coefficient (ADC), slow component of diffusion (D), incoherent microcirculation (Dp), and perfusion fraction (f) were calculated. Interobserver reliability was assessed with intraclass correlation coefficient (ICC). A Kruskal-Wallis H test with Steel-Dwass post hoc test was used for comparison. The diagnostic performance of each parameter was evaluated through receiver operating characteristic (ROC) curve analysis. RESULTS: Overall interobserver agreement was excellent (ICC = 0.860, 0.937, 0.968, and 0.983 for ADC, D, Dp, and f). D, Dp, and f significantly differed among PDACs and panNENs (p = 0.002, < 0.001, and < 0.001), albeit without significant difference at the pairwise comparison of ROC curves (p = 0.08-0.74). Perfusion fraction was higher in AIP compared with PDACs (p = 0.024; AUC = 0.735). Dp and f were higher in panNENs compared with AIP (p = 0.029 and 0.023), without differences at ROC analysis (p = 0.07). CONCLUSIONS: IVIM-derived parameters have excellent reliability and could help in differentiation among solid pancreatic lesions and NP.

16 Article The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs): Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution. 2019

Landoni, Luca / Marchegiani, Giovanni / Pollini, Tommaso / Cingarlini, Sara / D'Onofrio, Mirko / Capelli, Paola / De Robertis, Riccardo / Davì, Maria V / Amodio, Antonio / Impellizzeri, Harmony / Malpaga, Anna / Miotto, Marco / Boninsegna, Letizia / Crepaz, Lorenzo / Nessi, Chiara / Zingaretti, Caterina C / Paiella, Salvatore / Esposito, Alessandro / Casetti, Luca / Malleo, Giuseppe / Tuveri, Massimiliano / Butturini, Giovanni / Salvia, Roberto / Scarpa, Aldo / Falconi, Massimo / Bassi, Claudio. ·General and Pancreatic Surgery Department, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy. · Department of Oncology, 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 Pathology, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy. · Department of Radiology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy. · Department of Medicine, The Pancreas Institute-University of Verona Hospital Trust, Verona, Italy. · Division of Surgery, Ospedale "Sacro Cuore-Don Calabria", Negrar (VR), Italy. · Department of Surgery, Pederzoli Hospital, Peschiera del Garda, Verona, Italy. · Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy. ·Ann Surg · Pubmed #29189384.

ABSTRACT: OBJECTIVE: The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome. BACKGROUND: Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection. METHODS: From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses. RESULTS: Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years. CONCLUSIONS: Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.

17 Article Importance of main pancreatic duct dilatation in IPMN undergoing surveillance. 2018

Marchegiani, G / Andrianello, S / Morbin, G / Secchettin, E / D'Onofrio, M / De Robertis, R / Malleo, G / Bassi, C / Salvia, R. ·Department of Surgery and Oncology, General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Radiology, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Radiology, Casa di Cura Pederzoli, Peschiera del Garda, Italy. ·Br J Surg · Pubmed #30106195.

ABSTRACT: BACKGROUND: The association between risk of pancreatic cancer and a dilated main pancreatic duct (MPD) in intraductal papillary mucinous neoplasm (IPMN) is debated. The aim of this study was to assess the role of MPD size in predicting pancreatic cancer in resected IPMNs and those kept under surveillance. METHODS: All patients with IPMN referred to the Pancreas Institute, University of Verona Hospital Trust, from 2006 to 2016 were included. The primary endpoint was the occurrence of malignancy detected at surgery or during follow-up. RESULTS: The final cohort consisted of 1688 patients with a median follow-up of 60 months. Main pancreatic duct dilatation was associated with other features of malignancy in both the resected and surveillance groups. In patients who underwent resection, only a MPD of at least 10 mm was an independent predictor of malignancy. In patients kept under surveillance, MPD dilatation was not associated with malignancy. Fifteen of 71 patients (21 per cent) with malignancy in the resection cohort had a dilated MPD alone, whereas only one of 30 (3 per cent) under surveillance with MPD dilatation alone developed malignancy. Patients with a dilated MPD and other worrisome features had an increased 5-year cumulative incidence of malignancy compared with those with a non-dilated duct (11 versus 1·2 per cent; P < 0·001); however, the risk of malignancy was not significantly increased in patients with a dilated MPD alone (4 versus 1·2 per cent; P = 0·448). CONCLUSION: In patients under surveillance, a dilated MPD alone was not associated with an increased incidence of malignancy in IPMN.

18 Article CT Texture Analysis of Ductal Adenocarcinoma Downstaged After Chemotherapy. 2018

Ciaravino, Valentina / Cardobi, Nicolò / DE Robertis, Riccardo / Capelli, Paola / Melisi, Davide / Simionato, Francesca / Marchegiani, Giovanni / Salvia, Roberto / D'Onofrio, Mirko. ·Department of Radiology, G.B. Rossi Hospital - University of Verona, Verona, Italy. · Department of Radiology, Casa di Cura Dott. Pederzoli, Peschiera del Garda, Verona, Italy. · Department of Pathology, G.B. Rossi Hospital - University of Verona, Verona, Italy. · Department of Oncology, G.B. Rossi Hospital - University of Verona, Verona, Italy. · Department of Surgery, G.B. Rossi Hospital - University of Verona, Verona, Italy. · Department of Radiology, G.B. Rossi Hospital - University of Verona, Verona, Italy mirko.donofrio@univr.it. ·Anticancer Res · Pubmed #30061265.

ABSTRACT: BACKGROUND/AIM: Re-staging of ductal adenocarcinoma using computed tomography (CT) scan can be problematic so new imaging techniques and evaluation parameters are required. The aim of the study was to evaluate the added value of CT texture analysis in estimation of tissue changes in ductal adenocarcinoma downsized and resected after chemotherapy. MATERIALS AND METHODS: Patients with ductal adenocarcinoma downstaged after neoadjuvant treatment, and resected, were included. A pre- and post-treatment CT was obtained. In comparison, patients with disease progression were included for texture analysis evaluation at CT pre- and post-treatment. CT texture analysis results were compared. RESULTS: A total of 17 patients affected by un-resectable or borderline ductal adenocarcinoma reached the resectable stage after treatment. The comparison between Kurtosis pre- and Kurtosis post-treatment showed a statistically significant difference. On the contrary, in the comparison group composed of 14 patients with disease progression there was no statistical difference regarding this parameter. CONCLUSION: This evaluation may represent an added value in tumor tissue changes judgment and can be extremely useful to diagnose downstaging in those cases with no evident downsizing after chemotherapy.

19 Article Can histogram analysis of MR images predict aggressiveness in pancreatic neuroendocrine tumors? 2018

De Robertis, Riccardo / Maris, Bogdan / Cardobi, Nicolò / Tinazzi Martini, Paolo / Gobbo, Stefano / Capelli, Paola / Ortolani, Silvia / Cingarlini, Sara / Paiella, Salvatore / Landoni, Luca / Butturini, Giovanni / Regi, Paolo / Scarpa, Aldo / Tortora, Giampaolo / D'Onofrio, Mirko. ·Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. riccardo.derobertis@hotmail.it. · Department of Computer Science, University of Verona, Strada le Grazie 15, 37134, Verona, Italy. · Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Pathology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Pathology, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. · Department of Oncology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Oncology, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. · Department of Pancreatic Surgery, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. · Department of Pancreatic Surgery, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy. · Department of Radiology, G.B. Rossi Hospital - University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. ·Eur Radiol · Pubmed #29352378.

ABSTRACT: OBJECTIVES: To evaluate MRI derived whole-tumour histogram analysis parameters in predicting pancreatic neuroendocrine neoplasm (panNEN) grade and aggressiveness. METHODS: Pre-operative MR of 42 consecutive patients with panNEN >1 cm were retrospectively analysed. T1-/T2-weighted images and ADC maps were analysed. Histogram-derived parameters were compared to histopathological features using the Mann-Whitney U test. Diagnostic accuracy was assessed by ROC-AUC analysis; sensitivity and specificity were assessed for each histogram parameter. RESULTS: ADC CONCLUSIONS: Whole-tumour histogram analysis of ADC maps may be helpful in predicting tumour grade, vascular involvement, nodal and liver metastases in panNENs. ADC KEY POINTS: • Whole-tumour ADC histogram analysis can predict aggressiveness in pancreatic neuroendocrine neoplasms. • ADC entropy and kurtosis are higher in aggressive tumours. • ADC histogram analysis can quantify tumour diffusion heterogeneity. • Non-invasive quantification of tumour heterogeneity can provide adjunctive information for prognostication.

20 Article Vanishing Pancreatic Cysts during Follow-Up: Another Step Towards De-Emphasizing Cyst Size as a Major Clinical Predictor of Malignancy. 2018

Marchegiani, Giovanni / Andrianello, Stefano / Perri, Giampaolo / Bonamini, Deborah / De Robertis, Riccardo / 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, University of Verona Hospital Trust, Verona, Italy. ·Dig Surg · Pubmed #29232660.

ABSTRACT: INTRODUCTION: In the management of pancreatic cystic neoplasms (PCN), size plays a crucial role as the expression of disease progression. While many evidences regarding the natural history of growing pancreatic cysts exist, almost no data are available regarding cysts with a reduction in size. METHODS: Radiological and clinical data from patients of the dedicated pancreatic cysts outpatient clinic of the Department of General and Pancreatic Surgery, University of Verona Hospital were retrospectively reviewed. Patients diagnosed with PCNs reducing in size during follow-up were reviewed. RESULTS: From a total of 3,146 patients, we identified 12 (0.38%) vanishing/reducing cysts without a history of pancreatitis. Most of them were presumed IPMN (66.6%). The median follow-up was 69 months and the median cyst's size 30 mm (range 10-49). Most of the patients (75%) experienced a reduction in cyst size (median reduction of 8 mm, range 6-22) after a median time of 12 months (range 6-63), 3 patients experienced a complete disappearance of the cyst. CONCLUSION: Cyst size reduction during follow-up is a rare phenomenon of unknown explanation. It adds to the debate regarding the role of size as a clinical predictor whenever a definite diagnosis of a PCN cannot be reached.

21 Article Are Cystic Pancreatic Neuroendocrine Tumors an Indolent Entity Results from a Single-Center Surgical Series. 2018

Paiella, Salvatore / Marchegiani, Giovanni / Miotto, Marco / Malpaga, Anna / Impellizzeri, Harmony / Montagnini, Greta / Pollini, Tommaso / Nessi, Chiara / Butturini, Giovanni / Capelli, Paola / Posenato, Ilaria / Scarpa, Aldo / D'Onofrio, Mirko / De Robertis, Riccardo / Cingarlini, Sara / Boninsegna, Letizia / Bassi, Claudio / Salvia, Roberto / Landoni, Luca. · ·Neuroendocrinology · Pubmed #28586782.

ABSTRACT: INTRODUCTION: Cystic pancreatic neuroendocrine tumors (CPanNETs) represent an uncommon variant of pancreatic neuroendocrine tumors (PanNETs). Due to their rarity, there is a lack of knowledge with regard to clinical features and postoperative outcome. METHODS: The prospectively maintained surgical database of a high-volume institution was queried, and 46 resected CPanNETs were detected from 1988 to 2015. Clinical, demographic, and pathological features and survival outcomes of CPanNETs were described and matched with a population of 92 solid PanNETs (SPanNETs) for comparison. RESULTS: CPanNETs accounted for 7.8% of the overall number of resected PanNETs (46/587). CPanNETs were mostly sporadic (n = 42, 91%) and nonfunctioning (39%). Two functioning CPanNETs were detected (4.3%), and they were 2 gastrinomas. The median tumor diameter was 30 mm (range 10-120). All tumors were well differentiated, with 38 (82.6%) G1 and 8 (17.4%) G2 tumors. Overall, no CPanNET showed a Ki-67 >5%. A correct preoperative diagnosis of a CPanNET was made in half of the cases. After a median follow-up of >70 months, the 5- and 10-year overall survival of resected CPanNETs was 93.8 and 62.5%, respectively, compared to 92.7 and 84.6% for SPanNETs (p > 0.05). The 5- and 10-year disease-free survival rates were 94.5 and 88.2% for CPanNETs and 81.8 and 78.9% for SPanNETs, respectively (p > 0.05). CONCLUSION: In the setting of a surgical cohort, CPanNETs are rare, nonfunctional, and well-differentiated neoplasms. After surgical resection, they share the excellent outcome of their well-differentiated solid counterparts for both survival and recurrence.

22 Article Prevent Pancreatic Fistula after Pancreatoduodenectomy: Possible Role of Ultrasound Elastography. 2018

D'Onofrio, Mirko / Tremolada, Giulia / De Robertis, Riccardo / Crosara, Stefano / Ciaravino, Valentina / Cardobi, Nicolò / Marchegiani, Giovanni / Pulvirenti, Alessandra / Allegrini, Valentina / Salvia, Roberto / Bassi, Claudio / Pozzi Mucelli, Roberto. ·Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy. ·Dig Surg · Pubmed #28564643.

ABSTRACT: BACKGROUND: The purpose of the study is to evaluate the utility of acoustic radiation force impulse (ARFI) on pancreatic tissue as a preoperative predictor of postoperative pancreatic fistula (POPF). Studied patients underwent exclusively to pancreaticoduodenectomy (PD) surgery. METHODS: Shear wave velocity of pancreas was measured using ARFI in 71 patients scheduled for PD. An intraoperative pancreas palpation was made by surgeons. A postoperative clinical evaluation to detect occurrence of POPF was performed. Sensitivity, specificity, positive and negative predictive values together with the accuracy of the method were investigated. RESULTS: Incidence of fistula observed in 17 patients with soft pancreas was approximately 53% vs. 47% without fistula. Percentage of patients without fistula was higher (66%) among 24 patients with medium parenchymal texture values, and was even higher (69%) in 26 patients with hard pancreas. Comparing ARFI and intraoperative pancreatic palpation, low wave velocity values (≤1.40 m/s) match 60% with soft parenchyma assessed by palpation and high values (>2 m/s) match 59% with hard pancreas on palpation. CONCLUSIONS: This study shows that ARFI elastography may be clinically useful as a preoperative predictor of pancreatic fistula following PD.

23 Article Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors. 2017

Paiella, Salvatore / Impellizzeri, Harmony / Zanolin, Elisabetta / Marchegiani, Giovanni / Miotto, Marco / Malpaga, Anna / De Robertis, Riccardo / D'Onofrio, Mirko / Rusev, Borislav / Capelli, Paola / Cingarlini, Sara / Butturini, Giovanni / Davì, Maria Vittoria / Amodio, Antonio / Bassi, Claudio / Scarpa, Aldo / Salvia, Roberto / Landoni, Luca. ·Salvatore Paiella, Harmony Impellizzeri, Giovanni Marchegiani, Marco Miotto, Anna Malpaga, Claudio Bassi, Roberto Salvia, Luca Landoni, General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy. ·World J Gastroenterol · Pubmed #28533666.

ABSTRACT: AIM: To establish the ability of magnetic resonance (MR) and computer tomography (CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors (PanNET) in a caseload of a tertiary referral center. METHODS: Patients submitted to surgery for PanNET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination (MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman (BA) and Mountain-Plot (MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok (PB) regression analysis was used to check the agreement between MR and CT. RESULTS: Our study population consisted of 292 patients. Seventy-nine (27.1%) were functioning PanNET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning- PanNET, respectively. Limits of agreement (LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-PanNET, no statistical significance was found in the size estimation rate of MR and CT ( CONCLUSION: MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of PanNET.

24 Article Perfusion CT Changes in Liver Metastases from Pancreatic Neuroendocrine Tumors During Everolimus Treatment. 2017

D'Onofrio, Mirko / Cingarlini, Sara / Ortolani, Silvia / Crosara, Stefano / DE Robertis, Riccardo / Vallerio, Paola / Grego, Elisabetta / Ciaravino, Valentina / Ruzzenente, Andrea / Landoni, Luca / Scarpa, Aldo / Bassi, Claudio / Tortora, Giampaolo. ·Department of Diagnostic and Public Health, Institute of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy mirko.donofrio@univr.it. · Department of Oncology, G.B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Diagnostic and Public Health, Institute of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Radiology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy. · Department of Internal Medicine, G.B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Hepato-biliary Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Pancreatic Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy. · Department of Pathology, G.B. Rossi Hospital, University of Verona, Verona, Italy. ·Anticancer Res · Pubmed #28314296.

ABSTRACT: AIM: To evaluate modifications of perfusional parameters assessed by perfusion computed tomography (P-CT) of liver metastases (LM) from pancreatic neuroendocrine tumors (PanNETs) during everolimus treatment. PATIENTS AND METHODS: All patients with LMs from G1-2 PanNETs undergoing everolimus treatment between January 2013 and January 2015 were prospectively evaluated with P-CT at baseline, and after 2 and 4 months of therapy. Size, perfusion, blood volume (BV), peak enhancement intensity (PEI) and time to peak for each lesion were calculated. RESULTS: A total of 33 LMs in nine patients with G1-2 PanNETs were prospectively evaluated: 23/33 (69.7%) were responders, 10/33 (30.3%) were non-responders. Among perfusional parameters, only numerical peak enhancement intensity values significantly differed between the two groups at baseline (p=0.043). BV increase was the most significant perfusional modification identifying responding lesions, even at an early stage of treatment, with a high positive predictive value (89.47%). CONCLUSION: P-CT seems to be useful for prediction of response to everolimus of LMs from PanNETs.

25 Article Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage. 2017

De Robertis, Riccardo / Cingarlini, Sara / Tinazzi Martini, Paolo / Ortolani, Silvia / Butturini, Giovanni / Landoni, Luca / Regi, Paolo / Girelli, Roberto / Capelli, Paola / Gobbo, Stefano / Tortora, Giampaolo / Scarpa, Aldo / Pederzoli, Paolo / D'Onofrio, Mirko. ·Riccardo De Robertis, Department of Radiology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy. ·World J Gastroenterol · Pubmed #28127201.

ABSTRACT: AIM: To describe magnetic resonance (MR) imaging features of pancreatic neuroendocrine neoplasms (PanNENs) according to their grade and tumor-nodes-metastases stage by comparing them to histopathology and to determine the accuracy of MR imaging features in predicting their biological behavior. METHODS: This study was approved by our institutional review board; requirement for informed patient consent was waived due to the retrospective nature of the study. Preoperative MR examinations of 55 PanNEN patients (29 men, 26 women; mean age of 57.6 years, range 21-83 years) performed between June 2013 and December 2015 were reviewed. Qualitative and quantitative features were compared between tumor grades and stages determined by histopathological analysis. RESULTS: Ill defined margins were more common in G2-3 and stage III-IV PanNENs than in G1 and low-stage tumors ( CONCLUSION: MR features of PanNENs vary according to their grade of differentiation and their stage at diagnosis and could predict the biological behavior of these tumors.

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