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Pancreatic Neoplasms: HELP
Articles by Carlo Fabbri
Based on 30 articles published since 2009
(Why 30 articles?)
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Between 2009 and 2019, Carlo Fabbri wrote the following 30 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review Matricellular proteins and survival in patients with pancreatic cancer: A systematic review. 2018

Fiorino, Sirio / Bacchi-Reggiani, Maria Letizia / Birtolo, Chiara / Acquaviva, Giorgia / Visani, Michela / Fornelli, Adele / Masetti, Michele / Tura, Andrea / Sbrignadello, Stefano / Grizzi, Fabio / Patrinicola, Federica / Zanello, Matteo / Mastrangelo, Laura / Lombardi, Raffaele / Benini, Claudia / Di Tommaso, Luca / Bondi, Arrigo / Monetti, Francesco / Siopis, Elena / Orlandi, Paolo Emilio / Imbriani, Michele / Fabbri, Carlo / Giovanelli, Silvia / Domanico, Andrea / Accogli, Esterita / Di Saverio, Salomone / Grifoni, Daniela / Cennamo, Vincenzo / Leandri, Paolo / Jovine, Elio / de Biase, Dario. ·Internal Medicine Unit C, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. Electronic address: sirio.fiorino@ausl.bologna.it. · Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Cardiology Unit, Policlinico S. Orsola-Malpighi, University of Bologna, via Massarenti 9, Bologna, Italy. · Internal Medicine Unit A, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. · Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), University of Bologna, Azienda USL di Bologna, Largo Nigrisoli 3, Bologna, Italy. · Anatomic Pathology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. · Surgery Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. · CNR Institute of Neuroscience, Via Giuseppe Moruzzi 1, Padova, Italy. · Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy. · Department of Pathology, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milano, Italy. · Radiology Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. · Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. · Surgical Emergency Unit, Azienda USL-Maggiore Hospital, Largo Nigrisoli 3, Bologna, Italy. · Department of Pharmacy and Biotechnology, University of Bologna, via San Donato 15, Bologna, Italy. · Department of Pharmacy and Biotechnology, University of Bologna, via San Donato 15, Bologna, Italy. Electronic address: dario.debiase@unibo.it. ·Pancreatology · Pubmed #29137857.

ABSTRACT: Extracellular matrix (ECM) plays a fundamental role in tissue architecture and homeostasis and modulates cell functions through a complex interaction between cell surface receptors, hormones, several bioeffector molecules, and structural proteins like collagen. These components are secreted into ECM and all together contribute to regulate several cellular activities including differentiation, apoptosis, proliferation, and migration. The so-called "matricellular" proteins (MPs) have recently emerged as important regulators of ECM functions. The aim of our review is to consider all different types of MPs family assessing the potential relationship between MPs and survival in patients with pancreatic ductal adenocarcinoma (PDAC). A systematic computer-based search of published articles, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement issued in 2009 was conducted through Ovid interface, and literature review was performed in May 2017. The search text words were identified by means of controlled vocabulary, such as the National Library of Medicine's MESH (Medical Subject Headings) and Keywords. Collected data showed an important role of MPs in carcinogenesis and in PDAC prognosis even though the underlying mechanisms are still largely unknown and data are not univocal. Therefore, a better understanding of MPs role in regulation of ECM homeostasis and remodeling of specific organ niches may suggest potential novel extracellular targets for the development of efficacious therapeutic strategies.

2 Review Team work and cytopathology molecular diagnosis of solid pancreatic lesions. 2017

Fabbri, Carlo / Gibiino, Giulia / Fornelli, Adele / Cennamo, Vincenzo / Grifoni, Daniela / Visani, Michela / Acquaviva, Giorgia / Fassan, Matteo / Fiorino, Sirio / Giovanelli, Silvia / Bassi, Marco / Ghersi, Stefania / Tallini, Giovanni / Jovine, Elio / Gasbarrini, Antonio / de Biase, Dario. ·Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Italy. · Medical Pathology, Department of Internal Medicine, Gastroenterology Division, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy. · Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Italy. · Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Italy. · Department of Medicine (DIMES), Molecular Diagnostic Unit AUSL of Bologna, University of Bologna School of Medicine, Italy. · Department of Medicine, Anatomic Pathology, University of Padua, Padova, Italy. · Internal Medicine Unit, Maggiore Hospital, Bologna, Italy. ·Dig Endosc · Pubmed #28190274.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer-associated death in the next decade or so. It is widely accepted that tumorigenesis is linked to specific alterations in key genes and pancreatic neoplasms are some of the best characterized at the genomic level. Recent whole-exome and whole-genome sequencing analyses confirmed that PDAC is frequently characterized by mutations in a set of four genes among others: KRAS, TP53, CDKN2A/p16, and SMAD4. Sequencing, for example, is the preferable technique available for detecting KRAS mutations, whereas in situ immunochemistry is the main approach for detecting TP53 gene alteration. Nevertheless, the diagnosis of PDAC is still a clinical challenge, involving adequate acquisition of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and specific pathological assessment from tissue architecture to specific biomolecular tests. The aim of the present review is to provide a complete overview of the current knowledge of the biology of pancreatic cancer as detected by the latest biomolecular techniques and, moreover, to propose a paradigm for strict teamwork collaboration in order to improve the correct use of diagnostic sources.

3 Review Contribution of microRNA analysis to characterisation of pancreatic lesions: a review. 2015

Visani, Michela / Acquaviva, Giorgia / Fiorino, Sirio / Bacchi Reggiani, Maria Letizia / Masetti, Michele / Franceschi, Enrico / Fornelli, Adele / Jovine, Elio / Fabbri, Carlo / Brandes, Alba A / Tallini, Giovanni / Pession, Annalisa / de Biase, Dario. ·Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy. · Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy. · Operative Unit of Medicine, Budrio Hospital, Budrio, Italy. · Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, University of Bologna, Bologna, Italy. · Surgery Unit, Maggiore Hospital, Bologna, Italy. · Medical Oncology Department, Bellaria Hospital, Azienda USL/ IRCCS Institute of Neurological Sciences, Bologna, Italy. · Anatomic Pathology Unit, Maggiore Hospital, Bologna, Italy. · Endoscopy Unit, Maggiore Hospital, Bologna, Italy. · Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, Bologna, Italy. ·J Clin Pathol · Pubmed #26314585.

ABSTRACT: Pancreatic tumours are usually very aggressive cancer with a poor prognosis. A limitation of pancreatic imaging techniques is that lesions are often of ambiguous relevance. The inability to achieve a definitive diagnosis based on cytological evaluation of specimens, due to sampling error, paucicellular samples or coexisting inflammation, might lead to delay in clinical management. Given the morbidity associated with pancreatectomy, a proper selection of patients for surgery is fundamental. Many studies have been conducted in order to identify specific markers that could support the early diagnosis of pancreatic lesions, but, to date, none of them allow to diagnose pancreatic cancer with high sensitivity and specificity. MicroRNAs (miRNA) are small non-coding RNAs (19-25 nucleotides) that regulate gene expression interacting with mRNA targets. It is now established that each tissue shows a characteristic miRNA expression pattern that could be modified in association with a number of different diseases including neoplasia. Due to their key role in the regulation of gene expression, in the last years several studies have investigated miRNA tissue-specific expression, quantification and functional analysis to understand their peculiar involvement in cellular processes. The aim of this review is to focus on miRNA expression in pancreatic cancer and their putative role in early characterisation of pancreatic lesions.

4 Review Management of serous cystic neoplasms of the pancreas. 2015

Antonini, Filippo / Fuccio, Lorenzo / Fabbri, Carlo / Macarri, Giampiero / Palazzo, Laurent. ·Department of Gastroenterology, A.Murri Hospital, Polytechnic University of Marche, Fermo, Italy. ·Expert Rev Gastroenterol Hepatol · Pubmed #24981593.

ABSTRACT: Pancreatic serous cystadenomas are uncommon benign tumours that are often found incidentally on routine imaging examinations. Radiological imaging techniques alone have proven to be suboptimal to fully characterize cystic pancreatic lesions. Endoscopic ultrasound, with the addition of fine-needle aspiration in difficult cases, has showed greater diagnostic accuracy than conventional imaging techniques. The best management strategy of these neoplasms is still debated. Surgery should be limited only to symptomatic and highly selected cases and most of the patients should only be strictly monitored. In the current paper, we provide an updated overview on pancreatic serous cystadenomas, focusing our attention on epidemiology, clinical characteristics and diagnostic evaluation; finally, we also discuss different management strategies and areas for future research.

5 Review The role of endoscopic ultrasound in the radiation treatment of pancreatic tumor. 2014

Fuccio, Lorenzo / Guido, Alessandra / Larghi, Alberto / Antonini, Filippo / Lami, Gabriele / Fabbri, Carlo. ·Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. ·Expert Rev Gastroenterol Hepatol · Pubmed #24766230.

ABSTRACT: Radiotherapy is an established treatment modality for patients with pancreatic cancer. Image-guided radiation therapy (IGRT) allows the delivery of high doses to the tumour, while sparing the sensitive tissues around it, thus reducing side effects. However, the need of precisely contouring and identifying the target lesion is mandatory to be able to perform IGRT. Endoscopic ultrasound has been progressively implemented in the field of radiotherapy as a tool for intra-lesional placement of fiducial markers to perform IGRT and for direct placing of sealed radioactive sources in contact with the target lesions. In the current paper we provide an updated review on the role of endoscopic ultrasound in the radiation treatment of pancreatic cancer, highlighting areas of future research.

6 Review Endoscopic tattooing of gastrointestinal and pancreatic lesions. 2012

Luigiano, Carmelo / Ferrara, Francesco / Morace, Carmela / Mangiavillano, Benedetto / Fabbri, Carlo / Cennamo, Vincenzo / Bassi, Marco / Virgilio, Clara / Consolo, Pierluigi. ·Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi Nesima Hospital, Via Palermo 636, 95122, Catania, Italy. carmeluigiano@libero.it ·Adv Ther · Pubmed #23054693.

ABSTRACT: The intraoperative identification of the lesions found at endoscopic examination is often difficult, especially during laparoscopic surgery. At present, the most used technique for the intraoperative detection of pathological lesions is endoscopic tattooing. The large majority of studies carried out concern colorectal lesions; however, endoscopic tattooing has also been described for esophageal, gastric, small bowel and, more recently, pancreatic lesions. In this review, the authors evaluated indications, substances used, injection techniques, accuracy, safety and, finally, the risk of complications related to this procedure.

7 Review Analysis of prognostic factors in metastatic tumors of the pancreas: a single-center experience and review of the literature. 2010

Masetti, Michele / Zanini, Nicola / Martuzzi, Federica / Fabbri, Carlo / Mastrangelo, Laura / Landolfo, Giovanni / Fornelli, Adele / Burzi, Marcellino / Vezzelli, Elena / Jovine, Elio. ·School of Medicine, University of Modena, Modena, Bologna, Italy. m.masetti@ausl.bologna.it ·Pancreas · Pubmed #19820422.

ABSTRACT: OBJECTIVES: Pancreatic metastases are rare. The role of surgery is poorly defined, and data on long-term survival are lacking. METHODS: Data from patients with pancreatic metastases observed in our division from 2003 to 2008 were retrospectively analyzed. In addition, the recent English medical literature was reviewed regarding series of patients with pancreatic secondary tumors. RESULTS: Data from 234 patients including 9 consecutive patients observed in our division were retrieved. Metastasis from renal cell carcinoma accounted for 67.9% of all cases. Factors predictive of worse survival, as determined by multivariate analysis, were symptoms at diagnosis, synchronous tumors, radical-intent surgery not performed, and pathologic diagnosis of the primary tumor. Compared with pancreatic metastases from renal cell cancer, metastases from melanoma (P < 0.001) and lung cancer (P = 0.002) were associated with worse survival. The differences in survival of patients with renal cell cancer metastases and those with breast cancer, colorectal, or sarcoma metastases did not reach statistical significance. CONCLUSIONS: There may be a subset of patients with pancreatic metastases who are able to benefit from surgery with respect to improved long-term survival. Symptoms at diagnosis, presentation with primary tumor, surgical resection, and pathologic diagnosis seem to be important prognostic factors.

8 Article Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A multicenter study. 2018

Barresi, Luca / Crinò, Stefano F / Fabbri, Carlo / Attili, Fabia / Poley, Jan W / Carrara, Silvia / Tarantino, Ilaria / Bernardoni, Laura / Giovanelli, Silvia / Di Leo, Milena / Manfrin, Erminia / Tacelli, Matteo / Bruno, Marco J / Traina, Mario / Larghi, Alberto. ·Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy. · Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Gastroenterology and Surgical Sciences, Bellaria-Maggiore Hospital, AUSL Bologna, University of Bologna, Bologna, Italy. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy. · Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy. ·Dig Endosc · Pubmed #29808529.

ABSTRACT: BACKGROUND AND AIM: Tissue acquisition in pancreatic cystic lesions (PCL) is the ideal method for diagnosis and risk stratification for malignancy of these lesions. Direct sampling from the walls of PCL with different devices has shown better results than cytology from cystic fluid. We carried out a retrospective, multicenter study to evaluate the feasibility, safety, and diagnostic yield of a micro-forceps, specifically designed to be used through a 19-gauge needle after endoscopic ultrasonography (EUS)-guided puncture of PCL. METHODS: We retrospectively collected data from patients who underwent EUS-through-the-needle biopsy (EUS-TTNB) in PCL at six referral centers. RESULTS: The sampling procedure was carried out in 56 patients (mean age 57.5 ± 13.1 years, M:F 17:39), and was technically successful in all of them (100%; 95% confidence interval [CI], 94-100%). Adverse events occurred in 9/56 (16.1%; 95% CI, 8-28%) patients, with self-limited intracystic hemorrhage the most common (7/56, 12.5%; 95% CI, 5-24%). All adverse events were mild, and resolved without any specific intervention. Specimens were considered adequate for histological diagnosis in 47/56 (83.9%; 95% CI, 72-92%). In two of these patients, despite the histological adequacy, a diagnosis could not be reached. In two other cases, a specimen sufficient for a cytological diagnosis was obtained. Overall diagnostic yield by combining cytological and histological samples was 47/56 (83.9%; 95% CI, 72-92%). CONCLUSION: EUS-TTNB with micro-forceps in PCL is feasible, safe, and has a high diagnostic yield. Future prospective studies are needed to better assess the clinical impact of EUS-TTNB on the management of PCL.

9 Article The Role of Next-Generation Sequencing in the Cytologic Diagnosis of Pancreatic Lesions. 2018

de Biase, Dario / Visani, Michela / Acquaviva, Giorgia / Fornelli, Adele / Masetti, Michele / Fabbri, Carlo / Pession, Annalisa / Tallini, Giovanni. ·From the Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie)-Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy (Dr de Biase and Ms Pession) · the Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale)-Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy (Drs Visani and Tallini and Ms Acquaviva) · the Unit of Anatomic Pathology, Azienda USL-Maggiore Hospital, Bologna, Italy (Dr Fornelli) · and the Units of Surgery (Dr Masetti) and Gastroenterology and Digestive Endoscopy (Dr Fabbri), Azienda USL Bologna Bellaria-Maggiore Hospitals, Bologna, Italy. ·Arch Pathol Lab Med · Pubmed #29565213.

ABSTRACT: CONTEXT: - Integration of the analysis of genetic markers with endoscopic ultrasound-guided fine-needle aspiration and cytologic evaluation has increased the accuracy of the preoperative diagnosis of pancreatic lesions. The application of high-throughput gene panel analysis using next-generation sequencing platforms is now offering a great opportunity for further improvements. OBJECTIVE: - To review the application of next-generation sequencing to the preoperative diagnosis of pancreatic lesions. DATA SOURCES: - For data acquisition, a PubMed search using the terms next-generation sequencing, pancreas, pancreatic lesions, pancreatic tumors, and EUS-FNA was performed covering the years 2000-2017. CONCLUSIONS: - KRAS remains the gene most widely studied for preoperative single-gene tests. Next-generation sequencing reliably allows analysis of multiple gene markers starting from limited amounts of DNA. The study of multigene panels has become a very attractive option for the management and preoperative risk stratification of patients with pancreatic cancer.

10 Article Long-term survivors of pancreatic adenocarcinoma show low rates of genetic alterations in KRAS, TP53 and SMAD4. 2018

Masetti, Michele / Acquaviva, Giorgia / Visani, Michela / Tallini, Giovanni / Fornelli, Adele / Ragazzi, Moira / Vasuri, Francesco / Grifoni, Daniela / Di Giacomo, Simone / Fiorino, Sirio / Lombardi, Raffaele / Tuminati, David / Ravaioli, Matteo / Fabbri, Carlo / Bacchi-Reggiani, Maria Letizia / Pession, Annalisa / Jovine, Elio / de Biase, Dario. ·Surgery Unit, Azienda USL-Maggiore Hospital, Bologna, Italy. · Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy. · Anatomic Pathology Unit, Azienda USL-Maggiore Hospital, Bologna, Italy. · Anatomic Pathology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy. · Anatomic Pathology Unit, "F. Addarii" Institute of Oncology and Transplantation Pathology, S. Orsola-Malpighi University Hospital, Bologna, Italy. · Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy. · Internal Medicine Unit, Maggiore Hospital, Bologna, Italy. · Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Bologna, Italy. · Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. · Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), Cardiology Unit, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy. ·Cancer Biomark · Pubmed #29103024.

ABSTRACT: BACKGROUND: Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is currently the only effective treatment for PDAC, most patients survive less than 20 months after tumor resection. OBJECTIVE: The primary goal was to investigate alterations in KRAS, TP53, SMAD4 and CDKN2A/p16 in tumors from patients with exceptionally long survival after surgery. METHODS: Tumors from 15 patients with PDAC that survived more than 55 months after surgery ("LS") were analyzed for KRAS, TP53, IDH1, NRAS and BRAF using next-generation sequencing. SMAD4 and CDKN2A/p16 was tested using immunohistochemistry. MGMT promoter methylation was investigated. RESULTS: Tumors from "LS" have a lower prevalence of KRAS and TP53 mutations and had more frequently SMAD4 retained expression, if compared with that of patients died within 24 months from surgery. The survival of patients with wild-type KRAS and TP53 tumors was more than twice longer than that of patients bearing KRAS and TP53 mutations (90.2 vs. 41.1 months). Patients with KRAS wild-type tumors and that retained SMAD4 expression had a survival twice longer than cases with alterations in both genes (83.8 vs. 36.7 months). Eleven tumors (39.3%) showed MGMT methylation. CONCLUSIONS: Our data indicate that absence of KRAS, TP53 and SMAD4 genetic alterations may identify a subset of pancreatic carcinomas with better outcome.

11 Article Biliary plastic stent does not influence the accuracy of endoscopic ultrasound-guided sampling of pancreatic head masses performed with core biopsy needles. 2017

Antonini, Filippo / Fuccio, Lorenzo / Giorgini, Sara / Fabbri, Carlo / Frazzoni, Leonardo / Scarpelli, Marina / Macarri, Giampiero. ·Division of Gastroenterology, Augusto Murri Hospital, Polytechnic University of Marche, Fermo, Italy. Electronic address: filippore@yahoo.it. · Division of Gastroenterology, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Pathological Anatomy and Histopathology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy. · Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Division of Gastroenterology, Augusto Murri Hospital, Polytechnic University of Marche, Fermo, Italy. ·Dig Liver Dis · Pubmed #28465092.

ABSTRACT: OBJECTIVE: While the presence of biliary stent significantly decreases the accuracy of endoscopic ultrasound (EUS) for pancreatic head cancer staging, its impact on the EUS-guided sampling accuracy is still debated. Furthermore, data on EUS-fine needle biopsy (EUS-FNB) using core biopsy needles in patients with pancreatic mass and biliary stent are lacking. The aim of this study was to evaluate the influence of biliary stent on the adequacy and accuracy of EUS-FNB in patients with pancreatic head mass. METHODS: All patients who underwent EUS-guided sampling with core needles of solid pancreatic head masses causing obstructive jaundice were retrospectively identified in a single tertiary referral center. Adequacy, defined as the rate of cases in which a tissue specimen for proper examination was achieved, with and without biliary stent, was the primary outcome measure. The diagnostic accuracy and complication rate were the secondary outcome measures. RESULTS: A total of 130 patients with pancreatic head mass causing biliary obstruction were included in the study: 74 cases of them were sampled without stent and 56 cases with plastic stent in situ. The adequacy was 96.4% in the stent group and 90.5% in the group without stent (p=0.190). No significant differences were observed for sensitivity (88.9% vs. 85.9%), specificity (100% for both groups), and accuracy (89.3% vs. 86.5%) between those with and without stent, respectively. The accuracy was not influenced by the timing of stenting (<48h or ≥48h before EUS). No EUS-FNB related complications were recorded. CONCLUSION: The presence of biliary stent does not influence the tissue sampling adequacy, the diagnostic accuracy and the complication rate of EUS-FNB of pancreatic head masses performed with core biopsy needles.

12 Article The presence of rapid on-site evaluation did not increase the adequacy and diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions with core needle. 2017

Fabbri, Carlo / Fuccio, Lorenzo / Fornelli, Adele / Antonini, Filippo / Liotta, Rosa / Frazzoni, Leonardo / Larghi, Alberto / Maimone, Antonella / Paggi, Silvia / Gusella, Paolo / Barresi, Luca / Polifemo, Anna Maria / Iovine, Elio / Macarri, Giampiero / Cennamo, Vincenzo / Tarantino, Ilaria. ·Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, 40133, Bologna, Italy. carlo.fabbri@ausl.bologna.it. · Division of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Pathology Service, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Department of Gastroenterology, A. Murri Hospital, Fermo, Italy. · Pathology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bellaria-Maggiore Hospital, 40133, Bologna, Italy. · Gastroenterology Unit, Valduce Hospital, Como, Italy. · Pathology Service, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy. · Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy. · Emergency and General Surgery Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. ·Surg Endosc · Pubmed #27194261.

ABSTRACT: BACKGROUND: Rapid on-site evaluation (ROSE) improves the adequacy and accuracy of EUS-guided tissue acquisition, although it is not routinely widely available. Evidence suggested that core needles might overcome the absence of ROSE. The aim of this study was to evaluate the influence of ROSE on the adequacy and accuracy of EUS-guided tissue acquisition with core needles in patients with pancreatic solid lesions. METHODS: Patients who underwent EUS-guided tissue acquisition of pancreatic mass lesions were retrospectively identified at three tertiary referral centers and those performed with the core needle were included. Adequacy, defined as the rate of cases in which a tissue specimen for proper examination was achieved, with and without ROSE was the primary outcome measure. The diagnostic accuracy and tissue core acquisition were the secondary outcome measures. RESULTS: A total of 333 patients with pancreatic solid mass lesions were included in the study; 140 cases sampled with ROSE and 193 cases without ROSE. The adequacy was 92.1 % in the group sampled with ROSE and 88.1 % in the group without ROSE (p = 0.227). In the ROSE group sensitivity, specificity, and accuracy were 90.7, 100 and 92.1 %, respectively. In the group without ROSE, sensitivity, specificity, and accuracy were 87.2, 100, and 88.1 %, respectively. No difference for all these figures was observed between the two groups. The tissue core was available in 61.4 and 53.4 % of cases with and without ROSE, respectively (p = 0.143). CONCLUSION: In the absence of ROSE, EUS-based tissue acquisition with Core needle should be considered since it achieves comparable tissue sampling adequacy and accuracy.

13 Article Endoscopic ultrasound-guided fine-needle biopsy of small solid pancreatic lesions using a 22-gauge needle with side fenestration. 2015

Fabbri, Carlo / Luigiano, Carmelo / Maimone, Antonella / Tarantino, Ilaria / Baccarini, Paola / Fornelli, Adele / Liotta, Rosa / Polifemo, Annamaria / Barresi, Luca / Traina, Mario / Virgilio, Clara / Cennamo, Vincenzo. ·Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Via Altura, 40139, Bologna, Italy, carlo.fabbri@ausl.bologna.it. ·Surg Endosc · Pubmed #25303907.

ABSTRACT: BACKGROUND: Early detection of small pancreatic cancer is important because expected survival is markedly better for tumors ≤ 2 cm. A new endoscopic ultrasound-(EUS) guided biopsy needle with side fenestration has been recently developed to enable fine-needle biopsy (FNB) under EUS guidance. The aim of this study was to evaluate the outcome of EUS-FNB using a 22-gauge ProCore needle in solid pancreatic lesions ≤ 2 cm, in terms of diagnostic accuracy and yield. METHODS: From January 2011 to December 2012, all consecutive EUS-guided tissue sampling of small pancreatic lesions (≤ 2 cm) were performed using 22-gauge ProCore needles; the data of these patients were analyzed retrospectively. RESULTS: Sixty-eight patients with a mean age of 65.7 years were included. The mean lesion size was 16.5 mm (range 5-20). None of the patients developed complications. On pathological examination, the tissue retrieved was judged adequate in 58 out of 68 cases (85.3 %) and the presence of a tissue core was recorded in 36 out of 68 cases (52.9 %). The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80, 100, 100, 40, and 82 %, respectively. CONCLUSION: Our results suggested that EUS-FNB of small pancreatic lesions using a 22-gauge ProCore needle is effective and safe, and supports our hypothesis that EUS-FNB is highly useful in establishing the nature of small pancreatic lesions.

14 Article Ki-67 cytological index can distinguish well-differentiated from poorly differentiated pancreatic neuroendocrine tumors: a comparative cytohistological study of 53 cases. 2014

Carlinfante, Gabriele / Baccarini, Paola / Berretti, Debora / Cassetti, Tiziana / Cavina, Maurizio / Conigliaro, Rita / De Pellegrin, Alessandro / Di Tommaso, Luca / Fabbri, Carlo / Fornelli, Adele / Frasoldati, Andrea / Gardini, Giorgio / Losi, Luisa / Maccio, Livia / Manta, Raffaele / Pagano, Nico / Sassatelli, Romano / Serra, Silvia / Camellini, Lorenzo. ·Department of Pathology, Arcispedale Santa Maria Nuova-IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy, carlinfante.gabriele@asmn.re.it. ·Virchows Arch · Pubmed #24807732.

ABSTRACT: The Ki-67 labeling index has been found to bear prognostic significance in gastrointestinal neuroendocrine tumors (NETs), and it was recently incorporated in NET histological grading. Nevertheless, a reliable preoperative determination of NET grading could be useful in clinical practice. The aim of this study is to compare the results of Ki-67 labeling index, as measured on cytological samples and on surgical specimens of patients with pancreatic NETs (P-NETs). We also investigated whether concordance might be improved, using a 5 % (instead of 2 %) cutoff value for defining G2 tumors. We retrospectively identified 48 consecutive patients with 53 P-NETs, from our five institutions, and we measured Ki-67 labeling index on their cytological samples and surgical specimens. The traditional 2 % and the alternative 5 % cutoff values were used to classify G2 tumors. The concordance rate between cytological and histological grading was 46/53 (86.8 %; weighted κ statistic 0.77; 95 % confidence interval (95 % CI) 0.60-0.94). No cases of cytological G1-G2 NETs were upgraded to G3 neuroendocrine carcinoma (NEC) at histological grading. Cytology was found to be highly specific in the diagnosis of both G2 (94.1 %; 95 % CI 80.3-99.3) and G3 tumors (100.0 %; 95 % CI 92.8-100), but the sensitivity was poor for G2 NETs (66.7 %; 95 % CI 38.4-88.2) and high for the prediction of G3 NECs (100 %; 95 % CI 39.8-100.0). When the 5 % cutoff value was adopted, concordance rate was 49/53 (92.4 %; weighted κ 0.82; 95 % CI 0.64-1.00). In conclusion, Ki-67 cytological expression can distinguish well-differentiated (both G1 and G2) from poorly differentiated P-NETs, and it may be useful for their preoperative classification.

15 Article Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. 2014

Tarantino, Ilaria / Di Mitri, Roberto / Fabbri, Carlo / Pagano, Nico / Barresi, Luca / Granata, Antonino / Liotta, Rosa / Mocciaro, Filippo / Maimone, Antonella / Baccarini, Paola / Fabio, Tuzzolino / Curcio, Gabriele / Repici, Alessandro / Traina, Mario. ·Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. Electronic address: itarantino@ismett.edu. · Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy. · Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Gastroenterology Department, Humanitas Irccs, Rozzano, Milano, Italy. · Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. · Pathology Unit, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy. · Gastroenterology Department Ferrara University, Ferrara, Italy. · Pathology Unit, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Office of Research, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy. ·Dig Liver Dis · Pubmed #24704290.

ABSTRACT: BACKGROUND: Endoscopic ultrasound fine needle aspiration has a central role in the diagnostic algorithm of solid pancreatic masses. Data comparing the fine needle aspiration performed with different aspiration volume and without aspiration are lacking. We compared endoscopic ultrasound fine needle aspiration performed with the 22 gauge needle with different aspiration volumes (10, 20 and 0 ml), for adequacy, diagnostic accuracy and complications. METHODS: Prospective clinical study at four referral centres. Endoscopic ultrasound fine needle aspiration was performed with a 22G needle with both volume aspiration (10 and 20 cc) and without syringe, in randomly assigned sequence. The cyto-pathologist was blinded as to which aspiration was used for each specimen. RESULTS: 100 patients met the inclusion criteria, 88 completed the study. The masses had a mean size of 32.21±11.24 mm. Sample adequacy evaluated on site was 87.5% with 20 ml aspiration vs. 76.1% with 10 ml (p=0.051), and 45.4% without aspiration (20 ml vs. 0 ml p<0.001; 10 ml vs. 0 ml p<0.001). The diagnostic accuracy was significantly better with 20 ml than with 10 ml and 0 ml (86.2% vs. 69.0% vs. 49.4% p<0.001). CONCLUSIONS: A significantly higher adequacy and accuracy were observed with the 20 ml aspiration puncture, therefore performing all passes with this volume aspiration may improve the diagnostic power of fine needle aspiration.

16 Article Next generation sequencing improves the accuracy of KRAS mutation analysis in endoscopic ultrasound fine needle aspiration pancreatic lesions. 2014

de Biase, Dario / Visani, Michela / Baccarini, Paola / Polifemo, Anna Maria / Maimone, Antonella / Fornelli, Adele / Giuliani, Adriana / Zanini, Nicola / Fabbri, Carlo / Pession, Annalisa / Tallini, Giovanni. ·Department of Medicine (DIMES) - Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy ; Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy. · Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy. · Department of Medicine (DIMES) - Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy. · Unit of Gastroenterology, Azienda Unità Sanitaria Locale di Bologna - Bellaria Hospital, Bologna, Italy. · School of Gastroenterology, University of Ferrara, Ferrara, Italy. · Anatomic Pathology Unit, Azienda Unità Sanitaria Locale di Bologna - Maggiore Hospital, Bologna, Italy. · Indiana University, Bloomington, Indiana, United States of America. · Unit of General Surgery, Azienda Unità Sanitaria Locale di Bologna - Maggiore Hospital, Bologna, Italy. ·PLoS One · Pubmed #24504548.

ABSTRACT: The use of endoscopic ultrasonography has allowed for improved detection and pathologic analysis of fine needle aspirate material for pancreatic lesion diagnosis. The molecular analysis of KRAS has further improved the clinical sensitivity of preoperative analysis. For this reason, the use of highly analytical sensitive and specific molecular tests in the analysis of material from fine needle aspirate specimens has become of great importance. In the present study, 60 specimens from endoscopic ultrasonography fine needle aspirate were analyzed for KRAS exon 2 and exon 3 mutations, using three different techniques: Sanger sequencing, allele specific locked nucleic acid PCR and Next Generation sequencing (454 GS-Junior, Roche). Moreover, KRAS was also tested in wild-type samples, starting from DNA obtained from cytological smears after pathological evaluation. Sanger sequencing showed a clinical sensitivity for the detection of the KRAS mutation of 42.1%, allele specific locked nucleic acid of 52.8% and Next Generation of 73.7%. In two wild-type cases the re-sequencing starting from selected material allowed to detect a KRAS mutation, increasing the clinical sensitivity of next generation sequencing to 78.95%. The present study demonstrated that the performance of molecular analysis could be improved by using highly analytical sensitive techniques. The Next Generation Sequencing allowed to increase the clinical sensitivity of the test without decreasing the specificity of the analysis. Moreover we observed that it could be useful to repeat the analysis starting from selectable material, such as cytological smears to avoid false negative results.

17 Article Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. 2014

Tarantino, Ilaria / Fabbri, Carlo / Di Mitri, Roberto / Pagano, Nico / Barresi, Luca / Mocciaro, Filippo / Maimone, Antonella / Curcio, Gabriele / Repici, Alessandro / Traina, Mario. ·Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. Electronic address: itarantino@ismett.edu. · Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy. · Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy. · Gastroenterology Department, Humanitas Irccs, Rozzano, Milan, Italy. · Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy. · Gastroenterology Department Ferrara University, Ferrara, Italy. ·Dig Liver Dis · Pubmed #24054767.

ABSTRACT: BACKGROUND: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been reported to have a higher complication rate than that of solid lesions, but the real complication rate is unknown. Aim of the study was to identify the complication rate of endoscopic ultrasound-guided fine needle aspiration and related risk factors. METHODS: Prospective multicenter study at four referral centres. Data were collected from January 2010 to July 2012, searching for all adverse events related to guided fine needle aspiration. All complications occurring up to day 90 were recorded. RESULTS: 298 patients (43.9% male, mean age 63.2 ± 15.4 years) underwent endoscopic ultrasound-guided needle aspiration of pancreatic cystic lesions. Mean size was 34.1 ± 9 mm. Adverse events occurred in 18 patients (6%): mild complications in 12/18 (66.6%), and moderate complications in 6/18 (33.3%). Seven were immediate, 6 early, and 5 late. All resolved with medical therapy. CONCLUSIONS: Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been found to be associated with a higher complication rate than for solid lesions; however, the risk rate is acceptable considering the complication grade and the important diagnostic role of the technique in the management of pancreatic cystic lesions.

18 Article Endoscopic ultrasound-guided fine needle aspiration and biopsy using a 22-gauge needle with side fenestration in pancreatic cystic lesions. 2014

Barresi, Luca / Tarantino, Ilaria / Traina, Mario / Granata, Antonino / Curcio, Gabriele / Azzopardi, Neville / Baccarini, Paola / Liotta, Rosa / Fornelli, Adele / Maimone, Antonella / Jovine, Elio / Cennamo, Vincenzo / Fabbri, Carlo. ·Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy. Electronic address: lbarresi@ismett.edu. · Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy. · Pathology Unit, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. · Pathology Unit, ISMETT, Palermo, Italy. · Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. · Department of General Surgery, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. ·Dig Liver Dis · Pubmed #23916241.

ABSTRACT: BACKGROUND: Cytologic diagnosis by endoscopic ultrasound-guided fine needle aspiration is associated with low sensitivity and adequacy. A newly designed endoscopic ultrasound-guided fine needle biopsy device, endowed with a side fenestration, is now available. AIMS: We carried out a study with the aim of evaluating the feasibility, safety, and diagnostic yield of the 22-gauge needle with side fenestration for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions. METHODS: 58 patients with 60 pancreatic cystic lesions consecutively referred for endoscopic ultrasound guided-fine needle aspiration were enrolled in a prospective, dual centre study, and underwent fine needle aspiration and biopsy with the 22-gauge needle with side fenestration. RESULTS: Fine needle aspiration and biopsy was technically feasible in all cases. In 39/60 (65%) pancreatic cystic lesions, the specimens were adequate for cyto-histologic assessment. In lesions with solid components, and in malignant lesions, adequacy was 94.4% (p = 0.0149) and 100% (p = 0.0069), respectively. Samples were adequate for histologic evaluation in 18/39 (46.1%) cases. There were only 2 (3.3%) mild complications. CONCLUSIONS: Fine needle aspiration and biopsy with the 22-gauge needle with side fenestration is feasible, and superior to conventional endoscopic ultrasound-guided fine needle aspiration cytology from cystic fluid, particularly in pancreatic cystic lesions with solid component or malignancy, with a higher diagnostic yield and with no increase in complication rate.

19 Article Body tattooing: efficacy of a “new” practice. 2013

Fornelli, Adele / Fabbri, Carlo / Zanini, Nicola / Jovine, Elio. ·Department of Pathology, Maggiore Hospital, Bologna, Italy. adele.fornelli@ausl.bologna.it ·Pancreatology · Pubmed #24049874.

ABSTRACT: -- No abstract --

20 Article Preoperative diagnosis of a solid pseudopapillary tumour of the pancreas by Endoscopic Ultrasound Fine Needle Biopsy: A retrospective case series. 2013

Maimone, Antonella / Luigiano, Carmelo / Baccarini, Paola / Fornelli, Adele / Cennamo, Vincenzo / Polifemo, Annamaria / Fiscaletti, Marta / de Biase, Dario / Jaboli, Francesca / Virgilio, Clara / Stelitano, Liliana / Zanini, Nicola / Masetti, Michele / Jovine, Elio / Fabbri, Carlo. ·Unit of Gastroenterology, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. ·Dig Liver Dis · Pubmed #23876743.

ABSTRACT: BACKGROUND: A solid pseudopapillary tumour of the pancreas (SPTP) is a rare neoplasm. AIM: We herein present five cases of SPTP diagnosed using endoscopic ultrasound (EUS) guided fine-needle biopsy (FNB) using a needle with side fenestration (ProCore-needle). METHODS: From January 2011 to June 2012 in five patients with SPTP tissue acquisition was carried out with a 19-gauge (4 patients) or a 22-gauge (one patient) needle. RESULTS: The mean age of the patients was 30.8 years, the mean lesion size was 49mm and the most common location was the tail of the pancreas (3 cases). When the samples were evaluated macroscopically, small core fragments were observed in all cases. A preoperative diagnosis of SPTP was made in all patients on the basis of the histocytological and characteristic immunophenotypic patterns and was confirmed at final surgical histology. CONCLUSIONS: In our experience, EUS-FNB is an effective and secure method for a preoperative diagnosis of SPTP.

21 Article The role of K-ras gene mutation analysis in EUS-guided FNA cytology specimens for the differential diagnosis of pancreatic solid masses: a meta-analysis of prospective studies. 2013

Fuccio, Lorenzo / Hassan, Cesare / Laterza, Liboria / Correale, Loredana / Pagano, Nico / Bocus, Paolo / Fabbri, Carlo / Maimone, Antonella / Cennamo, Vincenzo / Repici, Alessandro / Costamagna, Guido / Bazzoli, Franco / Larghi, Alberto. ·Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. ·Gastrointest Endosc · Pubmed #23660563.

ABSTRACT: BACKGROUND: Differential diagnosis of pancreatic solid masses with EUS-guided FNA (EUS-FNA) is still challenging in about 15% of cases. Mutation of the K-ras gene is present in over 75% of pancreatic adenocarcinomas (PADC). OBJECTIVE: To assess the accuracy of K-ras gene mutation analysis for diagnosing PADC. DESIGN: We systematically searched the electronic databases for relevant studies published. Data from selected studies underwent meta-analysis by use of a bivariate model providing a pooled value for sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve. SETTING: Meta-analysis of 8 prospective studies. PATIENTS: Total of 931 patients undergoing EUS-FNA for diagnosis of pancreatic solid masses. INTERVENTION: K-ras mutation analysis. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy of K-ras mutation analysis and of combined diagnostic strategy by using EUS-FNA and K-ras mutation analysis in the diagnosis of PADC. RESULTS: The pooled sensitivity of EUS-FNA for the differential diagnosis of PADC was 80.6%, and the specificity was 97%. Estimated sensitivity and specificity were 76.8% and 93.3% for K-ras gene analysis, respectively, and 88.7% and 92% for combined EUS-FNA plus K-ras mutation analysis. Overall, K-ras mutation testing applied to cases that were inconclusive by EUS-FNA reduced the false-negative rate by 55.6%, with a false-positive rate of 10.7%. Not repeating EUS-FNA in cases in which mutation testing of the K-ras gene is inconclusive would reduce the repeat-biopsy rate from 12.5% to 6.8%. LIMITATIONS: Small number of studies and between-study heterogeneity. CONCLUSION: K-ras mutation analysis can be useful in the diagnostic work-up of pancreatic masses, in particular when tissue obtained by EUS-FNA is insufficient, and the diagnosis inconclusive.

22 Article Risk factors for intraductal papillary mucinous neoplasm (IPMN) of the pancreas: a multicentre case-control study. 2013

Capurso, Gabriele / Boccia, Stefania / Salvia, Roberto / Del Chiaro, Marco / Frulloni, Luca / Arcidiacono, Paolo Giorgio / Zerbi, Alessandro / Manta, Raffaele / Fabbri, Carlo / Ventrucci, Maurizio / Tarantino, Ilaria / Piciucchi, Matteo / Carnuccio, Antonella / Boggi, Ugo / Leoncini, Emanuele / Costamagna, Guido / Delle Fave, Gianfranco / Pezzilli, Raffaele / Bassi, Claudio / Larghi, Alberto / Anonymous6710751 / Anonymous6720751. ·Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy. gabriele.capurso@gmail.com ·Am J Gastroenterol · Pubmed #23458848.

ABSTRACT: OBJECTIVES: To investigate environmental, personal, and hereditary risk factors associated with the occurrence of intraductal papillary mucinous neoplasms of the pancreas (IPMNs). METHODS: Multicentre case-control study. Risk factors were identified from a questionnaire collecting data on family and medical history, and environmental factors. Cases were prevalent IPMNs seen at the participating units within an 18-month timeframe. Matched controls were enrolled alongside patients seen at outpatient clinics. RESULTS: Three-hundred and ninety patients with IPMN and 390 matched controls (166 males, mean age 65 in each group) were enrolled. Of the IPMNs, 310 had branch-duct involvement and 80 main-duct involvement. The only cancer with a 1st degree family history significantly higher in IPMN was pancreatic ductal adenocarcinoma (PDAC) (5.4% vs. 1.5%). Previous history of diabetes (13.6% vs. 7.5%), chronic pancreatitis (CP) (3.1% vs. 0.3%), peptic ulcer (7.2% vs. 4.3%), and insulin use (4.9% vs. 1.1%) were all more frequent with IPMNs. Logistic regression multivariate analysis revealed that history of diabetes (odds ratio (OR): 1.79, confidence interval (CI) 95%: 1.08-2.98), CP (OR: 10.10, CI 95%: 1.30-78.32), and family histories of PDAC (OR: 2.94, CI 95%: 1.17-7.39) were all independent risk factors. However, when analysis was restricted to diabetics who had taken insulin, risk of IPMN became stronger (OR: 6.03, CI 95%: 1.74-20.84). The association with all these risk factors seemed stronger for the subgroup with main duct involvement. CONCLUSIONS: A previous history of diabetes, especially with insulin use, CP, and family history of PDAC are all relevant risk factors for the development of IPMN. These results suggest an overlap between certain risk factors for PDAC and IPMN.

23 Article Multiple KRAS mutations in pancreatic adenocarcinoma: molecular features of neoplastic clones indicate the selection of divergent populations of tumor cells. 2013

Visani, Michela / de Biase, Dario / Baccarini, Paola / Fabbri, Carlo / Polifemo, Anna Maria / Zanini, Nicola / Pession, Annalisa / Tallini, Giovanni. ·1University of Bologna School of Medicine, Bologna, Italy. ·Int J Surg Pathol · Pubmed #23426962.

ABSTRACT: KRAS is one of the most common genes mutated in pancreatic adenocarcinoma. Multiple KRAS mutations may be detected within the same pancreatic adenocarcinoma, but it is usually unclear whether the different mutations represent biologically irrelevant molecular events or whether they indicate the coexistence of distinct sizable neoplastic clones within a given tumor. We identified a case of pancreatic adenocarcinoma with 5 different mutations in the KRAS gene and have been able to characterize the allelic distribution of the KRAS mutations and the size of the neoplastic clones using allele-specific locked nucleic acid polymerase chain reaction and next-generation sequencing (454 GS-Junior). The results indicate that the tumor is composed of 5 distinct cell populations: one is KRAS G12V mutated (~38% of neoplastic cells), the second is KRAS G12V in one allele and KRAS G12D in the other (~32%), the third is KRAS G12V in one allele and KRAS G12R in the other (~24%), and the fourth is KRAS G12V in one allele and KRAS G12C in the other (~6%). The fifth clone, representing a minority of neoplastic cells, has a KRAS Q61H mutation in addition to one of the above alterations. Microsatellite analysis identified mutation of the NR21 marker out of the 13 tested, indicating that the tumor has a defect in maintaining DNA integrity different from loss of conventional DNA mismatch repair. These results are consistent with the successive selection of divergent populations of tumor cells and underscore the relevance of nucleotide instability in pancreatic adenocarcinoma.

24 Article Very high CEA level in a large pancreatic cyst: is it a surgical indication by itself? 2012

Zanini, Nicola / Fornelli, Adele / Fiscaletti, Marta / Fabbri, Carlo / Lombardi, Raffaele / Polifemo, Anna Maria / Baccarini, Paola / Masetti, Michele / Jovine, Elio. ·Department of Surgery, Maggiore Hospital, L.go B. Nigrisoli 2, 40131-Bologna, Italy. nicozanini@gmail.com ·Pancreatology · Pubmed #22687373.

ABSTRACT: BACKGROUND: Pancreatic mucinous cystic lesions might develop malignancy if untreated, or could harbor malignancy at the time of the diagnosis. Many reports stated that cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. METHODS: A man with a incidental pancretic cystic lesion of 35 mm in diameter was admitted to our Department. CT and EUS did not reveal solid components, main duct was not dilated and cyst fluid CEA was very high (1445 ng/ml). RESULTS: The patient underwent a pancreatoduodenectomy and the surgical specimen showed a pseudocyst with columnar mucinous epithelium, consistent with low-grade PanIN. CONCLUSIONS: Is it possible that the mucinous epithelium of panIN was responsible for the unexpectedly high CEA value? Clinicians should be aware of the usefulness of the CEA level in cystic fluid but even a very high CEA value should not be considered by itself to be evidence of a mucinous lesion.

25 Article Interobserver agreement in contrast harmonic endoscopic ultrasound. 2012

Fusaroli, Pietro / Kypraios, Dimitrios / Mancino, Maria Grazia / Spada, Alessia / Benini, Maria Chiara / Bianchi, Marco / Bocus, Paolo / De Angelis, Claudio / De Luca, Leonardo / Fabbri, Carlo / Grillo, Antonino / Marzioni, Marco / Reggio, Dario / Togliani, Thomas / Zanarini, Stefano / Caletti, Giancarlo. ·Department of Clinical Medicine, GI Unit, University of Bologna/Imola Hospital, Italy Gastroenterology Unit, Bellaria Hospital, Bologna, Italy. pietro.fusaroli@unibo.it ·J Gastroenterol Hepatol · Pubmed #22414180.

ABSTRACT: BACKGROUND AND AIM: Contrast harmonic endoscopic ultrasound (CH-EUS) was recently introduced to clinical practice; its reproducibility among endosonographers is unknown. Our aim was to assess the interobserver agreement (IA) in CH-EUS. METHODS: Fifteen endosonographers (eight experienced and seven non-experienced) from 11 Italian EUS centers evaluated 80 video-cases (40 solid pancreatic lesions, 20 pancreatic cystic lesions and 20 submucosal lesions) of CH-EUS, according to the degree of enhancement, the pattern of distribution and the washout of the contrast agent. IA within each group and between the two groups of observers was assessed with the Fleiss kappa statistic. RESULTS: Overall IA was moderate for the uptake and fair for the pattern of distribution and the washout. In solid pancreatic lesions, IA was moderate for the uptake and fair for the pattern and the washout. In cystic pancreatic lesions, IA was uniformly moderate for the assessment of uptake, slight for the pattern and fair for the washout. In submucosal tumors, IA was substantial for the uptake, slight for the pattern and fair for the washout. Non-experienced endosonographers demonstrated, in most cases, comparable IA with the experienced ones. CONCLUSIONS: Interobserver agreement among endosonographers for CH EUS was satisfactory. In particular, overall IA varied from slight to substantial, being fair in the majority of cases. Inherent structural features of the lesions, as well as technical differences between the variables assessed, could have accounted for the fluctuation of the results. Outcomes of IA were reproducible between experienced and non-experienced endosonographers.

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