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Pancreatic Neoplasms: HELP
Articles by Adele Fornelli
Based on 20 articles published since 2008
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Between 2008 and 2019, Adele Fornelli wrote the following 20 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. 2017

Polkowski, Marcin / Jenssen, Christian / Kaye, Philip / Carrara, Silvia / Deprez, Pierre / Gines, Angels / Fernández-Esparrach, Gloria / Eisendrath, Pierre / Aithal, Guruprasad P / Arcidiacono, Paolo / Barthet, Marc / Bastos, Pedro / Fornelli, Adele / Napoleon, Bertrand / Iglesias-Garcia, Julio / Seicean, Andrada / Larghi, Alberto / Hassan, Cesare / van Hooft, Jeanin E / Dumonceau, Jean-Marc. ·Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland. · Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland. · Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany. · Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy. · Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. · Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain. · Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium. · Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy. · Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France. · Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal. · Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy. · Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France. · Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. · Gedyt Endoscopy Center, Buenos Aires, Argentina. ·Endoscopy · Pubmed #28898917.

ABSTRACT: For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

2 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.

3 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.

4 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.

5 Review Tensegrity model hypothesis: may this paradigm be useful to explain hepatic and pancreatic carcinogenesis in patients with persistent hepatitis B or hepatitis C virus infection? 2014

Fiorino, Sirio / Bacchi-Reggiani, Letizia / Pontoriero, Laura / Gallo, Claudio / Chili, Elisabetta / Masetti, Michele / Zanini, Nicola / Grondona, Ana / Silvestri, Tania / Deleonardi, Gaia / Fornelli, Adele / Bondi, Arrigo / de Biase, Dario / Baccarini, Paola / Tallini, Giovanni / Tropeano, Antonio / Quartuccio, Valeria / Cuppini, Andrea / Castellani, Gastone / Jovine, Elio. ·Unit of Internal Medicine, Hospital of Budrio. Budrio, BO, Italy. sirio.fiorino@ausl.bologna.it. ·JOP · Pubmed #24618442.

ABSTRACT: CONTEXT: Hepatitis B (HBV) and hepatitis C virus (HCV) possess well-known oncogenic properties and may promote carcinogenesis in liver. However antigens and replicative sequences of HBV/HCV have been also detected in different extra-hepatic tissues, including the pancreas. Although epidemiological studies and meta-analyses have recently suggested that HBV/HCV may be also risk factors for pancreatic cancer and several researches have investigated the possible mechanisms and intra-/extra-cellular paths involved in pancreatic and hepatic carcinogenesis, to date, these complex processes remain largely unexplained. OBJECTIVES: In our paper, we aimed to propose a comprehensive and qualitative hypothetical model, describing how HBV/HCV may exert their oncogenic role. METHODS: We performed a systematic research of scientific literature, by searching MEDLINE, the Cochrane Library and EMBASE databases. The used keywords were: "chronic HBV/HCV", "pancreatic cancer", "liver carcinoma", "carcinogenesis mechanisms", "tensional integrity", "cytoskeleton", and "extracellular matrix". RESULTS: Taking advantage from available studies, we suggest an unifying hypothesis based on results and data, obtained from different areas of research. In particular we considered the well-defined model of tensional integrity and correlated it to changes induced by HBV/HCV in viscoelastic properties/stiffness of cellular/extracellular microenvironments. These events perturb the tightly-regulated feedback loop, which usually couples the intracellular-generated forces to substrate rigidity of extracellular compartments. Therefore, such a change strongly affects intracellular functions and cellular fate, by promoting a substantial deregulation of critical intracellular biochemical activities and genome expression. CONCLUSIONS: Our hypothesis might provide for the first time a reliable system, which correlates tensional integrity model with intra-/extra-cellular modifications, occurring in liver and pancreas during HBV/HCV-induced carcinogenesis. This approach might improve our understanding of pathogenetic mechanisms involved in the development of pancreatic and hepatic carcinogenesis , enhancing the possibility of their treatment. Furthermore, should the usefulness of this model be definitively confirmed, it might be also helpful to extend its field of application to other viruses-related cancers.

6 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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 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.

13 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.

14 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 --

15 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.

16 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.

17 Article Endoscopic ultrasound-guided fine needle aspiration with 22- and 25-gauge needles in solid pancreatic masses: a prospective comparative study with randomisation of needle sequence. 2011

Fabbri, Carlo / Polifemo, Anna Maria / Luigiano, Carmelo / Cennamo, Vincenzo / Baccarini, Paola / Collina, Guido / Fornelli, Adele / Macchia, Sandro / Zanini, Nicola / Jovine, Elio / Fiscaletti, Marta / Alibrandi, Angela / D'Imperio, Nicola. ·Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy. carlo.fabbri@ausl.bologna.it ·Dig Liver Dis · Pubmed #21592873.

ABSTRACT: BACKGROUND: The difference in the diagnostic accuracy of 22- versus 25-gauge needles in EUS-FNA is not clear. AIMS: To compare the rates of technical success, diagnostic accuracy and complications of EUS-FNA performed with 22-gauge and 25-gauge needles on the same solid pancreatic mass. METHODS: All patients with solid pancreatic masses evaluated from September 2007 to December 2008 were enrolled and underwent EUS-FNA with both 22- and 25-gauge needles with randomisation of needle sequence. The accuracy of the EUS-FNA was determined by comparing the cytological results with the final surgical pathological diagnoses or with the results of a clinical follow-up. A cytological score with different qualitative parameters was created, and a comparison between these parameters was carried out for each needle. RESULTS: Fifty patients with 50 pancreatic masses were recruited. Technical success was 100% and no complications occurred. Diagnostic accuracy was 94% and 86% for the 25- and 22-gauge needles, respectively. Analysis of the cytological score showed a tendency towards the 25-gauge needle, although the difference was not statistically significant. CONCLUSIONS: EUS-FNA performed with 22- or 25-gauge needles had the same diagnostic accuracy. Our study results confirm a significant trend towards a better cytological diagnosis for the 25-gauge needle.

18 Minor Search for HBV and HCV Genome in Cancer Cells of Pancreatic Tumors. 2016

Fiorino, Sirio / Visani, Michela / Acquaviva, Giorgia / Fornelli, Adele / Masetti, Michele / Cuppini, Andrea / Bacchi-Reggiani, Maria Letizia / Jovine, Elio / Tallini, Giovanni / Pession, Annalisa / de Biase, Dario. ·Unità Operativa di Medicina Interna Ospedale di Budrio, Budrio Bologna, Italy sirio.fiorino@ausl.bologna.it Dipartimento di Farmacia e Biotecnologie (FABIT) Università di Bologna Bologna, Italy Unità Operativa di Anatomia Patologica AUSL Bologna Bellaria Hospital Bologna, Italy Operative Unit of Anatomic Pathology, AUSL Bologna, Maggiore Hospital Bologna, Italy Operative Unit of Surgery AUSL Bologna, Maggiore Hospital Bologna, Italy Unità Operativa di Medicina Interna Ospedale di Budrio, Budrio Bologna, Italy Department of Experimental Diagnostic and Specialty Medicine DIMES University of Bologna Bologna, Italy Operative Unit of Surgery AUSL Bologna Maggiore Hospital Bologna, Italy Department of Experimental Diagnostic and Specialty Medicine DIMES, University of Bologna Bologna, Italy Dipartimento di Farmacia e Biotecnologie (FABIT) Università di Bologna Bologna, Italy Dipartimento di Farmacia e Biotecnologie (FABIT) Università di Bologna Bologna, Italy and Department of Experimental Diagnostic and Specialty Medicine DIMES, University of Bologna Bologna, Italy. ·Pancreas · Pubmed #26658043.

ABSTRACT: -- No abstract --

19 Minor Hepatitis B virus infection and pancreatic neuroendocrine tumor: a case report. 2015

Fiorino, Sirio / de Biase, Dario / Fornelli, Adele / Masetti, Michele / Cuppini, Andrea / Bondi, Arrigo / Tallini, Giovanni / Jovine, Elio / Pession, Annalisa. ·Unità Operativa di Medicina Interna Ospedale di Budrio, Budrio Bologna, Italy sirio.fiorino@ausl.bologna.it Dipartimento di Medicina Diagnostica e Sperimentale Ospedale Bellaria Università di Bologna Bologna, Italy Unità Operativa di Anatomia Patologica Azienda Unità Sanitaria Locale Bologna Maggiore Hospital Bologna, Italy Unità Operativa di Chirurgia A Ospedale Maggiore Bologna, Italy Unità Operativa di Medicina Interna Ospedale di Budrio, Budrio Bologna, Italy Unità Operativa di Anatomia Patologica Azienda Unità Sanitaria Locale Bologna Maggiore Hospital Bologna, Italy Dipartimento di Medicina Diagnostica e Sperimentale Ospedale Bellaria Università di Bologna Bologna, Italy Unità Operativa di Chirurgia A Ospedale Maggiore Bologna, Italy Dipartimento di Farmacia e Biotecnologie Università di Bologna Bologna, Italy. ·Pancreas · Pubmed #25675420.

ABSTRACT: -- No abstract --

20 Minor Segmental groove pancreatitis and duodenal gangliocytic paraganglioma with lymph node metastasis: a newly described association. 2011

Fiscaletti, Marta / Fornelli, Adele / Zanini, Nicola / Fabbri, Carlo / Collina, Guido / Lega, Stefania / Stasi, Giovanni / Jovine, Elio. · ·Pancreas · Pubmed #21926554.

ABSTRACT: -- No abstract --