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Pancreatic Neoplasms: HELP
Articles by Cesare Hassan
Based on 8 articles published since 2009
(Why 8 articles?)
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Between 2009 and 2019, Cesare Hassan wrote the following 8 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 Clinical Trial Feasibility and yield of a novel 22-gauge histology EUS needle in patients with pancreatic masses: a multicenter prospective cohort study. 2013

Larghi, Alberto / Iglesias-Garcia, Julio / Poley, Jan-Werner / Monges, Geneviève / Petrone, Maria Chiara / Rindi, Guido / Abdulkader, Ihab / Arcidiacono, Paolo Giorgio / Costamagna, Guido / Biermann, Katharina / Bories, Erwan / Doglioni, Claudio / Dominguez-Muñoz, J Enrique / Hassan, Cesare / Bruno, Marco / Giovannini, Marc. ·Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli 8, 00168, Rome, Italy, albertolarghi@yahoo.it. ·Surg Endosc · Pubmed #23644834.

ABSTRACT: BACKGROUND: The option of obtaining tissue samples for histological examination during endoscopic ultrasound (EUS) has theoretical and practical advantages over cytology alone. The aim of this study was to evaluate the feasibility, yield, and diagnostic accuracy of a new EUS 22-G fine-needle biopsy (FNB) device in patients with solid pancreatic masses in a multicenter, prospective study. METHODS: All consecutive patients who underwent EUS-guided fine-needle biopsy (EUS-FNB) using a newly developed 22-G FNB needle between September 2010 and October 2010 were enrolled in the study. The EUS-FNB technique was standardized among the participating endoscopists. Only a single needle pass was performed. RESULTS: A total of 61 patients (35 males, mean age 64.2 ± 12.4 years) with solid pancreatic masses with a mean size of 32.4 ± 8.5 mm (range 13-90 mm) participated. EUS-FNB was performed through the duodenum in 35 cases (57.4 %) and was technically feasible in all but one of the 61 (98.4 %) patients without complications. Tissue samples for histological examination were obtained from 55 patients (90.2 %) and were deemed adequate in 54 of the cases (88.5 %). The diagnoses established by EUS-FNB were adenocarcinoma (39 patients), neuroendocrine tumors (5), chronic focal pancreatitis (5), sarcoma (2), lymphoma (1), acinar cellular tumor (1), and pancreatic metastasis from renal cell carcinoma (1). In an intention-to-treat (ITT) analysis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the histologic diagnosis of a pancreatic mass were 87.5, 100, 100, 41.7, and 88.5 %, respectively. CONCLUSIONS: EUS-FNB was technically feasible in 98 % of patients with a solid pancreatic mass. A suitable sample for histological evaluation was obtained in 88.5 % of the cases after only one single needle pass. The apparently low negative predictive value is likely to be improved by increasing the number of needle passes.

3 Article Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. 2018

Tringali, Alberto / Hassan, Cesare / Rota, Matteo / Rossi, Marta / Mutignani, Massimiliano / Aabakken, Lars. ·Endoscopy Unit, Niguarda Hospital, Milan, Italy. · Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. · Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy. · Department of Clinical Sciences and Community Health,University of Milan, Milan, Italy. · Endoscopy, Oslo University Hospital - Rikshospitalet, Oslo, Norway. ·Endoscopy · Pubmed #29342491.

ABSTRACT: BACKGROUND: Self-expandable metal stents (SEMS) are used for palliation of distal malignant biliary strictures, but the role of covered SEMS is less clear. We performed an up-to-date meta-analysis to compare the performance of covered and uncovered SEMS in patients with unresectable distal malignant biliary strictures. METHODS: A computerized medical search was performed using MEDLINE, EMBASE, and the Cochrane Library between 2000 and December 2016 to identify all randomized trials that compared covered with uncovered SEMS in patients with distal malignant biliary strictures. Primary outcomes were stent failure and patient mortality; secondary outcomes were stent dysfunction and adverse events. Pooled estimates were computed using the random effects model. RESULTS: Overall, 11 RCTs involving 1272 patients were included. The primary outcomes of stent failure and patient mortality did not differ significantly between covered and uncovered SEMS (hazard ratio [HR] 0.68, 95 % confidence interval [CI] 0.40 - 1.17; HR 0.89, 95 %CI 0.76 - 1.05, respectively). However, stent migration and sludge formation were much more common with covered SEMS (odds ratio [OR] 5.11, 95 %CI 1.84 - 14.17; OR 2.46, 95 %CI 1.37 - 4.43). The use of covered SEMS was associated with a lower rate of tumor ingrowth (OR 0.21, 95 %CI 0.09 - 0.50) but a higher rate of tumor overgrowth (OR 2.00, 95 %CI 1.15 - 3.48) compared with uncovered stents. The rates of procedure-related adverse events were similar in both groups. CONCLUSION: There was a risk reduction of about 32 % for both stent failure and patient mortality with covered SEMS but this difference was not significant. Migration and sludge rates were higher with covered SEMS, whereas tumor ingrowth was more likely with uncovered SEMS. The data show no added benefit of covered SEMS; further stent evolution is desirable.

4 Article EUS elastography (strain ratio) and fractal-based quantitative analysis for the diagnosis of solid pancreatic lesions. 2018

Carrara, Silvia / Di Leo, Milena / Grizzi, Fabio / Correale, Loredana / Rahal, Daoud / Anderloni, Andrea / Auriemma, Francesco / Fugazza, Alessandro / Preatoni, Paoletta / Maselli, Roberta / Hassan, Cesare / Finati, Elena / Mangiavillano, Benedetto / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy. · Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Milan, Italy. · Centro di Prevenzione Oncologica, Turin, Italy. · Department of Pathology, Humanitas Clinical and Research Center, Milan, Italy. · Endoscopic Unit, Nuovo Regina Margherita Hospital, Rome, Italy. · Digestive Endoscopy Unit, Humanitas Mater Domini, Varese, Italy. ·Gastrointest Endosc · Pubmed #29329992.

ABSTRACT: BACKGROUND AND AIMS: EUS elastography is useful in characterizing solid pancreatic lesions (SPLs), and fractal analysis-based technology has been used to evaluate geometric complexity in oncology. The aim of this study was to evaluate EUS elastography (strain ratio) and fractal analysis for the characterization of SPLs. METHODS: Consecutive patients with SPLs were prospectively enrolled between December 2015 and February 2017. Elastographic evaluation included parenchymal strain ratio (pSR) and wall strain ratio (wSR) and was performed with a new compact US processor. Elastographic images were analyzed using a computer program to determine the 3-dimensional histogram fractal dimension. A composite cytology/histology/clinical reference standard was used to assess sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve. RESULTS: Overall, 102 SPLs from 100 patients were studied. At final diagnosis, 69 (68%) were malignant and 33 benign. At elastography, both pSR and wSR appeared to be significantly higher in malignant as compared with benign SPLs (pSR, 24.5 vs 6.4 [P < .001]; wSR, 56.6 vs 15.3 [P < .001]). When the best cut-off levels of pSR and wSR at 9.10 and 16.2, respectively, were used, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve were 88.4%, 78.8%, 89.7%, 76.9%, and 86.7% and 91.3%, 69.7%, 86.5%, 80%, and 85.7%, respectively. Fractal analysis showed a significant statistical difference (P = .0087) between the mean surface fractal dimension of malignant lesions (D = 2.66 ± .01) versus neuroendocrine tumor (D = 2.73 ± .03) and a statistical difference for all 3 channels red, green, and blue (P < .0001). CONCLUSIONS: EUS elastography with pSR and fractal-based analysis are useful in characterizing SPLs. (Clinical trial registration number: NCT02855151.).

5 Article A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses. 2016

Carrara, Silvia / Anderloni, Andrea / Jovani, Manol / Di Tommaso, Luca / Rahal, Daoud / Hassan, Cesare / Ridola, Lorenzo / Federico, Davide / Loriga, Alessandra / Repici, Alessandro. ·Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. Electronic address: silvia.carrara@humanitas.it. · Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Department of Pathology, Humanitas Research Hospital, Rozzano, Milan, Italy. · Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. ·Dig Liver Dis · Pubmed #26607829.

ABSTRACT: BACKGROUND: A new needle platform for endoscopic ultrasound-guided fine-needle aspiration biopsy has been developed that allows interchangeability of all needle sizes. AIMS: To prospectively compare the efficacy of the new 25-G needles and 22-G needles for obtaining an adequate aspirate of solid masses. METHODS: Randomized controlled trial of 144 patients referred for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses, intraparietal tumours, or lymph-nodes, randomized to the 25-G or 22-G needle arms. RESULTS: An adequate specimen was obtained from 74.3% of cases. The sample tended to be more adequate in the 25-G compared to the 22-G group (81% vs. 68%; p=0.09). Crossover was required in 14 (19%) and 12 (17%) cases in the 22-G and in the 25-G groups, respectively (p=0.7). The overall rate of adequacy improved from 74% before crossover to 90% after crossover (p<0.01). When comparing the two groups after crossover, the rate of obtaining adequate samples was significantly higher in the 25-G arm than in the 22-G arm (95.8% vs. 86.1%; p=0.03). CONCLUSIONS: The 25-G needle was superior to the 22-G needle for endoscopic ultrasound-guided fine-needle aspiration biopsy. The adequacy and diagnostic accuracy improved after crossover, reaching 90%.

6 Article Accuracy and inter-observer agreement of the Procore™ 25 gauge needle for endoscopic ultrasound-guided tissue core biopsy. 2015

Attili, Fabia / Petrone, Gianluigi / Abdulkader, Ihab / Correale, Loredana / Inzani, Frediano / Iglesias-Garcia, Julio / Hassan, Cesare / Andrade Zurita, Santiago / Rindi, Guido / Dominguez-Muñoz, J Enrique / Costamagna, Guido / Larghi, Alberto. ·Digestive Endoscopy Unit, Catholic University, Rome, Italy. · Department of Pathology, Catholic University, Rome, Italy. · Department of Pathology, University Hospital of Santiago de Compostela, Spain. · Gastroenterology Department, Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Spain. · Digestive Endoscopy Unit, Catholic University, Rome, Italy. Electronic address: alberto.larghi@yahoo.it. ·Dig Liver Dis · Pubmed #26216067.

ABSTRACT: BACKGROUND: Scanty data on the performance of the new 25-gauge Procore™ biopsy needle are available. METHODS: Consecutive patients who underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using the 25G Procore™ were retrospectively retrieved. All samples were independently reviewed by 3 pathologists for the following: histological, cytological or no specimen, neoplasia, diagnostic or non-diagnostic. Diagnostic accuracy and inter-rater concordance among pathologists were calculated. RESULTS: 94 patients underwent EUS-FNB of 101 sites (69 solid masses, 25 lymph nodes, 5 wall thickening). Forty-one biopsies (40.5%) were classified as histological samples by at least two pathologists, 29 as cytological (28.7%), 31 had no sample (30.7%). Good and almost perfect agreements among pathologists in defining cytological vs. histological samples (k 0.82; 95% CI: 0.74-0.90), diagnostic vs. non-diagnostic (k 0.95; 95% CI: 0.85-1.00) and neoplastic vs. non-neoplastic (k 0.94; 95% CI: 0.83-1.00). According to consensus rating, 61 cases were diagnostic samples (60.4%). Histological samples were more likely to lead to a correct diagnosis (OR, 4.1; 95% P=0.027), while neoplastic lesions were less likely to be correctly classified than benign (OR, 0.11; P=0.04). CONCLUSIONS: EUS-FNB with the Procore™ 25G needle provided samples for histological examination in only 40% of the cases, with 31% of inadequate specimens, despite excellent results in term of inter-observer variability.

7 Article Interobserver agreement and accuracy of preoperative endoscopic ultrasound-guided biopsy for histological grading of pancreatic cancer. 2015

Larghi, Alberto / Correale, Loredana / Ricci, Riccardo / Abdulkader, Ihab / Monges, Geneviève / Iglesias-Garcia, Julio / Giovannini, Marc / Attili, Fabia / Vitale, Giovanna / Hassan, Cesare / Costamagna, Guido / Rindi, Guido. ·Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy. · Department of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy. · Department of Pathology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Department of Pathology, Paoli-Calmettes Institute, Marseilles, France. · Gastroenterology Department, Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Endoscopic Unit, Paoli-Calmettes Institute, Marseilles, France. ·Endoscopy · Pubmed #25521572.

ABSTRACT: BACKGROUND AND STUDY AIM: Poorly differentiated/high grade pancreatic ductal adenocarcinoma (PDAC) is associated with an early unfavorable outcome, and patients with these tumors may be candidates for neo-adjuvant treatment. Endoscopic ultrasound-guided pancreatic fine-needle biopsy (EUS-FNB) may, in theory, allow preoperative assessment of PDAC histological grading. The aim of the current study was to assess the interobserver agreement and accuracy of preoperative PDAC grading from EUS-FNB specimens. METHODS: Data from 42 postsurgical PDAC patients who had undergone preoperative EUS-FNB were retrieved. Four experienced pathologists independently reviewed the EUS-FNB slides and reported tumor grading (well, moderately, or poorly differentiated). Agreement among pathologists for grading of preoperative EUS-FNB samples was expressed by using Cohen's or Fleiss' kappa statistic, as appropriate. Postsurgical PDAC grading was used as the gold standard to assess the cumulative accuracy of EUS-FNB for the preoperative prediction of PDAC grading. RESULTS: The kappa values for PDAC grading on EUS-FNB specimens ranged from 0.09 to 0.41. The total agreement among the four pathologists was only fair (κ = 0.27; 95 % confidence interval [CI] 0.14 - 0.38). When tumor grades were grouped as well or moderately differentiated vs. poorly differentiated, kappa values ranged from 0.19 to 0.50, with only a fair overall agreement (κ = 0.27; 95 %CI 0.21 - 0.49). The accuracy of preoperative grading from EUS-FNB was 56 % (75/134 readings; 95 %CI 40 % - 65 %), with mean sensitivity and specificity to detect a high grade, poorly differentiated tumor of 41 % (95 %CI 19 % - 54 %) and 78 % (53/68 readings; 95 %CI 60 % - 99 %), respectively. CONCLUSIONS: Preoperative EUS-FNB-based histological grading of PDAC is unreliable, and current results do not support the use of this information in clinical practice. This appears to be due to suboptimal interobserver agreement among pathologists and an overall low accuracy in predicting postsurgical grading.

8 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.