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Pancreatic Neoplasms: HELP
Articles by Julio Iglesias-Garcia
Based on 33 articles published since 2008
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Between 2008 and 2019, J. Iglesias García wrote the following 33 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
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 Editorial Early detection of pancreatic cancer in patients with intraductal papillary mucinous neoplasms: the pivotal role of endoscopic ultrasound. 2014

Iglesias-Garcia, Julio / Domínguez-Muñoz, J Enrique. ·Gastroenterology Department, Foundation for Research in Digestive Diseases (FIENAD), University Hospital of Santiago de Compostela, Spain. ·Endoscopy · Pubmed #24353123.

ABSTRACT: -- No abstract --

3 Editorial Endoscopic ultrasound-guided fine needle aspiration for solid pancreatic masses. Optimizing the diagnostic yield. 2013

Iglesias-Garcia, Julio. · ·J Gastrointestin Liver Dis · Pubmed #23799209.

ABSTRACT: -- No abstract --

4 Review Early pancreatic cancer - The role of endoscopic ultrasound with or without tissue acquisition in diagnosis and staging. 2019

Moutinho-Ribeiro, Pedro / Iglesias-Garcia, Julio / Gaspar, Rui / Macedo, Guilherme. ·Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal. Electronic address: pmoutinho@saudeatlantica.pt. · Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain. · Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal. · Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal. ·Dig Liver Dis · Pubmed #30337098.

ABSTRACT: Pancreatic cancer (PC) is one of the deadliest cancers with a 5-year overall survival of less than 6%. Due to its insidious clinical course and unspecific symptoms, the diagnosis is usually late, with only 15-20% patients presenting with potentially curable disease. It is, therefore, extremely important to identify patients with PC at early stages of the disease when tumors may be amenable to surgical resection. For unresectable and borderline resectable PC it is consensual to perform a biopsy to have a cyto/histological confirmation of malignancy before treatment. However, for patients presenting with promptly resectable disease, the role of biopsy is more debatable. There are, in the literature, arguments both for and against the usefulness of a preoperative biopsy. Endoscopic ultrasound (EUS) is an important technique assisting in the diagnosis and staging of PC. EUS-guided tissue acquisition is a well-established tool to demonstrate the malignant nature of a pancreatic lesion. This review focuses on the role of EUS in the diagnosis and staging of PC, and highlights the controversy related to the role of EUS-guided tissue acquisition in the preoperative assessment of patients presenting with promptly resectable tumors (early PC).

5 Review Endoscopic ultrasound in the diagnosis of chronic pancreatitis. 2015

Iglesias-García, Julio / Lariño-Noia, José / Lindkvist, Björn / Domínguez-Muñoz, J Enrique. · ·Rev Esp Enferm Dig · Pubmed #25824921.

ABSTRACT: Diagnosis of chronic pancreatitis (CP) remains a challenge. Endoscopic ultrasound (EUS) can be considered nowadays as the technique of choice for the morphological diagnosis of this disease. More than three or four EUS defined criteria of CP need to be present for the diagnosis of the disease. The development of the more restrictive Rosemont classification aims to standardize the criteria, assigning different values to different features but its impact on the EUS-based diagnosis of CP is debatable. A combined use of endoscopic function test and EUS has even increased the diagnostic yield. Elastography and FNA may be also of help for diagnosing CP. EUS also provides with very valuable information on the severity of the disease, giving key information that may influence in the treatment. Differential diagnosis of solid pancreatic masses in the context of a CP is also challenging, EUS plays a key role in this context. It provides with the possibility of obtaining specimens for histopathological diagnosis. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, are also showing promising results for the differentiating between these pancreatic lesions.

6 Review Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic masses. 2014

Iglesias-Garcia, Julio / Lariño-Noia, Jose / Abdulkader, Ihab / Domínguez-Muñoz, J Enrique. ·Julio Iglesias-Garcia, Jose Lariño-Noia, J Enrique Domínguez-Muñoz, Department of Gastroenterology and Hepatology, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain. ·World J Gastroenterol · Pubmed #25071339.

ABSTRACT: Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, differential diagnosis remains a clinical challenge. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting. EUS-guided FNA and FNB, by obtaining cytological and/or histological samples, are able to diagnose pancreatic lesions with high sensitivity and specificity. In this context, several methodological features, trying to increase the diagnostic yield of EUS-guided FNA and FNB, have been evaluated. In this review, we focus on the role of rapid on-site evaluation (ROSE). From data reported in the literature, ROSE may increase diagnostic yield of EUS-FNA specimens by 10%-30%, and thus, diagnostic accuracy. However, we should point out that many recent studies have reported adequacy rates of > 90% without ROSE, indicating that, perhaps, at high-volume centers, ROSE may not be indispensable to achieve excellent results. The use of ROSE can be considered important during the learning curve of EUS-FNA, and also in hospital with diagnostic accuracy rates < 90%.

7 Review The actual management of early pancreatic cancer. 2012

Iglesias García, J / Lariño-Noia, J / Domínguez-Muñoz, J E. ·Department of Gastroenterology, University Hospital, Santiago de Compostela, Spain. julio.iglesias.garcia@sergas.es ·Minerva Gastroenterol Dietol · Pubmed #23207609.

ABSTRACT: Pancreatic cancer (PC) is a highly lethal disease. Early diagnosis remains the only possibility nowadays for an intention to cure the disease, since prognosis of PC is significantly better in patients diagnosed of small (<2 cm), well differentiated, stages I and II pancreatic tumors. However, the best approach would be to detect precursor lesions, like Intraductal papillary mucinous neoplasm (IPMN) or PanIN lesions. In this setting the best technique to diagnose either small PC and/or IPMN and PanIN lesions is clearly endoscopic ultrasound. However, detection of these lesions is very difficult, hampered by the absence of clinical manifestations of PC at these early stages. The implementation of screening programs, which - given the incidence of PC - is not cost effective for the general population, in high-risk individuals, may lead to increase the detection of PC an early stages as well as precursor lesion. When focusing on treatment, PC patients are best cared by multidisciplinary teams. For patients with resectable disease surgery remains the treatment of choice, followed by postoperative treatment. When precursor lesions are detected, mainly IPMN, treatment should be individualized, following latest international guidelines.

8 Review [Latest advances in pancreatic tumors]. 2012

Iglesias-García, Julio / Domínguez-Muñoz, J Enrique. ·Servicio de Aparato Digestivo, Fundación para la Investigación en Enfermedades del Aparato Digestivo (FIENAD), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. julio.iglesias.garcia@sergas.es ·Gastroenterol Hepatol · Pubmed #23018014.

ABSTRACT: Pancreatic cancer is difficult to diagnose and treat. Prognosis is poor, since this disease is usually detected at advanced stages, when the possibilities of any treatment with curative intent are 20% or less. To improve prognosis, new screening strategies are being designed, especially with the development of a new international consensus with recommendations on the management of patients at high risk of developing pancreatic cancer. Two especially useful techniques in the diagnosis of this disease are elastography and contrast-enhanced endoscopic ultrasound (EUS). Advances have been made in EUS-guided biopsy with the development of histology needles that increase diagnostic efficacy and the quality of the samples. Finally, there have been a few advances in treatment. The role of neoadjuvant therapy in locally advanced tumors and the efficacy of distinct neurolysis strategies in pain therapy have been confirmed. Covered metallic stents seem to be the best option to treat biliary obstruction. A notable development is the development of EUS-guided confocal endomicroscopy to improve the diagnosis and follow-up of cystic tumors of the pancreas, especially intraductal papillary mucinous tumors of the lateral branch.

9 Review The role of EUS in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma. 2012

Iglesias-García, Julio / Lindkvist, Björn / Lariño-Noia, José / Domínguez-Muñoz, J Enrique. ·Department of Gastroenterology and Foundation for Research in Digestive Diseases (FIENAD), Hospital Universitario de Santiago de Compostela, A Coruña, Spain. julio.iglesias.garcia@sergas.es ·Rev Esp Enferm Dig · Pubmed #22738702.

ABSTRACT: Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions.

10 Review Endoscopic ultrasound image enhancement elastography. 2012

Iglesias-Garcia, Julio / Domínguez-Muñoz, J Enrique. ·Gastroenterology Department, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, c/Choupana s/n, 15706 Santiago de Compostela, Spain. julio.iglesias.garcia@sergas.es ·Gastrointest Endosc Clin N Am · Pubmed #22632955.

ABSTRACT: Endoscopic ultrasound (EUS) represents an advance in the diagnosis and staging of several diseases. EUS-guided fine-needle aspiration is useful, but technically demanding, and can be associated with complications. Elastography emerges as a useful tool that is based on the knowledge that some diseases, like cancer, lead to a modification in tissue stiffness. Elastography evaluates the elastic properties of tissues and compares images obtained before and after compression to target tissues; differentiating benign from malignant lesions. This article reviews theoretical aspects and the methodology of EUS elastography. Clinical applications, mainly in pancreatic diseases and lymph nodes, are analyzed.

11 Review Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. 2009

Iglesias García, J / Lariño Noia, J / Domínguez Muñoz, J E. ·Gastroenterology Department, Foundation for Research in Digestive Diseases, University Hospital of Santiago deCompostela, A Coruña, Spain. julioiglesiasgarcia@hotmail.es ·Rev Esp Enferm Dig · Pubmed #19803666.

ABSTRACT: Pancreatic cancer is the 5th leading cause of cancer-related death in Western countries. The 5-year survival rate is approximately 4%, without significant changes over the last 50 years. This poor survival rate and bad prognosis are associated with the diagnosis of advanced-stage disease, which precludes the only potential curative treatment - surgical resection. In this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and a correct staging of the disease. Endoscopic ultrasonography (EUS) appears to be an essential tool for the diagnosis and staging of pancreatic cancer. EUS diagnostic accuracy for detecting pancreatic tumors ranges from 85 to 100%, clearly superior to other imaging techniques. EUS accuracy for the local staging of pancreatic cancer ranges from 70 to 90%, superior or equivalent to other imaging modalities. EUS-guided fine-needle aspiration allows a cyto-histological diagnosis in nearly 90% of cases, with a very low complication rate. At present, the formal indications for EUS-guided fine-needle aspiration are the necessity of palliative treatment or whenever the possibility of neoadjuvant treatment is present. It could be also indicated to differentiate pancreatic adenocarcinoma from other pancreatic conditions, like lymphoma, metastasis, autoimmune pancreatitis or chronic pancreatitis. We can conclude that EUS is an essential tool in the management of patients with pancreatic tumors.

12 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.

13 Clinical Trial Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. 2011

Săftoiu, A / Vilmann, P / Gorunescu, F / Janssen, J / Hocke, M / Larsen, M / Iglesias-Garcia, J / Arcidiacono, P / Will, U / Giovannini, M / Dietrich, C / Havre, R / Gheorghe, C / McKay, C / Gheonea, D I / Ciurea, T / Anonymous2510690. ·Gastroenterology Department, University of Medicine and Pharmacy, Craiova, Romania. adry@umfcv.ro ·Endoscopy · Pubmed #21437851.

ABSTRACT: BACKGROUND AND STUDY AIMS: Endoscopic ultrasound (EUS) elastography represents a new imaging procedure that might characterize the differences of hardness and strain between diseased tissue and normal tissue. The aim of this study was to assess the efficiency of EUS elastography for the differentiation of focal masses in chronic pancreatitis and pancreatic cancer. PATIENTS AND METHODS: The study group comprised 258 patients with focal pancreatic masses included prospectively at 13 participating centers. Qualitative analysis of the diagnoses made by two expert doctors using all recorded video clips was performed in order to test the interobserver variability. A post-processing software analysis was used to examine the EUS elastography videos by calculating average-hue histograms of individual elastography images. The quantitative information was used to calculate intra-observer variability and the accuracy of the method. RESULTS: Qualitative analysis of the recorded videos revealed a kappa value of 0.72. Intra-observer variability analysis revealed that the single measure intraclass correlation ranged between 0.86 and 0.94. The average-hue histogram analysis of the data indicated a sensitivity of 93.4 %, a specificity of 66.0 %, a positive predictive value of 92.5 %, a negative predictive value of 68.9 %, and an overall accuracy of 85.4 %, based on a cut-off value of 175. Area under the receiver operating characteristic curve (AUROC) was 0.854 ( P < 0.0001) with a confidence interval of 0.804 - 0.894. CONCLUSION: The value of quantitative analysis of EUS elastography recordings was proven by good reproducibility of the videos, as well as good parameters of the AUROC analysis. (Clinical Trials.gov identifier: CT00909103).

14 Article A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device. 2019

van Riet, Priscilla A / Larghi, Alberto / Attili, Fabia / Rindi, Guido / Nguyen, Nam Quoc / Ruszkiewicz, Andrew / Kitano, Masayuki / Chikugo, Takaaki / Aslanian, Harry / Farrell, James / Robert, Marie / Adeniran, Adebowale / Van Der Merwe, Schalk / Roskams, Tania / Chang, Kenneth / Lin, Fritz / Lee, John G / Arcidiacono, Paolo Giorgio / Petrone, Mariachiara / Doglioni, Claudio / Iglesias-Garcia, Julio / Abdulkader, Ihab / Giovannini, Marc / Bories, Erwan / Poizat, Flora / Santo, Erwin / Scapa, Erez / Marmor, Silvia / Bucobo, Juan Carlos / Buscaglia, Jonathan M / Heimann, Alan / Wu, Maoxin / Baldaque-Silva, Francisco / Moro, Carlos Fernández / Erler, Nicole S / Biermann, Katharina / Poley, Jan-Werner / Cahen, Djuna L / Bruno, Marco J. ·Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. · Department of Endoscopy, Catholic University Rome, Rome, Italy. · Department of Pathology, Catholic University Rome, Rome, Italy. · Department of Endoscopy, Royal Adelaide Hospital, Adelaide, Australia. · Department of Pathology, Royal Adelaide Hospital, Adelaide, Australia. · Department of Endoscopy, Kinki University, Osaka-Sayama, Japan. · Department of Pathology, Kinki University, Osaka-Sayama, Japan. · Department of Endoscopy, Yale University School of Medicine, New Haven, Connecticut, USA. · Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA. · Department of Endoscopy, University Hospital Leuven, Leuven, Belgium. · Department of Pathology, University Hospital Leuven, Leuven, Belgium. · Department of Endoscopy, University of California, Irvine, California, USA. · Department of Pathology, University of California, Irvine, California, USA. · Department of Endoscopy, Vita Salute San Raffaele University, Milan, Italy. · Department of Pathology, Vita Salute San Raffaele University, Milan, Italy. · Department of Endoscopy, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Department of Pathology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Department of Endoscopy, Institut Paoli-Calmettes, Marseilles, France. · Department of Pathology, Institut Paoli-Calmettes, Marseilles, France. · Department of Endoscopy, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. · Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. · Department of Endoscopy, Stony Brook University Hospital, Stony Brook, New York, USA. · Department of Pathology, Stony Brook University Hospital, Stony Brook, New York, USA. · Department of Upper GI Diseases, Unit of Gastrointestinal Endoscopy, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden. · Department of Clinical Pathology/Cytology, Karolinska University Hospital, Stockholm, Sweden. · Department of Biostatistics, Erasmus MC University Medical Center Rotterdam, the Netherlands. · Department of Pathology, Erasmus MC University Medical Center Rotterdam, the Netherlands. ·Gastrointest Endosc · Pubmed #30367877.

ABSTRACT: BACKGROUND AND AIMS: Several studies have compared EUS-guided FNA with fine-needle biopsy (FNB), but none have proven superiority. We performed a multicenter randomized controlled trial to compare the performance of a commonly used 25-gauge FNA needle with a newly designed 20-gauge FNB needle. METHODS: Consecutive patients with a solid lesion were randomized in this international multicenter study between a 25-gauge FNA (EchoTip Ultra) or a 20-gauge FNB needle (ProCore). The primary endpoint was diagnostic accuracy for malignancy and the Bethesda classification (non-diagnostic, benign, atypical, malignant). Technical success, safety, and sample quality were also assessed. Multivariable and supplementary analyses were performed to adjust for confounders. RESULTS: A total of 608 patients were allocated to FNA (n = 306) or FNB (n = 302); 312 pancreatic lesions (51%), 147 lymph nodes (24%), and 149 other lesions (25%). Technical success rate was 100% for the 25-gauge FNA and 99% for the 20-gauge FNB needle (P = .043), with no differences in adverse events. The 20-gauge FNB needle outperformed 25-gauge FNA in terms of histologic yield (77% vs 44%, P < .001), accuracy for malignancy (87% vs 78%, P = .002) and Bethesda classification (82% vs 72%, P = .002). This was robust when corrected for indication, lesion size, number of passes, and presence of an on-site pathologist (odds ratio, 3.53; 95% confidence interval, 1.55-8.56; P = .004), and did not differ among centers (P = .836). CONCLUSION: The 20-gauge FNB needle outperformed the 25-gauge FNA needle in terms of histologic yield and diagnostic accuracy. This benefit was irrespective of the indication and was consistent among participating centers, supporting the general applicability of our findings. (Clinical trial registration number: NCT02167074.).

15 Article Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis. 2018

Domínguez-Muñoz, Juan Enrique / Nieto-Garcia, Laura / López-Díaz, Javier / Lariño-Noia, Jose / Abdulkader, Ihab / Iglesias-Garcia, Julio. ·Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain. enriquedominguezmunoz@hotmail.com. · Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain. enriquedominguezmunoz@hotmail.com. · Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain. · Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain. · Department of Pathology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706, Santiago de Compostela, Spain. ·BMC Cancer · Pubmed #29728096.

ABSTRACT: BACKGROUND: Malnutrition and weight loss are commonly observed in patients with pancreatic cancer and contribute to poor survival. Pancreatic exocrine insufficiency (PEI), which can be caused by ductal obstruction by a tumor, causes maldigestion and malabsorption of nutrients, thus contributing to malnutrition in these patients. In this study, we evaluated the effects of pancreatic enzyme replacement therapy (PERT) on survival in patients with unresectable pancreatic cancer. METHODS: A retrospective analysis was conducted on a database of patients with unresectable, pathologically confirmed pancreatic cancer. All patients were evaluated for palliative chemotherapy and received the optimal palliative care. Patients were divided into two groups: Group 1 received standard therapy; Group 2 underwent additional evaluation of the pancreatic function and therapy with PERT, if needed. Survival (median and 95% confidence interval [CI]) was analyzed using Kaplan-Meier and Cox regression; groups were compared using the log-rank test. RESULTS: Overall, 160 patients with unresectable pancreatic cancer were included in the analysis (mean age: 70.5 years [range 28-100]; gender: 57.5% male; tumor stage: 78.7% Stage IV). Eighty-six patients (53.75%) were in Group 1 and 74 (46.25%) were in Group 2. Age, gender, tumor size, location and stage, weight loss, and serum CA 19-9 were similar between groups. Ninety-three (58.1%) patients received palliative chemotherapy; 46.5% in Group 1 and 71.6% in Group 2 (P < 0.001). Forty-nine (66.2%) patients in Group 2 and none in Group 1 received PERT. Survival in Group 2 (189 days, 95% CI 167.0-211.0 days) was significantly longer than in Group 1 (95.0 days, 95% CI 75.4-114.6 days) (HR 2.117, 95% CI 1.493-3.002; P < 0.001). Chemotherapy and PERT were significantly and independently associated with longer survival in a model controlled by age and tumor stage. In patients with significant weight loss at diagnosis (> 10% bodyweight within 6 months), PERT was associated with longer survival (HR 2.52, 95% CI 1.55-4.11; P < 0.001). CONCLUSIONS: In patients with unresectable pancreatic cancer, PERT in patients with PEI was associated with longer survival compared with those not receiving PERT, especially in those experiencing significant weight loss. This finding should guide future prospective clinical trials of similar interventions.

16 Article Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study. 2018

Ignee, Andre / Jenssen, Christian / Arcidiacono, Paolo G / Hocke, Michael / Möller, Kathleen / Saftoiu, Adrian / Will, Uwe / Fusaroli, Pietro / Iglesias-Garcia, Julio / Ponnudurai, Ryan / Petrone, Maria C / Braden, Barbara / Burmester, Eike / Dong, Yi / Atkinson, Nathan S / Dietrich, Christoph F. ·Medical Department 2, Caritas-Krankenhaus, Bad Mergentheim, Germany. · Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany. · Pancreato-Biliary Endoscopy and Endosonography Division, Vita Salute San Raffaele University, Milan, Italy. · Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Meiningen, Germany. · Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany. · Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania. · SRH Wald Klinikum Gera, Germany. · Gastroenterology Unit, Department of Medical and Surgical Sciences University of Bologna, Hospital of Imola, Italy. · Gastroenterology and Hepatology Department, University Hospital, Santiago de Compostela, Spain. · Division of Gastroenterology, Prince Court Medical Centre, Kuala Lumpur, Malaysia. · Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. · Medical Department I, Sana Hospital Lübeck, Germany. · Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China. · Ultrasound Department of the First Affiliated Hospital of Zhengzhou, Zhengzhou University, China. ·Endoscopy · Pubmed #29689572.

ABSTRACT: BACKGROUND: The prevalence of malignancy in patients with small solid pancreatic lesions is low; however, early diagnosis is crucial for successful treatment of these cases. Therefore, a method to reliably distinguish between benign and malignant small solid pancreatic lesions would be highly desirable. We investigated the role of endoscopic ultrasound (EUS) elastography in this setting. METHODS: Patients with solid pancreatic lesions ≤ 15 mm in size and a definite diagnosis were included. Lesion stiffness relative to the surrounding pancreatic parenchyma, as qualitatively assessed and documented at the time of EUS elastography, was retrospectively compared with the final diagnosis obtained by fine-needle aspiration/biopsy or surgical resection. RESULTS: 218 patients were analyzed. The average size of the lesions was 11 ± 3 mm; 23 % were ductal adenocarcinoma, 52 % neuroendocrine tumors, 8 % metastases, and 17 % other entities; 66 % of the lesions were benign. On elastography, 50 % of lesions were stiffer than the surrounding pancreatic parenchyma (stiff lesions) and 50 % were less stiff or of similar stiffness (soft lesions). High stiffness of the lesion had a sensitivity of 84 % (95 % confidence interval 73 % - 91 %), specificity of 67 % (58 % - 74 %), positive predictive value (PPV) of 56 % (50 % - 62 %), and negative predictive value (NPV) of 89 % (83 % - 93 %) for the diagnosis of malignancy. For the diagnosis of pancreatic ductal adenocarcinoma, the sensitivity, specificity, PPV, and NPV were 96 % (87 % - 100 %), 64 % (56 % - 71 %), 45 % (40 % - 50 %), and 98 % (93 % - 100 %), respectively. CONCLUSIONS: In patients with small solid pancreatic lesions, EUS elastography can rule out malignancy with a high level of certainty if the lesion appears soft. A stiff lesion can be either benign or malignant.

17 Article Agreement among Magnetic Resonance Imaging/Magnetic Resonance Cholangiopancreatography (MRI-MRCP) and Endoscopic Ultrasound (EUS) in the evaluation of morphological features of Branch Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN). 2018

Uribarri-Gonzalez, Laura / Keane, Margaret G / Pereira, Stephen P / Iglesias-García, Julio / Dominguez-Muñoz, J Enrique / Lariño-Noia, Jose. ·Gastroenterology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. Electronic address: luribarrigonzalez@gmail.com. · Gastroenterology Department, University College London Hospital NHS Foundation Trust and the Royal Free Hospital NHS Foundation Trust, London, UK. Electronic address: geri.keane.09@ucl.ac.uk. · Gastroenterology Department, University College London Hospital NHS Foundation Trust and the Royal Free Hospital NHS Foundation Trust, London, UK. Electronic address: stephen.pereira@ucl.ac.uk. · Gastroenterology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. Electronic address: julioiglesiasgarcia@gmail.com. · Gastroenterology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. Electronic address: enriquedominguezmunoz@hotmail.com. · Gastroenterology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. Electronic address: joselarnoi@outlook.es. ·Pancreatology · Pubmed #29338919.

ABSTRACT: BACKGROUND/OBJECTIVES: To evaluate the agreement between the imaging modalities MRI-MRCP and EUS in cystic lesions of the pancreas which were thought to be a BD-IPMN. METHODS: Multicenter retrospective study included all patients between 2010 and 2015 with a suspected BD-IPMN who underwent an EUS and MRI-MRCP within 6 months or less of each other. Location, number, size, worrisome features and high-risk stigmata were evaluated. Interobserver agreement was evaluated by Kappa score. RESULTS: 173 patients were included (97 UHSC, 76 UCLH-RFH), mean age 65 (range 25-87 years), 66 males. When comparing both modalities there was good agreement for the location of the cyst. The median lesion size was larger by MRI-MRCP than EUS although it was not significant. With regards to worrisome features, there was moderate agreement for main PD of 5-9 mm and abrupt change (k = 0.45 and 0.52). Fair agreement was seen for the cyst wall thickening (k = 0.25). No agreement was seen between the presence of non-enhanced mural nodules or lymphadenopathy (k < 0). With regards to high-risk stigmata, poor agreement was obtained for the detection of an enhanced solid component (k = 0.12). No agreement was observed for main PD > 10 mm (k < 0). CONCLUSIONS: In this multicentre study of patients with a BD-IPMN under active surveillance, most disagreement between these modalities was seen in the proximal pancreas. There was generally only minimal concordance between the imaging findings of EUS and MRI-MRCP for the detection of high-risk stigmata and worrisome features.

18 Article Differential diagnosis of small solid pancreatic lesions. 2016

Dietrich, Christoph Frank / Sahai, Anand Vasante / D'Onofrio, Mirko / Will, Uwe / Arcidiacono, Paolo Giorgio / Petrone, Maria Chiara / Hocke, Michael / Braden, Barbara / Burmester, Eike / Möller, Kathleen / Săftoiu, Adrian / Ignee, Andre / Cui, Xin-Wu / Iordache, Sevastita / Potthoff, Andrej / Iglesias-Garcia, Julio / Fusaroli, Pietro / Dong, Yi / Jenssen, Christian. ·Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China; Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany. · Division of Gastroenterology, CHUM, Hopital Saint Luc, Montreal, Quebec, Canada. · Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy. · SRH Wald Klinikum Gera, Germany. · PancreatoBiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy. · Medical Department, Helios Klinikum Meiningen, Meiningen, Germany. · Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom. · Medical Department I, Sana Hospital Lübeck, Lübeck, Germany. · Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany. · Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania; Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Herlev, Denmark. · Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany. · Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania. · Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany. · Gastroenterology and Hepatology Department, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. · Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna and Hospital of Imola, Imola, Italy. · Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China. · Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Germany. ·Gastrointest Endosc · Pubmed #27155592.

ABSTRACT: BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical management. METHODS: Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients. RESULTS: The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%). CONCLUSIONS: Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.

19 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.

20 Article Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos). 2015

Săftoiu, Adrian / Vilmann, Peter / Dietrich, Christoph F / Iglesias-Garcia, Julio / Hocke, Michael / Seicean, Andrada / Ignee, Andre / Hassan, Hazem / Streba, Costin Teodor / Ioncică, Ana Maria / Gheonea, Dan Ionuţ / Ciurea, Tudorel. ·Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania; Endoscopy Department, Copenhagen University Hospital, Herlev, Denmark. · Endoscopy Department, Copenhagen University Hospital, Herlev, Denmark. · Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Medical D 2, Caritas-Krankenhaus Bad, Mergentheim, Germany. · Gastroenterology Department, University Hospital Santiago de Compostela, Coruña, Spain. · Internal Medicine II, Hospital Meiningen, Meiningen, Germany. · Regional Institute of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Iuliu Haţieganu" Cluj-Napoca, Romania. · Medical D 2, Caritas-Krankenhaus Bad, Mergentheim, Germany. · Research Center of Gastroenterology and Hepatology of Craiova, University of Medicine and Pharmacy, Craiova, Romania. ·Gastrointest Endosc · Pubmed #25792386.

ABSTRACT: BACKGROUND: The role of EUS with contrast agents can be expanded through the use of time-intensity curve (TIC) analysis and computer-aided interpretation. OBJECTIVE: To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed to diagnose pancreatic carcinoma (PC) and chronic pancreatitis (CP). SETTING: Prospective, multicenter, observational trial-endoscopy units from Romania, Denmark, Germany, and Spain. PATIENTS: A total of 167 consecutive patients with PC or CP. INTERVENTIONS: Contrast-enhanced harmonic EUS (CEH-EUS) and EUS-guided FNA (EUS-FNA), TIC analysis, and ANN processing. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for EUS-FNA, CEH-EUS, and the ANN. RESULTS: After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases of PC and 55 cases of CP were included. EUS-FNA was performed in 129 patients, and the diagnosis was confirmed by surgery (n = 15) or follow-up (n = 23) in the remaining cases. Its sensitivity and specificity were 84.82% and 100%, respectively, whereas the PPV and NPV were 100% and 76.63%, respectively. The sensitivity of real-time quantitative assessment of CEH-EUS was 87.5%, specificity 92.72%, PPV 96.07%, and NPV 78.46%. Peak enhancement, wash-in area under the curve, wash-in rate, and the wash-in perfusion index were significantly different between the groups. No significant differences were found between rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%. LIMITATIONS: Only PC and CP lesions were included. CONCLUSION: Parameters obtained through TIC analysis can differentiate between PC and CP cases and can be used in an automated computer-aided diagnostic system with good diagnostic results. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01315548.).

21 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.

22 Article Usefulness of endoscopic ultrasound in the evaluation of a lymphoma with multiple gastric and pancreatic lesions. 2012

Rodríguez-Pérez, Ramiro / Iglesias-García, Julio / Alvarez-del-Castillo, Matilde / Lariño-Noia, José / Iglesias-Canle, José / Domínguez-Muñoz, J Enrique. ·Department of Gastroenterology, Hospital Universitario de Gran Canaria “Doctor Negrin”, Las Palmas de GranCanaria, Spain. ·Rev Esp Enferm Dig · Pubmed #22738703.

ABSTRACT: -- No abstract --

23 Article Diagnostic protocol for pancreatic neuroendocrine tumors (PNETs). 2012

Varas, Modesto / Gornals, Joan / Prieto, José Luis / Iglesias-García, Julio / Anonymous1630717. ·Unit of Echoendoscopy, Centro Médico Teknon and Hospital Universitario del Valle Hebrón, Barcelona, Spain. varas@dr.teknon.es ·Rev Esp Enferm Dig · Pubmed #22300114.

ABSTRACT: -- No abstract --

24 Article Early diagnosis of pancreatic cancer, time to screen high-risk individuals? 2011

Iglesias-Garcia, J / Lariño-Noia, J / Dominguez-Muñoz, J E. ·Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. julio.iglesias.garcia@sergas.es ·Minerva Gastroenterol Dietol · Pubmed #21587149.

ABSTRACT: Pancreatic cancer (PC) is considered as one of the malignant tumors with poorest survival rate (less than 5% 5-year survival). Despite new developments in imaging techniques, surgery and oncologic treatments, survival rate remains unchanged. In order to improve the outcome of this disease, it would be of interest the development of a screening program trying to detect small asymptomatic tumors or precursor lesions at the time when the disease is still at a curable stage. Although screening in general population is not feasible nowadays, screening programs in high risk individuals may be of help in this setting. A specific population has been defined to be screened, those with a >10-fold increased risk for developing the disease (inherited PC syndromes due to inherited gene mutations and individuals with a strong family history of PC with at least 2 first-degree relatives affected, but without a known genetic defect). Regarding the methods for screening, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) appears to be the most accurate, mainly based in their ability to detect those small pancreatic tumors and precursor lesions (like IPMN and PanIN lesions). In these patients screening should start at the age of 45, or 15 years earlier than the earliest occurrence of PC in the family, whichever is the earlier age. Explorations should be schedule every 1 to 3 years, depending on initial findings.

25 Article Clinical relevance of epidermal growth factor receptor (EGFR) alterations in human pancreatic tumors. 2011

Lozano-Leon, Antonio / Perez-Quintela, Begona Vieites / Iglesias-García, Julio / Urisarri-Ruiz, Adela / Lariño-Noia, Jose / Abdulkader, Ihab / Varo, Evaristo / Forteza, Jeronimo / Domínguez-Muñoz, J Enrique. ·Department of Gastroenterology and Foundation for Research in Digestive Diseases, University Hospital Santiago de Compostela, c/ Choupana s/n. Santiago de Compostela, Spain. antoniolozan@gmail.com ·Oncol Rep · Pubmed #21573507.

ABSTRACT: Pancreatic cancer is a malignant neoplasm with an extremely poor prognosis. The mechanisms of aggressive growth and metastasis are currently not well understood. Expression of epidermal growth factor receptor (EGFR) has been suggested to be associated with the malignant transformation of pancreatic cancer. In this study, we examined the EGFR status of 52 pancreatic tumors by PCR-sequencing (exons 19 and 21), immunohistochemistry and FISH probes. We subsequently investigated the relationship between EGFR status and clinicopathological factors. Somatic alterations in EGFR (R841R, T571T and R831C) were observed only in ductal adenocarcinoma (3/34). In 4 (8%) of the 52 tumors analyzed EGFR was overexpressed, 6 (12%) of the tumors showed moderate expression while 19 (32%) were weakly stained. EGFR overexpression (3+ score) was frequently found in endocrine tumors (29%) followed of ampullary tumors (13%; p < 0.01). No significant correlation was observed between the presence of a somatic EGFR mutation and clinicopathological variables. Fluorescence in situ hybridization (FISH) analysis did not demonstrate amplification in any tumors. Only three somatic mutations in the EGFR gene were detected in pancreatic ductal adenocarcinoma and no association was observed with the clinical variables. Our results suggest that EGFR mutations are rare in pancreatic tumors and not associated with clinical prognosis, and treatment response.

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