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Pancreatic Neoplasms: HELP
Articles by Joseph Romagnuolo
Based on 8 articles published since 2009
(Why 8 articles?)
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Between 2009 and 2019, J. Romagnuolo wrote the following 8 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Editorial Flow, firmness, or FNA? Is enhanced EUS fantastic or just fancy? 2012

Romagnuolo, Joseph. · ·Gastrointest Endosc · Pubmed #22817785.

ABSTRACT: -- No abstract --

2 Clinical Trial Phase 2 trial of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer. 2014

Esnaola, Nestor F / Chaudhary, Uzair B / O'Brien, Paul / Garrett-Mayer, Elizabeth / Camp, E Ramsay / Thomas, Melanie B / Cole, David J / Montero, Alberto J / Hoffman, Brenda J / Romagnuolo, Joseph / Orwat, Kelly P / Marshall, David T. ·Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina. · Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina. · Division of Biostatistics and Epidemiology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina. · Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina. · Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina. · Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina. Electronic address: marshadt@musc.edu. ·Int J Radiat Oncol Biol Phys · Pubmed #24606850.

ABSTRACT: PURPOSE: To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). METHODS AND MATERIALS: Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; "downstaged" patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. RESULTS: A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. CONCLUSIONS: This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved.

3 Article Poor 'real-life' negative predictive value of cross-sectional imaging in obstructive jaundice. 2014

Brunson, Brian A / Hawes, Robert / Hoffman, Brenda / Vela, Stacie / Romagnuolo, Joseph. · ·Can J Gastroenterol Hepatol · Pubmed #25157530.

ABSTRACT: BACKGROUND: Cross-sectional imaging remains the first-line test for obstructive jaundice despite high miss rates for pancreatobiliary tumours. Improvements in resolution and slice thickness of spiral computed tomography⁄magnetic resonance imaging⁄magnetic resonance cholangiopancreatography promised to increase accuracy. OBJECTIVE: To assess whether the post-test probability of neoplasm is truly altered by the presence or absence of a mass on computed tomography⁄magnetic resonance imaging in obstructive jaundice. METHODS: The institutional endoscopic ultrasound (EUS) database was retrospectively reviewed to stratify patients presenting to EUS over a two-year period for obstructive jaundice (suspicious for malignancy) according to their pre-EUS imaging results. The primary analysis involved the calculation of the positive predictive value and negative predictive value (NPV) of imaging with 95% binomial CIs. Test performance of EUS⁄fine-needle aspiration (FNA) was also calculated. Final diagnosis was determined by positive cytology⁄histology; negative EUS was supplemented by clinical follow-up. RESULTS: The positive predictive value (n = 51) and NPV (n = 53) of pre-EUS imaging was 98% (95% CI 90% to 100%) and 9% (95% CI 3% to 21%), respectively (accuracy 53%), with post-test suspicion of malignancy similar between imaging-positive and -negative groups. EUS demonstrated a mass in 96% of imaging-positive cases versus 85% in imaging-negative cases (exact P = 0.09). Malignant or suspicious FNA cytology was obtained with EUS in 92% of the imaging-positive group, and 62% of the imaging-negative group (75% of subgroup with FNA) (P < 0.001). CONCLUSION: Lack of a definite mass on pre-EUS imaging had low NPV, and was clearly not sufficiently accurate or reassuring in this clinical setting. In suspicious obstructive jaundice, EUS with FNA has a high diagnostic yield regardless of the findings of pre-EUS cross-sectional imaging and, as such, EUS may be a more reasonable first-line test in this high-suspicion setting.

4 Article Double plastic stents for distal malignant biliary obstruction: preliminary evidence for a novel cost-effective alternative to metal stenting. 2014

Lawrence, Christopher / Romagnuolo, Joseph. ·Medical University of South Carolina, Charleston, South Carolina, USA. ·Am J Gastroenterol · Pubmed #24496429.

ABSTRACT: -- No abstract --

5 Article Endoscopic choledochoenterostomy using a new blunt-ended endoscopic ultrasound-guided access device. 2011

Romagnuolo, J. ·Medical University of South Carolina, Charleston, South Carolina 29425, USA. romagnuo@musc.edu ·Endoscopy · Pubmed #22020725.

ABSTRACT: -- No abstract --

6 Article Accuracy of contrast-enhanced harmonic EUS with a second-generation perflutren lipid microsphere contrast agent (with video). 2011

Romagnuolo, Joseph / Hoffman, Brenda / Vela, Stacie / Hawes, Robert / Vignesh, Shivakumar. ·Department of Medicine, Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA. romagnuo@musc.edu ·Gastrointest Endosc · Pubmed #21184870.

ABSTRACT: BACKGROUND: EUS-FNA has limitations in cancer diagnosis/staging. New contrast agents, transducers, and processors have improved the potential of contrast-enhanced harmonic (CEH)-EUS. OBJECTIVE: To determine optimal settings and preliminary accuracy of CEH-EUS by using a second-generation perflutren lipid microsphere contrast agent and a prototype linear echoendoscope. DESIGN: Prospective, comparative, pilot study. SETTING: Tertiary-care medical center. PATIENTS: This study involved patients with esophageal/pancreatic/liver tumors or adenopathy. INTERVENTION: Contrast agent was injected (10 μL/kg intravenously in 1-2 doses), and the mechanical index was optimized over 5 cases (0.3). Intermittent/continuous imaging was used with extended pure harmonic detection. MAIN OUTCOME MEASUREMENTS: Before-contrast and after-contrast predictions of neoplasia (5-point Likert scale). The reference standard was positive tissue or 6-month follow-up. Perfusion factors (sequence, pattern, washout) were noted, and phases were video recorded (arterial, venous, and postvenous). RESULTS: Thirty sites (7 nodes and 16 pancreatic and 7 nonpancreatic masses) were imaged in 21 patients; 21 of 30 had FNA, and 5 had surgery. Four cases (13.3%) were rated as undecided/indeterminate with EUS (vs 1 [3.3%] with CEH-EUS; P = .35). Twenty-four cases with confirmed diagnoses (12 malignant and 12 benign) were used for test performance: positive/negative predictive values for CEH-EUS were 80.0% (95% confidence interval, 51.9%-95.7%)/100.0% (95% confidence interval, 63.0%-100.0%) versus 84.6%/100.0% for EUS. Accuracies, counting "undecided" (1 in CEH-EUS and 4 in EUS) as incorrect, were 83.3% and 79.2%. In 2 cases, management would change significantly: (1) liver hemangioma, avoiding FNA; and (2) mediastinal "cyst" confirmed as solid. LIMITATIONS: Small sample. Tissue not always available. CONCLUSION: CEH-EUS adds minimal imaging time and is accurate, with small improvement over EUS. Added information in vascular and cystic lesions can potentially change management.

7 Article Adenocarcinoma arising from a gastric submucosal intraductal papillary mucinous neoplasm. 2010

Wilson, Jason A / Lewin, David N / Esnaola, Nestor F / Romagnuolo, Joseph. ·Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina, USA. ·Gastrointest Endosc · Pubmed #20598257.

ABSTRACT: -- No abstract --

8 Article Primary squamous cell carcinoma of pancreas diagnosed by EUS-FNA: a case report. 2009

Lai, Larry Hin / Romagnuolo, Joseph / Adams, David / Yang, Jack. ·Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China. larrylai@alumni.cuhk.net ·World J Gastroenterol · Pubmed #19750582.

ABSTRACT: Squamous cell carcinoma of the pancreas has been sparsely described since the 1940s, and generally has a poor prognosis. Herein, we present a case of primary squamous cell carcinoma of the pancreas with liver metastasis, both confirmed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). To the best of our knowledge, this is the first case report in literature utilizing EUS-FNA for a cell-type specific diagnosis of primary pancreatic squamous cell carcinoma with a liver metastasis.