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Pancreatic Neoplasms: HELP
Articles by Dushyant V. Sahani
Based on 22 articles published since 2010
(Why 22 articles?)
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Between 2010 and 2020, Dushyant Sahani wrote the following 22 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Cystic Pancreatic Tumors. 2018

Burk, Kristine S / Knipp, David / Sahani, Dushyant V. ·Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: ksburk@partners.org. · Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. ·Magn Reson Imaging Clin N Am · Pubmed #30376978.

ABSTRACT: Cystic pancreatic lesions are common and often incidentally detected on cross-sectional examinations of the abdomen. Most lesions are asymptomatic and benign. However, some carry a significant risk of malignant degeneration, so correct identification, complete characterization, and adequate follow-up/management of these lesions are paramount. MR imaging/magnetic resonance cholangiopancreatography is an ideal single imaging modality for complete characterization and follow-up of cystic pancreatic lesions. This article discusses the epidemiology, pathology, and imaging characteristics of the most common cystic pancreatic neoplasms and concludes with a discussion of the most up-to-date follow-up imaging guideline recommendations.

2 Review Imaging and Screening of Pancreatic Cancer. 2017

Burk, Kristine S / Lo, Grace C / Gee, Michael S / Sahani, Dushyant V. ·Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: ksburk@partners.org. · Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. ·Radiol Clin North Am · Pubmed #28991562.

ABSTRACT: Given the low disease prevalence of both exocrine and endocrine cancers in the general population, screening is not recommended. However, in as many as 25% of cases there is a precursor lesion or an identifiable genetic predisposition. For these patients at increased risk, screening with imaging is recommended. Multidetector computed tomography, MR imaging or magnetic resonance cholangiopancreatography, and endoscopic ultrasound examination can be used as screening modalities. Recent advances in dual energy CT and total body MR imaging have increased the suitability of these noninvasive modalities as first-line imaging screening options.

3 Review AACE/ACE disease state clinical review: pancreatic neuroendocrine incidentalomas. 2015

Herrera, Miguel F / Åkerström, Göran / Angelos, Peter / Grant, Clive S / Hoff, Ana O / Pantoja, Juan Pablo / Pérez-Johnston, Rocio / Sahani, Dushyant V / Wong, Richard J / Randolph, Gregory. · ·Endocr Pract · Pubmed #25962093.

ABSTRACT: Incidental detection of pancreatic neuroendocrine tumors (PNETs) has substantially increased over the last decade due to widespread use of advanced imaging studies. Reliable initial imaging-based characterization is crucial for the differential diagnosis from other exocrine neoplasms and to determine the appropriate management plan. Measurements of chromogranin A, pancreatic polypeptide, and calcitonin are recommended for the biochemical evaluation. A thorough medical history needs to be performed to rule out multiple endocrine neoplasia (MEN) type 1. The European Neuroendocrine Tumor Society (ENETS)/Tumor Node Metastasis (TNM) staging system together with a grading based on the Ki-67 proliferation index and mitotic counts has proven to give more appropriate prognostic information than the World Health Organization (WHO)/American Joint Committee on Cancer (AJCC) TNM staging but may still fail to safely differentiate benign from malignant lesions. Poorly differentiated PNETs generally present with metastases and are rarely amenable for resection. Well- or intermediately differentiated tumors ≥2 cm with imaging evidence of malignancy or with a Ki-67 >2% should be resected. It has been suggested that non-MEN related, nonfunctioning, and asymptomatic PNETs <2 cm with a Ki-67 index ≤2% carry a low risk of metastasis and may be observed in the absence of clinical or radiologic criteria of malignancy or progression, especially in older patients. However, because metastases may occur with long delay with smaller PNETS, physicians should consider patient age, lesion location, and the risks of operation, and patients not undergoing surgery need to be closely followed closely.

4 Review Autoimmune pancreatitis in the context of IgG4-related disease: review of imaging findings. 2014

Lee, Leslie K / Sahani, Dushyant V. ·Leslie K Lee, Dushyant V Sahani, Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States. ·World J Gastroenterol · Pubmed #25386067.

ABSTRACT: Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the "capsule" and "penetrating duct" signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.

5 Review Diagnosis and management of cystic pancreatic lesions. 2013

Sahani, Dushyant V / Kambadakone, Avinash / Macari, Michael / Takahashi, Noaki / Chari, Suresh / Fernandez-del Castillo, Carlos. ·Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114, USA. dsahani@partners.org ·AJR Am J Roentgenol · Pubmed #23345356.

ABSTRACT: OBJECTIVE: The purpose of this review is to outline the management guidelines for the care of patients with cystic pancreatic lesions. CONCLUSION: The guidelines are as follows: Annual imaging surveillance is generally sufficient for benign serous cystadenomas smaller than 4 cm and for asymptomatic lesions. Asymptomatic thin-walled unilocular cystic lesions smaller than 3 cm or side-branch intraductal papillary mucinous neoplasms should be followed up with CT or MRI at 6 and 12 months interval after detection. Cystic lesions with more complex features or with growth rates greater than 1 cm/year should be followed more closely or recommended for resection if the patient's condition allows surgery. Symptomatic cystic lesions, neoplasms with high malignant potential, and lesions larger than 3 cm should be referred for surgical evaluation. Endoscopic ultrasound with fine-needle aspiration (FNA) biopsy can be used preoperatively to assess the risk of malignancy.

6 Review CT angiography of the hepatic and pancreatic circulation. 2010

Perez-Johnston, Rocio / Lenhart, Dipti K / Sahani, Dushyant V. ·Division of Abdominal Imaging and Intervention, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA. ·Radiol Clin North Am · Pubmed #20609876.

ABSTRACT: Multidetector computed tomography angiography (MDCTA) is an established, noninvasive, and effective imaging method to evaluate the liver and the pancreas primarily for neoplasm staging and presurgical planning. However, its role has also extended into a variety of other clinical indications. Technological advances in MDCT scanners and post processing now offer new opportunities with CTA, but the challenges of protocol optimization should be confronted appropriately to meet the new expectations. In this review, we focus on the technical details with MDCTA protocols for liver and pancreas and briefly discuss the common pathologic conditions where CTA is now considered integral to patient management.

7 Article Association Between Changes in Body Composition and Neoadjuvant Treatment for Pancreatic Cancer. 2018

Sandini, Marta / Patino, Manuel / Ferrone, Cristina R / Alvarez-Pérez, Carlos A / Honselmann, Kim C / Paiella, Salvatore / Catania, Matteo / Riva, Luca / Tedesco, Giorgia / Casolino, Raffaella / Auriemma, Alessandra / Salandini, Maria C / Carrara, Giulia / Cristel, Giulia / Damascelli, Anna / Ippolito, Davide / D'Onofrio, Mirko / Lillemoe, Keith D / Bassi, Claudio / Braga, Marco / Gianotti, Luca / Sahani, Dushyant / Fernández-Del Castillo, Carlos. ·Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. · Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy. · Department of Radiology, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy. · Department of Radiology, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. · Department of Oncology, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy. · Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy. · Department of Radiology, Vita-Salute San Raffaele University, Milan, Italy. ·JAMA Surg · Pubmed #29801062.

ABSTRACT: Importance: Sarcopenia and sarcopenic obesity have been associated with poor outcomes in unresectable pancreatic cancer (PC). Neoadjuvant treatment (NT) is used increasingly to improve resectability; however, its effects on fat and muscle body composition have not been characterized. Objectives: To evaluate whether NT affects muscle mass and adipose tissue in patients with borderline resectable PC (BRPC) and locally advanced PC (LAPC) and determine whether there were potential differences between patients who ultimately underwent resection and those who did not. Design, Setting, and Participants: In this retrospective cohort study conducted at 4 academic medical centers, 193 patients with BRPC and LAPC undergoing surgical exploration after NT who had available computed tomographic scans (both at diagnosis and preoperatively) and confirmed pancreatic ductal adenocarcinoma were evaluated. The study was conducted from January 2013 to December 2015. Data analysis was performed from September 2016 to May 2017. Measurement of body compartments was evaluated with volume assessment software before and after NT. A radiologist blinded to the patient outcome assessed the areas of skeletal muscle, total adipose tissue, and visceral adipose tissue through a standardized protocol. Exposures: Receipt of NT. Main Outcomes and Measures: Achievement of pancreatic resection at surgical exploration after the receipt of NT. Results: Of the 193 patients with complete radiologic imaging available after NT, 96 (49.7%) were women; mean (SD) age at diagnosis was 64 (11) years. Most patients received combined therapy with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid (124 [64.2%]) and 86 (44.6%) received chemoradiotherapy as well. The median interval between pre-NT and post-NT imaging was 6 months (interquartile range [IQR], 4-7 months). All body compartments significantly changed. The adipose compound decreased (median total adipose tissue area from 284.0 cm2; IQR, 171.0-414.0 to 250.0 cm2; IQR, 139.0-363.0; P < .001; median visceral adipose tissue area from 115.2 cm2; IQR, 59.9-191.0 to 97.7 cm2; IQR, 48.0-149.0 cm2; P < .001), whereas the lean mass slightly improved (median skeletal muscle from 122.1 cm2; IQR, 99.3-142.0 to 123 cm2; IQR 104.8-152.5 cm2; P = .001). Surgical resection was achievable in 136 (70.5%) patients. Patients who underwent resection had experienced a 5.9% skeletal muscle area increase during NT treatment, whereas those who did not undergo resection had a 1.7% decrease (P < .001). Conclusions and Relevance: Patients with PC experience a significant loss of adipose tissue during neoadjuvant chemotherapy, but no muscle wasting. An increase in muscle tissue during NT is associated with resectability.

8 Article Prediction of Pancreatic Neuroendocrine Tumor Grade Based on CT Features and Texture Analysis. 2018

Canellas, Rodrigo / Burk, Kristine S / Parakh, Anushri / Sahani, Dushyant V. ·1 Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, White 270, 55 Fruit St, Boston, MA 02114. ·AJR Am J Roentgenol · Pubmed #29140113.

ABSTRACT: OBJECTIVE: The purposes of this study were to assess whether CT texture analysis and CT features are predictive of pancreatic neuroendocrine tumor (PNET) grade based on the World Health Organization (WHO) classification and to identify features related to disease progression after surgery. MATERIALS AND METHODS: Preoperative contrast-enhanced CT images of 101 patients with PNETs were assessed. The images were evaluated for tumor location, tumor size, tumor pattern, predominantly solid or cystic composition, presence of calcification, presence of heterogeneous enhancement on contrast-enhanced images, presence of pancreatic duct dilatation, presence of pancreatic atrophy, presence of vascular involvement by the tumor, and presence of lymphadenopathy. Texture features were also extracted from CT images. Surgically verified tumors were graded according to the WHO classification, and patients underwent CT or MRI follow-up after surgical resection. Data were analyzed with chi-square tests, kappa statistics, logistic regression analysis, and Kaplan-Meier curves. RESULTS: The CT features predictive of a more aggressive tumor (grades 2 and 3) were size larger than 2.0 cm (odds ratio [OR], 3.3; p = 0.014), presence of vascular involvement (OR, 25.2; p = 0.003), presence of pancreatic ductal dilatation (OR, 6.0; p = 0.002), and presence of lymphadenopathy (OR, 6.8; p = 0.002). The texture parameter entropy (OR, 3.7; p = 0.008) was also predictive of more aggressive tumors. Differences in progression-free survival distribution were found for grade 1 versus grades 2 and 3 tumors (χ CONCLUSION: CT texture analysis and CT features are predictive of PNET aggressiveness and can be used to identify patients at risk of early disease progression after surgical resection.

9 Article Role of rapid kV-switching dual-energy CT in assessment of post-surgical local recurrence of pancreatic adenocarcinoma. 2018

Parakh, Anushri / Patino, Manuel / Muenzel, Daniela / Kambadakone, Avinash / Sahani, Dushyant V. ·Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. · Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany. · Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. dsahani@mgh.harvard.edu. ·Abdom Radiol (NY) · Pubmed #29138890.

ABSTRACT: PURPOSE: The purpose of this study is to evaluate the performance of material-specific iodine (MS-I) images generated by rapid kV-switching single-source dual-energy computed tomography (rsDECT) for distinguishing post-operative changes from local tumor recurrence in patients on follow-up for pancreatic adenocarcinoma after surgical resection. METHODS: In this IRB-approved HIPPA-compliant study, retrospective review of 51 patients who underwent surgical resection of pancreatic adenocarcinoma was conducted and were followed up using contrast-enhanced rsDECT (Discovery CT 750HD, GE Healthcare, Milwaukee, WI). Independent qualitative assessment for presence of local tumor recurrence was performed by two radiologists who evaluated 65 keV (single-energy CT-equivalent interpretation) and 65 keV with MS-I (rsDECT interpretation) in separate sessions. Quantitative analysis of Hounsfield unit (HU, on 65 keV) and normalized iodine concentration (NIC on MS-I images; iodine concentration ratio in post-operative tissue to aorta) was measured. Follow-up imaging, temporal change of CEA and CA 19-9 or biopsy served as reference standard for presence and absence of local recurrence. Sensitivity and specificity of readers and quantitative parameters was calculated and receiver operating characteristic curves and Fisher's exact test were generated. A p value < 0.05 was considered statistically significant. RESULTS: A total of 51 patients (27 females, 24 males) with mean age of 64 years built the final cohort. Local recurrence was absent in 23 (Group A) and present in 28 (Group B) patients. The follow-up imaging was performed within 7 months of rsDECT. For both readers, the addition of MS-I increased the specificity for tissue characterization and improved reader confidence as compared to 65 keV (specificity: 80% and 56%, respectively) images alone. Quantitative analysis revealed a significantly lower NIC (0.28 vs. 0.35; p < 0.05) for non-recurrent tissue. However, HU was not significantly different for non-recurrent and recurrent tissue (0.63 vs. 0.70; p > 0.05). CONCLUSION: In inherently complex cases of post-operative pancreatic adenocarcinoma, MS-I images from rsDECT can be a useful adjunct to conventional scans in characterizing loco-regional soft tissue.

10 Article Intraductal Papillary Mucinous Neoplasm of the Pancreas in Young Patients: Tumor Biology, Clinical Features, and Survival Outcomes. 2018

Morales-Oyarvide, Vicente / Mino-Kenudson, Mari / Ferrone, Cristina R / Warshaw, Andrew L / Lillemoe, Keith D / Sahani, Dushyant V / Pergolini, Ilaria / Attiyeh, Marc A / Al Efishat, Mohammad / Rezaee, Neda / Hruban, Ralph H / He, Jin / Weiss, Matthew J / Allen, Peter J / Wolfgang, Christopher L / Fernández-Del Castillo, Carlos. ·Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Wang Ambulatory Care Center 460, Boston, MA, 02114, USA. · Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Wang Ambulatory Care Center 460, Boston, MA, 02114, USA. cfernandez@partners.org. ·J Gastrointest Surg · Pubmed #29047068.

ABSTRACT: AIM: The aim of this paper is to describe the characteristics of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas in young patients. METHODS: We evaluated 1693 patients from the Pancreatic Surgery Consortium who underwent resection for IPMN and classified them as younger or older than 50 years of age at the time of surgery. We assessed the relationship of age with clinical, radiological, pathological, and prognostic features. RESULTS: We identified 90 (5%) young patients. Age was not associated with differences in main pancreatic duct size (P = 0.323), presence of solid components (P = 0.805), or cyst size (P = 0.135). IPMNs from young patients were less likely to be of gastric type (37 vs. 57%, P = 0.005), and more likely to be of oncocytic (15 vs. 4%, P = 0.003) and intestinal types (44 vs. 26%, P = 0.004). Invasive carcinomas arising from IPMN were less common in young patients (17 vs. 27%, P = 0.044), and when present they were commonly of colloid type (47 vs. 31% in older patients, P = 0.261) and had better overall survival than older patients (5-year, 71 vs. 37%, log-rank P = 0.031). CONCLUSION: Resection for IPMN is infrequent in young patients, but when they are resected, IPMNs from young patients demonstrate different epithelial subtypes from those in older patients and more favorable prognosis.

11 Article Pancreatic neuroendocrine tumor: Correlations between MRI features, tumor biology, and clinical outcome after surgery. 2018

Canellas, Rodrigo / Lo, Grace / Bhowmik, Sreejita / Ferrone, Cristina / Sahani, Dushyant. ·Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts, USA. · Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. ·J Magn Reson Imaging · Pubmed #28480609.

ABSTRACT: PURPOSE: To assess which magnetic resonance imaging (MRI) features are associated with pNETs (pancreatic neuroendocrine tumors) grade based on the WHO classification, as well as identify MRI features related to disease progression after surgery. MATERIALS AND METHODS: In this Institutional Review Board (IRB)-approved study, 1.5T and 3.0T MRI scans of 80 patients with surgically verified pNETs were assessed. The images were evaluated for tumor location; size; pattern; predominant signal intensity on precontrast T RESULTS: The MRI features that were associated with aggressive tumors were: size >2.0 cm (odds ratio [OR] = 4.8, P = 0.002), "T CONCLUSION: MRI features can be used to assess pNETs aggressiveness and identify patients at risk for early disease progression after surgical resection. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:425-432.

12 Article Diabetes mellitus in intraductal papillary mucinous neoplasm of the pancreas is associated with high-grade dysplasia and invasive carcinoma. 2017

Morales-Oyarvide, Vicente / Mino-Kenudson, Mari / Ferrone, Cristina R / Sahani, Dushyant V / Pergolini, Ilaria / Negreros-Osuna, Adrián A / Warshaw, Andrew L / Lillemoe, Keith D / Fernández-Del Castillo, Carlos. ·Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA. · Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. · Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA. Electronic address: cfernandez@partners.org. ·Pancreatology · Pubmed #28890154.

ABSTRACT: BACKGROUND: While the association between Diabetes Mellitus (DM) and pancreatic ductal adenocarcinoma is well recognized, its importance in intraductal papillary mucinous neoplasm of the pancreas (IPMN) is not well-defined. We sought to examine the associations of DM with degree of dysplasia and morphological subtypes in IPMN. METHODS: In 454 patients with resected IPMN, we evaluated associations of DM with high-grade dysplasia (HGD), invasive carcinoma, precursor epithelial subtype (gastric, intestinal, oncocytic, pancreatobiliary), and histological type of invasive carcinomas (tubular, colloid, oncocytic) using logistic regression. We performed multivariate analyses adjusting for worrisome features and high-risk stigmata of malignancy in a subset of 289 patients with annotated radiological characteristics. RESULTS: The prevalence of DM in our study was 34%. DM was significantly associated with HGD (OR 2.02, 95% CI 1.02-4.01, P = 0.045) and invasive carcinoma (OR 2.05, 95% CI 1.08-3.87, P = 0.027) after adjusting for worrisome features. Compared to patients without DM, those with recent-onset DM (≤5 years before surgery) had 6.9-fold (95% CI 2.38-19.92, P < 0.001) higher risk of invasive carcinoma. DM was associated with increased likelihood of intestinal-type precursor epithelium (OR 1.63, 95% CI 1.07-2.47, P = 0.022) and colloid carcinomas (OR 2.46, 95% CI 1.01-5.99, P = 0.047) CONCLUSION: Preoperative DM was associated with significantly higher risk of HGD and invasive carcinoma in resected IPMN, and risk of invasive carcinoma was highest in patients with recent-onset DM. Patients with DM were more likely to harbor intestinal-type IPMN and colloid carcinomas. Our findings suggest that a diagnosis of DM in patients with IPMN may warrant more aggressive surveillance.

13 Article Long-term Risk of Pancreatic Malignancy in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasm in a Referral Center. 2017

Pergolini, Ilaria / Sahora, Klaus / Ferrone, Cristina R / Morales-Oyarvide, Vicente / Wolpin, Brian M / Mucci, Lorelei A / Brugge, William R / Mino-Kenudson, Mari / Patino, Manuel / Sahani, Dushyant V / Warshaw, Andrew L / Lillemoe, Keith D / Fernández-Del Castillo, Carlos. ·Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Universita' Politecnica delle Marche, Ancona, Italy. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. · Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. · Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. · Department of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: cfernandez@partners.org. ·Gastroenterology · Pubmed #28739282.

ABSTRACT: BACKGROUND & AIMS: Little is known about the development of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). We evaluated long-term outcomes of a large cohort of patients with BD-IPMNs to determine risk of malignancy and define a subset of low-risk BD-IPMNs. METHODS: We performed a retrospective analysis of data from 577 patients with suspected or presumed BD-IPMN under surveillance at the Massachusetts General Hospital. Patients underwent cross-sectional imaging analysis at 3 months or later after their initial diagnosis. The diagnosis of BD-IPMN was based on the presence of unilocular or multilocular cysts of the pancreas and a non-dilated main pancreatic duct (<5 mm). We collected demographic, clinical, and pathology data. Cysts were characterized at the time of diagnosis and during the follow-up period. Follow-up duration was time between initial cyst diagnosis and date of last visit or death for patients without development of pancreatic cancer, date of surgery for patients with histologically confirmed malignancy, or date of first discovery of malignancy by imaging analysis for patients with unresectable tumors or who underwent neoadjuvant treatment before surgery. The primary outcome was risk of malignancy, with a focus on patients followed for 5 years or more, compared with that of the US population, based on standardized incidence ratio. RESULTS: Of the 577 patients studied, 479 (83%) were asymptomatic at diagnosis and 363 (63%) underwent endoscopic ultrasound at least once. The median follow-up time was 82 months (range, 6-329 months) for the entire study cohort; 363 patients (63%) underwent surveillance for more than 5 years, and 121 (21%) for more than 10 years. Malignancies (high-grade dysplasia or invasive neoplasm) developed after 5 years in 20 of 363 patients (5.5%), and invasive cancer developed in 16 of 363 patients (4.4%). The standardized incidence ratio for patients with BD-IPMNs without worrisome features of malignancy at 5 years was 18.8 (95% confidence interval, 9.7-32.8; P < .001). One hundred and eight patients had cysts ≤1.5 cm for more than 5 years of follow-up; only 1 of these patients (0.9%) developed a distinct ductal adenocarcinoma. By contrast, among the 255 patients with cysts >1.5 cm, 19 (7.5%) developed malignancy (P = .01). CONCLUSIONS: In a retrospective analysis of patients with BD-IPMNs under surveillance, their overall risk of malignancy, almost 8%, lasted for 10 years or more, supporting continued surveillance after 5 years. Cysts that remain ≤1.5 cm for more than 5 years might be considered low-risk for progression to malignancy.

14 Article Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: implications of minimal involvement of the main pancreatic duct. 2014

Sahora, Klaus / Fernández-del Castillo, Carlos / Dong, Fei / Marchegiani, Giovanni / Thayer, Sarah P / Ferrone, Cristina R / Sahani, Dushyant V / Brugge, William R / Warshaw, Andrew L / Lillemoe, Keith D / Mino-Kenudson, Mari. ·Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA. · Department of Pathology, Massachusetts General Hospital, Boston, MA. · Department of Radiology, Massachusetts General Hospital, Boston, MA; Department of Radiology, Harvard Medical School, Boston, MA. · Division of Gastroenterology, Massachusetts General Hospital, Boston, MA; Department of Internal Medicine, Harvard Medical School, Boston, MA. · Department of Pathology, Massachusetts General Hospital, Boston, MA; Department of Pathology, Harvard Medical School, Boston, MA. Electronic address: mminokenudson@partners.org. ·Surgery · Pubmed #25081232.

ABSTRACT: BACKGROUND: The malignant potential of intraductal mucinous neoplasm of the pancreas (IPMN) is associated closely with main pancreatic duct (MPD) involvement. Because mixed-type IPMN is thought to have the same malignant potential as that of main-duct (MD)-IPMN, resection is recommended; however, the biological nature of mixed-type IPMN with only minimal involvement of MPD (min-mix-IPMN) may be different. METHODS: A prospective database of 404 resected IPMNs was re-reviewed to subclassify mixed-type IPMNs. We defined min-mix-IPMN as absence of gross abnormalities (except for dilatation) of MPD and noncircumferential microscopic involvement of MPD limited to few sections. RESULTS: We identified 46 min-mix-IPMNs, 163 IPMNs with extensive involvement of MPD (ex-mix-IPMN), 175 branch-duct (BD)-IPMNs, and 20 MD-IPMNs. The majority of min-mix-IPMNs were found incidentally and increased cyst size on surveillance was the leading operative indication. The median diameter of MPD was 2 mm in min-mix-IPMN versus 9 mm in ex-mix-IPMN (P < .0001), and cysts ≥10 mm were present in 62% of ex-mix-IPMNs versus 93% of min-mix-IPMNs (P < .0001). Most importantly, the vast majority of min-mix-IPMNs exhibited gastric-type epithelium, similar to BD-IPMNs, whereas intestinal-type epithelium was present in half of ex-mix-IPMNs, similar to MD-IPMNs. The prevalence of high-grade lesions was less in min-mix-IPMN than ex-mix-IPMN (P < .0001). These differences were reflected in better disease-specific outcomes of min-mix-IPMN compared with ex-mix-IPMN (P = .046). CONCLUSION: Min-mix-IPMN often presents with no MPD dilation and is an incidental finding by microscopic examination. min-mix-IPMN shares the pathologic features and less aggressive biology with BD-IPMN. We propose that min-mix-IPMN be categorized differently than ex-mix-IPMN.

15 Article Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. 2014

Al-Hawary, Mahmoud M / Francis, Isaac R / Chari, Suresh T / Fishman, Elliot K / Hough, David M / Lu, David S / Macari, Michael / Megibow, Alec J / Miller, Frank H / Mortele, Koenraad J / Merchant, Nipun B / Minter, Rebecca M / Tamm, Eric P / Sahani, Dushyant V / Simeone, Diane M. · ·Gastroenterology · Pubmed #24355035.

ABSTRACT: Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions.

16 Article Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. 2014

Al-Hawary, Mahmoud M / Francis, Isaac R / Chari, Suresh T / Fishman, Elliot K / Hough, David M / Lu, David S / Macari, Michael / Megibow, Alec J / Miller, Frank H / Mortele, Koenraad J / Merchant, Nipun B / Minter, Rebecca M / Tamm, Eric P / Sahani, Dushyant V / Simeone, Diane M. ·From the Departments of Radiology (M.M.A., I.R.F.), Surgery (R.M.M., D.M.S.), and Molecular and Integrative Physiology (D.M.S.), University of Michigan Health System, 1500 E Medical Center Dr, University Hospital, Room B1 D502, Ann Arbor, MI 48109 · Departments of Internal Medicine (S.T.C.) and Radiology (D.M.H.), Mayo Clinic, Rochester, Minn · Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (E.K.F.) · Department of Radiology, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, Calif (D.S.L.) · Department of Radiology, New York University Medical Center, New York, NY (M.M., A.J.M.) · Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (F.H.M.) · Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (K.J.M.) · Department of Surgery, Vanderbilt University, Nashville, Tenn (N.B.M.) · Department of Radiology, University of Texas-MD Anderson Cancer Center, Houston, Tex (E.P.T.) · and Department of Radiology, Massachusetts General Hospital, Boston, Mass (D.V.S.). ·Radiology · Pubmed #24354378.

ABSTRACT: Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions.

17 Article Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. 2013

Sahora, Klaus / Mino-Kenudson, Mari / Brugge, William / Thayer, Sarah P / Ferrone, Cristina R / Sahani, Dushyant / Pitman, Martha B / Warshaw, Andrew L / Lillemoe, Keith D / Fernandez-del Castillo, Carlos F. ·Departments of *Surgery †Pathology ‡Gastroenterology and §Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. ·Ann Surg · Pubmed #24022439.

ABSTRACT: OBJECTIVE: The aim of this study was to critically analyze the safety of the revised guidelines, with focus on cyst size and worrisome features in the management of BD-IPMN. BACKGROUND: The Sendai guidelines for management of branch duct (BD) intraductal papillary mucinous neoplasm (IPMN) espouse safety of observation of asymptomatic cysts smaller than 3 cm without nodules (Sendai negative). Revised international consensus guidelines published in 2012 suggest a still more conservative approach, even for lesions of 3 cm or larger. By contrast, 2 recent studies have challenged the safety of both guidelines, describing invasive carcinoma or carcinoma in situ in 67% of BD-IPMN smaller than 3 cm and in 25% of "Sendai-negative" BD-IPMN. METHODS AND RESULTS: Review of a prospective database identified 563 patients with BD-IPMN. A total of 240 patients underwent surgical resection (152 at the time of diagnosis and 88 after being initially followed); the remaining 323 have been managed by observation with median follow-up of 60 months. No patient developed unresectable BD-IPMN carcinoma during follow-up. Invasive cancer arising in BD-IPMN was found in 23 patients of the entire cohort (4%), and an additional 21 patients (3.7%) had or developed concurrent pancreatic ductal adenocarcinoma. According to the revised guidelines, 76% of resected BD-IPMN with carcinoma in situ and 95% of resected BD-IPMN with invasive cancer had high-risk stigmata or worrisome features. The risk of high-grade dysplasia in nonworrisome lesions smaller than 3 cm was 6.5%, but when the threshold was raised to greater than 3 cm, it was 8.8%, and 1 case of invasive carcinoma was found. CONCLUSIONS: Expectant management of BD-IPMN following the old guidelines is safe, whereas caution is advised for larger lesions, even in the absence of worrisome features.

18 Article FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience. 2013

Faris, Jason E / Blaszkowsky, Lawrence S / McDermott, Shaunagh / Guimaraes, Alexander R / Szymonifka, Jackie / Huynh, Mai Anh / Ferrone, Cristina R / Wargo, Jennifer A / Allen, Jill N / Dias, Lauren E / Kwak, Eunice L / Lillemoe, Keith D / Thayer, Sarah P / Murphy, Janet E / Zhu, Andrew X / Sahani, Dushyant V / Wo, Jennifer Y / Clark, Jeffrey W / Fernandez-del Castillo, Carlos / Ryan, David P / Hong, Theodore S. ·Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jfaris@partners.org ·Oncologist · Pubmed #23657686.

ABSTRACT: The objective of our retrospective institutional experience is to report the overall response rate, R0 resection rate, progression-free survival, and safety/toxicity of neoadjuvant FOLFIRINOX (5-fluorouracil [5-FU], oxaliplatin, irinotecan, and leucovorin) and chemoradiation in patients with locally advanced pancreatic cancer (LAPC). Patients with LAPC treated with FOLFIRINOX were identified via the Massachusetts General Hospital Cancer Center pharmacy database. Demographic information, clinical characteristics, and safety/tolerability data were compiled. Formal radiographic review was performed to determine overall response rates (ORRs). Twenty-two patients with LAPC began treatment with FOLFIRINOX between July 2010 and February 2012. The ORR was 27.3%, and the median progression-free survival was 11.7 months. Five of 22 patients were able to undergo R0 resections following neoadjuvant FOLFIRINOX and chemoradiation. Three of the five patients have experienced distant recurrence within 5 months. Thirty-two percent of patients required at least one emergency department visit or hospitalization while being treated with FOLFIRINOX. FOLFIRINOX possesses substantial activity in patients with LAPC. The use of FOLFIRINOX was associated with conversion to resectability in >20% of patients. However, the recurrences following R0 resection in three of five patients and the toxicities observed with the use of this regimen raise important questions about how to best treat patients with LAPC.

19 Article Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy. 2013

Gallotti, Anna / Johnston, Rocio Perez / Bonaffini, Pietro A / Ingkakul, Thun / Deshpande, Vikram / Fernández-del Castillo, Carlos / Sahani, Dushyant V. ·Department of Radiology, University Hospital G. B. Rossi, University of Verona, Verona, Italy. ·AJR Am J Roentgenol · Pubmed #23345357.

ABSTRACT: OBJECTIVE: The objective of our study was to evaluate the MDCT features of incidentally detected neuroendocrine tumors (NETs) of the pancreas, identify features that can predict tumor biology or aggressiveness and long-term outcome, and determine the incidence of "nonbenign" behavior. MATERIALS AND METHODS: In this retrospective study, 60 histologically verified pancreatic NETs incidentally detected with contrast-enhanced MDCT were included. Various MDCT features such as size, morphology, enhancement, and presence of calcifications were evaluated and were correlated with tumor biology on histopathology. The sensitivity, specificity, predictive values, and accuracy were calculated for MDCT features in predicting nonbenign biology and risk of recurrence. RESULTS: A total of 32 of 60 (53%) NETs were nonbenign: most were large (mean, 29.1 mm) with a solid or complex pattern. NET size of 3 cm or larger yielded a positive predictive value of 61% for nonbenign tumors and 100% when calcification was present. In 12 patients with recurrence, 92% of NETs were nonbenign. The presence of calcification, local invasion, main pancreatic duct dilatation, vascular invasion, and lymph node enlargement along with angioinvasion and a Ki-67 index greater than 2% on histology were associated with a nonbenign diagnosis and a higher risk of recurrence. CONCLUSION: Approximately 50% of incidental NETs show uncertain or malignant behavior. Solid tumors 3 cm or larger are commonly nonbenign; however, about 30% of tumors smaller than that size cutoff can be malignant. Nonbenign tumors and those with invasive features on MDCT have a higher incidence of recurrence.

20 Article Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. 2013

Sahani, Dushyant V / Bonaffini, Pietro A / Fernández-Del Castillo, Carlos / Blake, Michael A. ·Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114, USA. dsahani@partners.org ·Radiology · Pubmed #23264526.

ABSTRACT: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogeneous group of neoplasms that arise from cells of the diffuse neuroendocrine system and are characterized by a wide spectrum of clinical manifestations. All NETs are potentially malignant but differ in their biologic characteristics and the probability of metastatic disease. The pathologic classification of these tumors relies on their proliferation and differentiation. In the past decades, several nomenclatures have been proposed to stratify neuroendocrine tumors, but the World Health Organization classification is the one that is most widely accepted and used. The diagnosis of neuroendocrine tumor relies on clinical manifestation, laboratory parameters, imaging features, and tissue biomarkers in a biopsy specimen. With improved understanding of the natural history and lesion biology, management of GEP-NETs has also evolved. Although surgery remains the only potentially curative therapy for patients with primary GEP-NETs, other available treatments include chemotherapy, interferon, somatostatin analogs, and targeted therapies. Recent improvements in both morphologic and functional imaging methods have contributed immensely to patient care. Morphologic imaging with contrast agent-enhanced multidetector computed tomography and magnetic resonance imaging is most widely used for initial evaluation and staging of disease in these patients, whereas functional imaging techniques are useful both for detection and prognostic evaluation and can change treatment planning.

21 Article Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. 2011

Genevay, Muriel / Mino-Kenudson, Mari / Yaeger, Kurt / Konstantinidis, Ioannis T / Ferrone, Cristina R / Thayer, Sarah / Castillo, Carlos Fernandez-del / Sahani, Dushyant / Bounds, Brenna / Forcione, David / Brugge, William R / Pitman, Martha Bishop. ·Department of Pathology, The James Homer Wright Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. ·Ann Surg · Pubmed #22041510.

ABSTRACT: OBJECTIVE: Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND: The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for malignancy warranting surgical triage. METHODS: We reviewed clinical, radiological and cytological data of 112 patients with histologically confirmed mucinous cysts of the pancreas evaluated in a single tertiary medical center. Cytology slides were blindly re-reviewed and epithelial cells grouped as either benign or high-grade atypia (HGA) [≥high-grade dysplasia]. Histologically, neoplasms were grouped as benign (low-grade and moderate dysplasia) and malignant (in situ and invasive carcinoma). Performance characteristics of cytology relative to other risk factors were evaluated. RESULTS: Dilated MPD, MN, and HGA were independent predictors of malignancy (p < 0.0001), but not symptoms (p = 0.29) or cyst size >30 mm (p = 0.51). HGA was the most sensitive predictor of malignancy in all cysts (72%) and in small (≤30 mm) branch-duct intraductal papillary mucinous neoplasm (BD IPMN; 67%), whereas also being specific (85 and 88%, respectively). MN and dilated MPD were highly specific (>90%), but insensitive (39%-44%). Cytology detected 30% more cancers in small cysts than dilated MPD or MN and half of the cancers without either of these high-risk imaging features. CONCLUSIONS: Cytology adds value to the radiological assessment of predicting malignancy in mucinous cysts, particularly in small BD IPMN.

22 Article Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. 2011

Mino-Kenudson, Mari / Fernández-del Castillo, Carlos / Baba, Yoshifumi / Valsangkar, Nakul P / Liss, Andrew S / Hsu, Maylee / Correa-Gallego, Camilo / Ingkakul, Thun / Perez Johnston, Rocio / Turner, Brian G / Androutsopoulos, Vasiliki / Deshpande, Vikram / McGrath, Deborah / Sahani, Dushyant V / Brugge, William R / Ogino, Shuji / Pitman, Martha B / Warshaw, Andrew L / Thayer, Sarah P. ·Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. mminokenudson@partners.org ·Gut · Pubmed #21508421.

ABSTRACT: OBJECTIVE: Invasive cancers arising from intraductal papillary mucinous neoplasm (IPMN) are recognised as a morphologically and biologically heterogeneous group of neoplasms. Less is known about the epithelial subtypes of the precursor IPMN from which these lesions arise. The authors investigate the clinicopathological characteristics and the impact on survival of both the invasive component and its background IPMN. DESIGN AND PATIENTS: The study cohort comprised 61 patients with invasive IPMN (study group) and 570 patients with pancreatic ductal adenocarcinoma (PDAC, control group) resected at a single institution. Multivariate analyses were performed using a stage-matched Cox proportional hazard model. RESULTS: The histology of invasive components of the IPMN cohort was tubular in 38 (62%), colloid in 16 (26%), and oncocytic in seven (12%). Compared with PDAC, invasive IPMNs were associated with a lower incidence of adverse pathological features and improved mortality by multivariate analysis (HR 0.58; 95% CI 0.39 to 0.86). In subtype analysis, this favourable outcome remained only for colloid and oncocytic carcinomas, while tubular adenocarcinoma was associated with worse overall survival, not significantly different from that of PDAC (HR 0.85; 95% CI 0.53 to 1.36). Colloid and oncocytic carcinomas arose only from intestinal- and oncocytic-type IPMNs, respectively, and were mostly of the main-duct type, whereas tubular adenocarcinomas primarily originated in the gastric background, which was often associated with branch-duct IPMN. Overall survival of patients with invasive adenocarcinomas arising from gastric-type IPMN was significantly worse than that of patients with non-gastric-type IPMN (p=0.016). CONCLUSIONS: Tubular, colloid and oncocytic invasive IPMNs have varying prognosis, and arise from different epithelial subtypes. Colloid and oncocytic types have markedly improved biology, whereas the tubular type has a course that resembles PDAC. Analysis of these subtypes indicates that the background epithelium plays an equally, if not more, important role in defining the biology and prognosis of invasive IPMNs.