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Pancreatic Neoplasms: HELP
Articles by Eric P. Tamm
Based on 39 articles published since 2008
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Between 2008 and 2019, E. Tamm wrote the following 39 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline ACR Appropriateness Criteria 2017

Anonymous7930925 / Qayyum, Aliya / Tamm, Eric P / Kamel, Ihab R / Allen, Peter J / Arif-Tiwari, Hina / Chernyak, Victoria / Gonda, Tamas A / Grajo, Joseph R / Hindman, Nicole M / Horowitz, Jeanne M / Kaur, Harmeet / McNamara, Michelle M / Noto, Richard B / Srivastava, Pavan K / Lalani, Tasneem. ·Principal Author, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: aqayyum@mdanderson.org. · Research Author, University of Texas MD Anderson Cancer Center, Houston, Texas. · Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Memorial Sloan Kettering Cancer Center, New York, New York; American College of Surgeons. · University of Arizona, Banner University Medical Center, Tucson, Arizona. · Montefiore Medical Center, Bronx, New York. · Columbia University, New York, New York; American Gastroenterological Association. · University of Florida College of Medicine, Gainesville, Florida. · New York University Medical Center, New York, New York. · Northwestern University, Chicago, Illinois. · University of Texas MD Anderson Cancer Center, Houston, Texas. · University of Alabama Medical Center, Birmingham, Alabama. · The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. · University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians. · Specialty Chair, University of Washington, Seattle, Washington. ·J Am Coll Radiol · Pubmed #29101993.

ABSTRACT: Pancreatic adenocarcinoma is associated with poor overall prognosis. Complete surgical resection is the only possible option for cure. As such, increasingly complex surgical techniques including sophisticated vascular reconstruction are being used. Continued advances in surgical techniques, in conjunction with use of combination systemic therapies, and radiation therapy have been suggested to improve outcomes. A key aspect to surgical success is reporting of pivotal findings beyond absence of distant metastases, such as tumor size, location, and degree of tumor involvement of specific vessels associated with potential perineural tumor spread. Multiphase contrast-enhanced multidetector CT and MRI are the imaging modalities of choice for pretreatment staging and presurgical determination of resectability. Imaging modalities such as endoscopic ultrasound and fluorine-18-2-fluoro-2-deoxy-D-glucose imaging with PET/CT are indicated for specific scenarios such as biopsy guidance and confirmation of distant metastases, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

2 Review State-of-the-art Imaging of Pancreatic Neuroendocrine Tumors. 2016

Tamm, Eric P / Bhosale, Priya / Lee, Jeffrey H / Rohren, Eric M. ·Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Unit 1473, PO Box 301402, Houston, TX 77230-1402, USA. Electronic address: etamm@mdanderson.org. · Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Unit 1473, PO Box 301402, Houston, TX 77230-1402, USA. · Department of Gastroenterology, Hepatology and Nutrition, T. Boone Pickens Academic Tower (FCT13.6028), 1515 Holcombe Boulevard, Unit 1466, Houston, TX 77030, USA. · Department of Nuclear Medicine, T. Boone Pickens Academic Tower (FCT16.6012), 1515 Holcombe Boulevard, Unit 1483, Houston, TX 77030, USA. ·Surg Oncol Clin N Am · Pubmed #27013371.

ABSTRACT: Pancreatic neuroendocrine tumors are rare tumors that present many imaging challenges, from detecting small functional tumors to fully staging large nonfunctioning tumors, including identifying all sites of metastatic disease, particularly nodal and hepatic, and depicting vascular involvement. The correct choice of imaging modality requires knowledge of the tumor type (eg, gastrinoma versus insulinoma), and also the histology (well vs poorly differentiated). Evolving techniques in computed tomography (CT), MRI, endoscopic ultrasonography, and nuclear medicine, such as dual-energy CT, diffusion-weighted MRI, liver-specific magnetic resonance contrast agents, and new nuclear medicine agents, offer new ways to visualize, and ultimately manage, these tumors.

3 Review Imaging of pancreatic neoplasms. 2014

Balachandran, Aparna / Bhosale, Priya R / Charnsangavej, Chuslip / Tamm, Eric P. ·Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA. Electronic address: abalachandran@mdanderson.org. · Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA. · Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. ·Surg Oncol Clin N Am · Pubmed #25246049.

ABSTRACT: Ductal adenocarcinoma accounts for 85% to 90% of all solid pancreatic neoplasms, is increasing in incidence, and is the fourth leading cause of cancer-related deaths. There are currently no screening tests available for the detection of ductal adenocarcinoma. The only chance for cure in pancreatic adenocarcinoma is surgery. Imaging has a crucial role in the identification of the primary tumor, vascular variants, identification of metastases, disease response assessment to treatment, and prediction of respectability. Pancreatic neuroendocrine neoplasms can have a distinctive appearance and pattern of spread, which should be recognized on imaging for appropriate management of these patients.

4 Review Solid pseudo-papillary tumors of the pancreas: current update. 2013

Ganeshan, Dhakshina Moorthy / Paulson, Erik / Tamm, Eric P / Taggart, Melissa Wainwright / Balachandran, Aparna / Bhosale, Priya. ·Department of Diagnostic Imaging, Body Imaging section, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA, dganeshan@mdanderson.org. ·Abdom Imaging · Pubmed #23775388.

ABSTRACT: Solid pseudo-papillary tumors are rare pancreatic tumors, which occur in females and are typically indolent neoplasms. However, atypical, aggressive variants can occur with locally advanced disease or metastases. They have characteristic imaging features, which vary according to size. This article provides a current update on the molecular biology, histopathology, clinico-radiological features, and management of these tumors.

5 Review Vascular pancreatic lesions: spectrum of imaging findings of malignant masses and mimics with pathologic correlation. 2013

Bhosale, Priya R / Menias, Christine O / Balachandran, Aparna / Tamm, Eric P / Charnsangavej, Chusilp / Francis, Isaac R / Elsayes, Khaled M. ·Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA. ·Abdom Imaging · Pubmed #22968429.

ABSTRACT: The differential diagnosis of hypervascular pancreatic lesions is complex, and includes endocrine and exocrine tumors of the pancreas, metastases to the pancreas, and masses, or mass-like lesions, arising from the neurovascular networks traversing the pancreas. In this manuscript, we will discuss salient imaging findings of these masses, pertinent differential diagnoses, as well as review clinical symptomatology that may aid in the diagnosis of some of these lesions.

6 Review Imaging of pancreatic adenocarcinoma: update on staging/resectability. 2012

Tamm, Eric P / Balachandran, Aparna / Bhosale, Priya R / Katz, Matthew H / Fleming, Jason B / Lee, Jeffrey H / Varadhachary, Gauri R. ·Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA. etamm@mdanderson.org ·Radiol Clin North Am · Pubmed #22560689.

ABSTRACT: Because of the evolution of treatment strategies staging criteria for pancreatic cancer now emphasize arterial involvement for determining unresectable disease. Preoperative therapy may improve the likelihood of margin negative resections of borderline resectable tumors. Cross-sectional imaging is crucial for correctly staging patients. Magnetic resonance (MR) imaging and computed tomography (CT) are probably comparable, with MR imaging probably offering an advantage for identifying liver metastases. Positron emission tomography/CT and endoscopic ultrasound may be helpful for problem solving. Clear and concise reporting of imaging findings is important. Several national organizations are developing templates to standardize the reporting of imaging findings.

7 Review Imaging features of hematogenous metastases to the pancreas: pictorial essay. 2011

Tan, Cher Heng / Tamm, Eric P / Marcal, Leonardo / Balachandran, Aparna / Charnsangavej, Chusilp / Vikram, Raghu / Bhosale, Priya. ·Tan Tock Seng Hospital, Singapore, Singapore. tchers1977@gmail.com ·Cancer Imaging · Pubmed #21367687.

ABSTRACT: This pictorial essay illustrates the imaging appearances of a wide variety of metastases to the pancreas as seen on computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT. Key clinical and radiologic features (lesion distribution, non-contrast imaging appearance, enhancement pattern and pattern of spread) that may aid differentiation of primary from solitary secondary pancreatic malignancies are discussed.

8 Review Pictorial essay: multimodality imaging of metastases from pancreatic ductal adenocarcinoma. 2010

Ozkan, Efe / Balachandran, Aparna / Bhosale, Priya R / Tamm, Eric P / Marcal, Leonardo P / Szklaruk, Janio. ·Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. efe.ozkan@di.mdacc.tmc.edu ·Clin Imaging · Pubmed #20630340.

ABSTRACT: Surgical resection is the only curative therapy available for pancreatic ductal adenocarcinoma. Unfortunately, metastatic disease constitutes an absolute contraindication for surgery. Therefore, the detection of metastatic disease is a critical component of preoperative imaging of pancreatic adenocarcinoma. Computed tomography and magnetic resonance imaging are currently used for the preoperative evaluation of these patients. Positron emission tomography/computed tomography and ultrasonography may also be helpful in the detection of metastatic disease. This pictorial essay reviews the imaging findings of common and uncommon metastases from pancreatic adenocarcinoma.

9 Review Update on 3D and multiplanar MDCT in the assessment of biliary and pancreatic pathology. 2009

Tamm, Eric P / Balachandran, Aparna / Bhosale, Priya / Szklaruk, Janio. ·Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. etamm@di.mdacc.tmc.edu ·Abdom Imaging · Pubmed #18483805.

ABSTRACT: The development of multidetector row computed tomography (MDCT) has led to the acquisition of true isotropic voxels that can be postprocessed to yield images in any plane of the same resolution as the original axially acquired images. This, coupled with rapid MDCT imaging during peak target organ enhancement has led to a variety of means to review imaging information beyond that of the axial perspective. Postprocessing can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary-related surgery, determine the level and cause of biliary obstruction and assist in staging of biliary cancer. Postprocessing can also be used to identify pancreatic ductal variants, visualize diagnostic features of pancreatic cystic lesions, diagnose and stage pancreatic cancer, and differentiate pancreatic from peripancreatic disease.

10 Review Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach. 2008

Katz, Matthew H G / Mortenson, Melinda M / Wang, Huamin / Hwang, Rosa / Tamm, Eric P / Staerkel, Gregg / Lee, Jeffrey H / Evans, Douglas B / Fleming, Jason B. ·Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA. ·J Am Coll Surg · Pubmed #18589369.

ABSTRACT: -- No abstract --

11 Review Current diagnosis and management of unusual pancreatic tumors. 2008

Mortenson, Melinda M / Katz, Matthew H G / Tamm, Eric P / Bhutani, Manoop S / Wang, Huamin / Evans, Douglas B / Fleming, Jason B. ·Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. ·Am J Surg · Pubmed #18466869.

ABSTRACT: BACKGROUND: The finding of a solid or cystic mass in the pancreas is becoming more common secondary to the increasing use of cross-sectional imaging and the improved sensitivity of such studies for the detection of pancreatic abnormalities. Because of the aggressive natural history of pancreatic cancer, this has caused concern that all pancreatic abnormalities may be cancer as well as confusion over proper diagnostic and treatment algorithms. This review provides an overview of the natural history, diagnostic considerations, and treatment recommendations for the less common tumors of the pancreas which can be misinterpreted as pancreatic cancer including: solid pseudopapillary tumors (SPT), acinar cell carcinoma (ACC), lymphoplasmacytic sclerosing pancreatitis (LPSP), primary pancreatic lymphoma (PPL), and metastatic renal cell carcinoma to the pancreas. DATA SOURCES: A Medline search was conducted to identify studies investigating the clinicopathologic features, molecular genetics, pathogenesis, diagnosis, and treatment of SPT, ACC, LPSP, PPL, and pancreatic metastases. CONCLUSIONS: It is often possible to obtain an accurate pretreatment diagnosis for these unusual pancreatic tumors and to successfully differentiate them from the more common pancreatic malignancies.

12 Clinical Trial Transport properties of pancreatic cancer describe gemcitabine delivery and response. 2014

Koay, Eugene J / Truty, Mark J / Cristini, Vittorio / Thomas, Ryan M / Chen, Rong / Chatterjee, Deyali / Kang, Ya'an / Bhosale, Priya R / Tamm, Eric P / Crane, Christopher H / Javle, Milind / Katz, Matthew H / Gottumukkala, Vijaya N / Rozner, Marc A / Shen, Haifa / Lee, Jeffery E / Wang, Huamin / Chen, Yuling / Plunkett, William / Abbruzzese, James L / Wolff, Robert A / Varadhachary, Gauri R / Ferrari, Mauro / Fleming, Jason B. · ·J Clin Invest · Pubmed #24614108.

ABSTRACT: BACKGROUND: The therapeutic resistance of pancreatic ductal adenocarcinoma (PDAC) is partly ascribed to ineffective delivery of chemotherapy to cancer cells. We hypothesized that physical properties at vascular, extracellular, and cellular scales influence delivery of and response to gemcitabine-based therapy. METHODS: We developed a method to measure mass transport properties during routine contrast-enhanced CT scans of individual human PDAC tumors. Additionally, we evaluated gemcitabine infusion during PDAC resection in 12 patients, measuring gemcitabine incorporation into tumor DNA and correlating its uptake with human equilibrative nucleoside transporter (hENT1) levels, stromal reaction, and CT-derived mass transport properties. We also studied associations between CT-derived transport properties and clinical outcomes in patients who received preoperative gemcitabine-based chemoradiotherapy for resectable PDAC. RESULTS: Transport modeling of 176 CT scans illustrated striking differences in transport properties between normal pancreas and tumor, with a wide array of enhancement profiles. Reflecting the interpatient differences in contrast enhancement, resected tumors exhibited dramatic differences in gemcitabine DNA incorporation, despite similar intravascular pharmacokinetics. Gemcitabine incorporation into tumor DNA was inversely related to CT-derived transport parameters and PDAC stromal score, after accounting for hENT1 levels. Moreover, stromal score directly correlated with CT-derived parameters. Among 110 patients who received preoperative gemcitabine-based chemoradiotherapy, CT-derived parameters correlated with pathological response and survival. CONCLUSION: Gemcitabine incorporation into tumor DNA is highly variable and correlates with multiscale transport properties that can be derived from routine CT scans. Furthermore, pretherapy CT-derived properties correlate with clinically relevant endpoints. TRIAL REGISTRATION: Clinicaltrials.gov NCT01276613. FUNDING: Lustgarten Foundation (989161), Department of Defense (W81XWH-09-1-0212), NIH (U54CA151668, KCA088084).

13 Clinical Trial Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. 2008

Varadhachary, Gauri R / Wolff, Robert A / Crane, Christopher H / Sun, Charlotte C / Lee, Jeffrey E / Pisters, Peter W T / Vauthey, Jean-Nicolas / Abdalla, Eddie / Wang, Huamin / Staerkel, Gregg A / Lee, Jeffrey H / Ross, William A / Tamm, Eric P / Bhosale, Priya R / Krishnan, Sunil / Das, Prajnan / Ho, Linus / Xiong, Henry / Abbruzzese, James L / Evans, Douglas B. ·Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 426, Houston, TX 77030, USA. gvaradha@mdanderson.org ·J Clin Oncol · Pubmed #18640929.

ABSTRACT: PURPOSE: We conducted a phase II trial of preoperative gemcitabine and cisplatin chemotherapy in addition to chemoradiation (Gem-Cis-XRT) and pancreaticoduodenectomy (PD) for patients with stage I/II pancreatic adenocarcinoma. PATIENTS AND METHODS: Chemotherapy consisted of gemcitabine (750 mg/m(2)) and cisplatin (30 mg/m(2)) given every 2 weeks for four doses. Chemoradiation consisted of four weekly infusions of gemcitabine (400 mg/m(2)) combined with radiation therapy (30 Gy in 10 fractions administered over 2 weeks) delivered 5 days per week. Patients underwent restaging 4 to 6 weeks after completion of chemoradiation and, in the absence of disease progression, were taken to surgery. RESULTS: The study enrolled 90 patients; 79 patients (88%) completed chemo-chemoradiation. Sixty-two (78%) of 79 patients were taken to surgery and 52 (66%) of 79 underwent PD. The median overall survival of all 90 patients was 17.4 months. Median survival for the 79 patients who completed chemo-chemoradiation was 18.7 months, with a median survival of 31 months for the 52 patients who underwent PD and 10.5 months for the 27 patients who did not undergo surgical resection of their primary tumor (P < .001). CONCLUSION: Preoperative Gem-Cis-XRT did not improve survival beyond that achieved with preoperative gemcitabine-based chemoradiation (Gem-XRT) alone. The longer preoperative interval required more durable biliary decompression (metal stents) but was not associated with local tumor progression. The gemcitabine-based chemoradiation platform is a reasonable foundation on which to build future phase II multimodality trials for stage I/II pancreatic cancer incorporating emerging systemic therapies.

14 Article Significance of T1a and T1b Carcinoma Arising in Mucinous Cystic Neoplasm of Pancreas. 2018

Hui, Ling / Rashid, Asif / Foo, Wai Chin / Katz, Matthew H / Chatterjee, Deyali / Wang, Hua / Fleming, Jason B / Tamm, Eric P / Wang, Huamin. ·Departments of Pathology. · Surgical Oncology. · Gastrointestinal Medical Oncology. · Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX. ·Am J Surg Pathol · Pubmed #29462092.

ABSTRACT: Mucinous cystic neoplasm (MCN) of pancreas is one of the precursor lesions of pancreatic ductal adenocarcinoma. The 5-year disease-specific survival for noninvasive MCNs was 100% and 20% to 60% for those with pancreatic ductal adenocarcinoma arising in a MCN. However, the significance of T1a (≤0.5 cm) and T1b (>0.5 and <1.0 cm) carcinoma arising in MCN as defined by the upcoming American Joint Committee on Cancer, eighth edition is unclear. In this study, we examined 3 cases of MCN with T1a or T1b carcinoma and compared their clinicopathologic characteristics and survival to 46 cases of MCN with low-grade dysplasia (MCN-LGD), 7 cases of MCN with high-grade dysplasia (MCN-HGD), and 7 cases of MCN with advanced invasive carcinoma (T2 or higher T stage). The tumors from all 3 cases were submitted in their entirety in 123, 296, and 200 blocks, respectively. All 3 patients were alive with no recurrence during the follow-up of 20.0, 113.8, and 137.2 months, respectively. Similarly, none of the patients who had MCN with either LGD or HGD had recurrence or died of disease. In contrast, 5 of 7 patients who had MCN with advanced invasive carcinoma had recurrence and later died of disease with a median survival of 22.9 months (P<0.001). Our study showed that MCN with T1a and T1b carcinoma had an excellent prognosis similar to MCNs with LGD or HGD after complete tumor sampling for histologic examination. Our results along with the previous studies suggest that close follow-up, rather than aggressive systemic therapy, may be a better approach for these patients.

15 Article Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm? 2018

Rastogi, Ashita / Assing, Mathew / Taggart, Mellisa / Rao, Brinda / Sun, Jia / Elsayes, Khaled / Tamm, Eric / Bhosale, Priya. ·Radiology Fellow, Stanford Hospital, Palo Alto, CA. · Department of Pathology Administration, The University of Texas MD Anderson Cancer Center. · Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX. ·J Comput Assist Tomogr · Pubmed #29287021.

ABSTRACT: OBJECTIVE: The aim of the study was to assess the ability of contrast-enhanced computed tomography (CECT) to differentiate aggressive from nonaggressive solid pseudopapillary neoplasms (SPNs). MATERIALS AND METHODS: Forty treatment-naive patients with pathologically proven pancreatic SPNs were included. Imaging characteristics were determined by consensus of 3 radiologists blinded to histopathologic aggressiveness. All patients underwent 4-phase CECT using a pancreatic protocol. The regions of interest of the tumor and the normal pancreas were documented on all phases. Lymph nodes were considered metastatic if greater than 1.0 cm in short-axis diameter.Fisher exact and Wilcoxon rank-sum tests were used to compare between aggressive and nonaggressive tumors. RESULTS: No significant difference was noted between imaging covariates, such as internal hemorrhage, calcification, wall thickness perceptibility, vascular invasion, margins, cystic component, and pancreatic and biliary ductal dilation. Tumors with greater than 62.5 Hounsfield units and progressive enhancement during the delayed phase had aggressive characteristics (P = 0.03). CONCLUSIONS: On delayed phase CECT, pathologically aggressive SPNs may show greater enhancement than nonaggressive SPNs.

16 Article Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience. 2017

Cloyd, Jordan M / Katz, Matthew H G / Prakash, Laura / Varadhachary, Gauri R / Wolff, Robert A / Shroff, Rachna T / Javle, Milind / Fogelman, David / Overman, Michael / Crane, Christopher H / Koay, Eugene J / Das, Prajnan / Krishnan, Sunil / Minsky, Bruce D / Lee, Jeffrey H / Bhutani, Manoop S / Weston, Brian / Ross, William / Bhosale, Priya / Tamm, Eric P / Wang, Huamin / Maitra, Anirban / Kim, Michael P / Aloia, Thomas A / Vauthey, Jean-Nicholas / Fleming, Jason B / Abbruzzese, James L / Pisters, Peter W T / Evans, Douglas B / Lee, Jeffrey E. ·Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA. · Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Gasteroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA. · University Health Network, Toronto, ON, Canada. · Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA. · Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA. jelee@mdanderson.org. ·J Gastrointest Surg · Pubmed #27778257.

ABSTRACT: BACKGROUND: The purpose of this study was to evaluate a single-institution experience with delivery of preoperative therapy to patients with pancreatic ductal adenocarcinoma (PDAC) prior to pancreatoduodenectomy (PD). METHODS: Consecutive patients (622) with PDAC who underwent PD following chemotherapy and/or chemoradiation between 1990 and 2014 were retrospectively reviewed. Preoperative treatment regimens, clinicopathologic characteristics, operative details, and long-term outcomes in four successive time periods (1990-1999, 2000-2004, 2005-2009, 2010-2014) were evaluated and compared. RESULTS: The average number of patients per year who underwent PD following preoperative therapy as well as the proportion of operations performed for borderline resectable and locally advanced (BR/LA) tumors increased over time. The use of induction systemic chemotherapy, as well as postoperative adjuvant chemotherapy, also increased over time. Throughout the study period, the mean EBL decreased while R0 margin rates and vascular resection rates increased overall. Despite the increase in BR/LA resections, locoregional recurrence (LR) rates remained similar over time, and overall survival (OS) improved significantly (median 24.1, 28.1, 37.3, 43.4 months, respectively, p < 0.0001). CONCLUSIONS: Despite increases in case complexity, relatively low rates of LR have been maintained while significant improvements in OS have been observed. Further improvements in patient outcomes will likely require disruptive advances in systemic therapy.

17 Article Quantitative imaging to evaluate malignant potential of IPMNs. 2016

Hanania, Alexander N / Bantis, Leonidas E / Feng, Ziding / Wang, Huamin / Tamm, Eric P / Katz, Matthew H / Maitra, Anirban / Koay, Eugene J. ·University of Texas Medical School, Houston, TX, USA. · Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. ·Oncotarget · Pubmed #27588410.

ABSTRACT: OBJECTIVE: To investigate using quantitative imaging to assess the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) in the pancreas. BACKGROUND: Pancreatic cysts are identified in over 2% of the population and a subset of these, including intraductal papillary mucinous neoplasms (IPMNs), represent pre-malignant lesions. Unfortunately, clinicians cannot accurately predict which of these lesions are likely to progress to pancreatic ductal adenocarcinoma (PDAC). METHODS: We investigated 360 imaging features within the domains of intensity, texture and shape using pancreatic protocol CT images in 53 patients diagnosed with IPMN (34 "high-grade" [HG] and 19 "low-grade" [LG]) who subsequently underwent surgical resection. We evaluated the performance of these features as well as the Fukuoka criteria for pancreatic cyst resection. RESULTS: In our cohort, the Fukuoka criteria had a false positive rate of 36%. We identified 14 imaging biomarkers within Gray-Level Co-Occurrence Matrix (GLCM) that predicted histopathological grade within cyst contours. The most predictive marker differentiated LG and HG lesions with an area under the curve (AUC) of .82 at a sensitivity of 85% and specificity of 68%. Using a cross-validated design, the best logistic regression yielded an AUC of 0.96 (σ = .05) at a sensitivity of 97% and specificity of 88%. Based on the principal component analysis, HG IPMNs demonstrated a pattern of separation from LG IPMNs. CONCLUSIONS: HG IPMNs appear to have distinct imaging properties. Further validation of these findings may address a major clinical need in this population by identifying those most likely to benefit from surgical resection.

18 Article Dual-energy CT of pancreatic adenocarcinoma: reproducibility of primary tumor measurements and assessment of tumor conspicuity and margin sharpness. 2016

Gupta, Shiva / Wagner-Bartak, Nicolaus / Jensen, Corey T / Hui, Anthony / Wei, Wei / Lertdilok, Patrick / Qayyum, Aliya / Tamm, Eric P. ·Department of Diagnostic Radiology, Unit 1473, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. sgupta6@mdanderson.org. · Department of Diagnostic Radiology, Unit 1473, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. · The Pennsylvania State University, 201 Old Main, University Park, PA, 16802, USA. · Department of Biostatistics, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77040-4008, USA. · Women's Radiology Associates, LLP, The Woman's Hospital of Texas, 7600 Fannin Street, Houston, TX, 77054, USA. ·Abdom Radiol (NY) · Pubmed #26956643.

ABSTRACT: PURPOSE: To determine the inter- and intra-reader agreement of size, conspicuity, and margin sharpness of pancreatic adenocarcinoma on monochromatic, polychromatic, and iodine map dual-energy CT (DECT) images. METHODS: Retrospective review of DECT images from 61 patients with untreated pancreatic adenocarcinoma was performed by three radiologists independently. Pancreatic parenchymal phase images were generated as 50 and 70 keV, 140 kVp quality control (QC), and iodine map images. These were analyzed in a blinded randomized order during four reading sessions separated by 5-7 days. For each image set, readers recorded the longest axial and perpendicular primary tumor dimensions, and qualitatively scored tumor conspicuity and edge sharpness on 5-point scales. Linear mixed model was used to estimate and compare tumor measurements, tumor conspicuity, and tumor edge sharpness scores between readers and image sets. Kappa statistics were used to determine inter-observer agreement for tumor conspicuity and edge sharpness. RESULTS: The range of tumor measures (mean of longest dimension ± standard deviation) was 3.18 ± 1.41 to 3.83 ± 1.57 cm. Reproducibility of tumor measurements was very high with mild variability (s (2) = 0.01-0.10) between readers for the different image sets. Inter-observer agreement values for tumor conspicuity (κ = 0.01-0.17) and edge sharpness (κ = 0.12-0.25) were low for all image sets, although two of three readers scored tumor conspicuity and edge sharpness higher on monochromatic and iodine map DECT images than on 140 kVp QC images (p < 0.05). CONCLUSIONS: Pancreatic adenocarcinoma measurements were highly reproducible on DECT images, and subjective reader preference trended toward monochromatic and iodine images rather than polychromatic images.

19 Article Quantitative and Qualitative Comparison of Single-Source Dual-Energy Computed Tomography and 120-kVp Computed Tomography for the Assessment of Pancreatic Ductal Adenocarcinoma. 2015

Bhosale, Priya / Le, Ott / Balachandran, Aprana / Fox, Patricia / Paulson, Eric / Tamm, Eric. ·From the Departments of *Diagnostic Radiology and †Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX. ·J Comput Assist Tomogr · Pubmed #26295192.

ABSTRACT: PURPOSE: The aim of this study was to compare contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) between pancreatic-phase dual-energy computed tomography (DECT) and 120-kVp CT for pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS: Seventy-eight patients underwent multiphasic pancreatic imaging protocols for PDA (40, DECT; 38, 120-kVp CT [control]). Using pancreatic phase, CNR and SNR for PDA were obtained for DECT at monochromatic energies 50 through 80 keV, iodine material density images, and 120-kVp images. Using a 5-point scale (1, excellent; 5, markedly limited), images were qualitatively assessed by 2 radiologists in consensus for PDA detection, extension, vascular involvement, and noise. Wilcoxon signed rank and 2-sample tests were used to compare the qualitative measures, CNR and SNR, for DECT and 120-kVp images. Bonferroni correction was applied. RESULTS: Iodine material density image had significantly higher CNR and SNR for PDA than any monochromatic energy images (P < 0.0001) and the 120-kVp images. Qualitatively, 70-keV images were rated highest in the categories of tumor extension and vascular invasion and were similar to 120-kVp images. CONCLUSIONS: Our results indicate that DECT improves PDA lesion conspicuity compared with routine 120-kVp CT, which may allow for better detection of PDA.

20 Article Analysis of free-form radiology dictations for completeness and clarity for pancreatic cancer staging. 2015

Marcal, Leonardo P / Fox, Patricia S / Evans, Douglas B / Fleming, Jason B / Varadhachary, Gauri R / Katz, Matthew H / Tamm, Eric P. ·Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. lemarcal@gmail.com. · Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. · Department of Surgery, The University of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA. · Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. · Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. · Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. ·Abdom Imaging · Pubmed #25906341.

ABSTRACT: PURPOSE: To assess the completeness and clarity of current free-form radiology reports for pancreatic cancer staging by evaluating them against the elements of the RSNA CT oncology primary pancreas mass dictation template. METHODS: This retrospective study was approved by our Institutional Review Board (IRB). 295 free-form computed tomography (CT) reports for baseline staging of pancreatic cancer (PC) generated between August 2008 and December 2010 were evaluated by one of two radiologists with expertise in pancreatic cancer imaging. Reports which indicated that metastatic disease was present were excluded. The completeness and clarity of the reports were analyzed against the elements of the RSNA CT pancreas mass dictation template. Fisher's exact tests were used to analyze differences by year and type of radiologist. RESULTS: Primary lesion location, size, and effect on bile duct (BD) were provided in 93.9% (277/295), 69.8% (206/295), and 67.5% (199/295) of reports, respectively. Standard terms to describe vascular involvement were used in 47.5% (140/295) of reports. In 20.3% (60/295), the resectability status could not be defined based on the report alone. In 36.9% (109/295) of reports, review of CT images was necessary to understand vascular involvement. Radiologists expert in pancreatic oncology had a higher proportion of reports using standardized terminology and reports in which vascular involvement was understood without revisiting the images. CONCLUSIONS: Free-form reports were more likely to use ambiguous terminology and/or require review of the actual images for understanding resectability status. The use of a standardized reporting template may improve the usefulness of pancreatic cancer staging reports.

21 Article Multidetector CT detection of peritoneal metastases: evaluation of sensitivity between standard 2.5 mm axial imaging and maximum-intensity-projection (MIP) reconstructions. 2015

Jensen, Corey T / Vicens-Rodriguez, Rafael A / Wagner-Bartak, Nicolaus A / Fox, Patricia S / Faria, Silvana C / Carrion, Ivan / Qayyum, Aliya / Tamm, Eric P. ·Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA. cjensen@mdanderson.org. · Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA. · Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. · University Hospital Joan XXIII (Tarragona), Avda. Jaume Balmes, XX, X-X, Vilanova i la Geltru Barcelona, 08800, Spain. ·Abdom Imaging · Pubmed #25666971.

ABSTRACT: OBJECTIVE: Our purpose was to evaluate the sensitivity of multidetector CT for the detection of peritoneal metastases between standard 2.5 mm axial imaging and maximum-intensity-projection (MIP) reconstructions. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study and waived the need to obtain patient consent. We retrospectively identified 36 patients with pancreatic adenocarcinoma and peritoneal metastatic disease who underwent a pancreatic protocol CT examination of the abdomen and pelvis between January 2012 and January 2014. Three independent radiologists reviewed a randomized combination of standard axial (2.5 mm reconstructed thickness, 2.5 mm interval) and axial MIP reconstructions (6, 3 mm interval) over two sessions. Each reader recorded metastasis location in PACS. Subsequent consensus review by two radiologists determined the final number and size of metastases. RESULTS: The reviewers found 328 peritoneal implants in 36 patients. After accounting for the size, location, and number of lesions as well as multiple readers, a generalized estimating equations model showed that the statistical combination of MIP with standard technique significantly increased the odds of correctly identifying a lesion (OR 2.16; 95% CI 1.86-2.51; p value < 0.0001) compared to standard technique alone. MIP reconstruction as a standalone technique was less sensitive compared to standard technique alone (OR 0.81; 95% CI 0.65-0.99; p value = 0.0468). When compared to standard axial imaging, evaluation via MIP reconstructions resulted in the identification of an additional 50 (15%), 45 (14%), and 55 (17%) lesions by Readers 1-3, respectively. CONCLUSION: The axial 6 mm MIP series is complimentary in the CT evaluation of peritoneal metastases. MIP reconstruction evaluation identified a significant number of additional lesions, but is not adequate as a standalone technique for peritoneal cavity assessment.

22 Article Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts. 2015

Rastegar, Neda / Matteoni-Athayde, Luciana G / Eng, John / Takahashi, Naoki / Tamm, Eric P / Mortele, Koenraad J / Syngal, Sapna / Margolis, Daniel / Lennon, Anne Marie / Wolfgang, Christopher L / Fishman, Elliot K / Hruban, Ralph H / Goggins, Michael / Canto, Marcia I / Kamel, Ihab R. ·Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States. · Mayo Clinic, United States. · MD Anderson Cancer Center, United States. · Beth Israel Deaconess Medical Center, United States. · Dana Farber Cancer Institute, United States. · University of California, Los Angeles, United States. · Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States. Electronic address: ikamel@jhmi.edu. ·Eur J Radiol · Pubmed #25619503.

ABSTRACT: PURPOSE: We investigated the incremental diagnostic yield of S-MRCP in a population with high prevalence of small pancreatic cysts. METHODS: Standard MRCP protocol was performed with and without secretin using 1.5 T units in subjects undergoing pancreatic screening because of a strong family history of pancreatic cancer as part of the multicenter Cancer of the Pancreas Screening-3 trial (CAPS 3). All studies were reviewed prospectively by two independent readers who recorded the presence and number of pancreatic cysts, the presence of visualized ductal communication before and after secretin, and the degree of confidence in the diagnoses. RESULT: Of 202 individuals enrolled (mean age 56 years, 46% males), 93 (46%) had pancreatic cysts detected by MRCP, and 64 of the 93 had pre-and post-secretin MRCP images available for comparison. Data from the 128 readings show that 6 (6/128=4.7%) had ductal communication visualized only on the secretin studies compared to pre-secretin studies (odds ratio 1.28, p=0.04). In addition, there was a statistically significant increase in confidence in reporting ductal communication after secretin compared to before secretin (p<0.0005). CONCLUSION: At 1.5 T MRI, the use of secretin can improve the visualization of ductal communication of cystic pancreatic lesions.

23 Article Intra-tumoral heterogeneity of gemcitabine delivery and mass transport in human pancreatic cancer. 2014

Koay, Eugene J / Baio, Flavio E / Ondari, Alexander / Truty, Mark J / Cristini, Vittorio / Thomas, Ryan M / Chen, Rong / Chatterjee, Deyali / Kang, Ya'an / Zhang, Joy / Court, Laurence / Bhosale, Priya R / Tamm, Eric P / Qayyum, Aliya / Crane, Christopher H / Javle, Milind / Katz, Matthew H / Gottumukkala, Vijaya N / Rozner, Marc A / Shen, Haifa / Lee, Jeffrey E / Wang, Huamin / Chen, Yuling / Plunkett, William / Abbruzzese, James L / Wolff, Robert A / Maitra, Anirban / Ferrari, Mauro / Varadhachary, Gauri R / Fleming, Jason B. ·Division of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA. ·Phys Biol · Pubmed #25427073.

ABSTRACT: There is substantial heterogeneity in the clinical behavior of pancreatic cancer and in its response to therapy. Some of this variation may be due to differences in delivery of cytotoxic therapies between patients and within individual tumors. Indeed, in 12 patients with resectable pancreatic cancer, we previously demonstrated wide inter-patient variability in the delivery of gemcitabine as well as in the mass transport properties of tumors as measured by computed tomography (CT) scans. However, the variability of drug delivery and transport properties within pancreatic tumors is currently unknown. Here, we analyzed regional measurements of gemcitabine DNA incorporation in the tumors of the same 12 patients to understand the degree of intra-tumoral heterogeneity of drug delivery. We also developed a volumetric segmentation approach to measure mass transport properties from the CT scans of these patients and tested inter-observer agreement with this new methodology. Our results demonstrate significant heterogeneity of gemcitabine delivery within individual pancreatic tumors and across the patient cohort, with gemcitabine DNA incorporation in the inner portion of the tumors ranging from 38 to 74% of the total. Similarly, the CT-derived mass transport properties of the tumors had a high degree of heterogeneity, ranging from minimal difference to almost 200% difference between inner and outer portions of the tumor. Our quantitative method to derive transport properties from CT scans demonstrated less than 5% difference in gemcitabine prediction at the average CT-derived transport value across observers. These data illustrate significant inter-patient and intra-tumoral heterogeneity in the delivery of gemcitabine, and highlight how this variability can be reproducibly accounted for using principles of mass transport. With further validation as a biophysical marker, transport properties of tumors may be useful in patient selection for therapy and prediction of therapeutic outcome.

24 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.

25 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.

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