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Pancreatic Neoplasms: HELP
Articles by Eric P. Tamm
Based on 45 articles published since 2008
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Between 2008 and 2019, E. Tamm wrote the following 45 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 Staging of pancreatic cancer: resectable, borderline resectable, and unresectable disease. 2018

Soloff, Erik V / Zaheer, Atif / Meier, Jeffrey / Zins, Marc / Tamm, Eric P. ·Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA. esoloff@uw.edu. · Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, USA. · Department of Radiology, University of Colorado Denver School of Medicine, Denver, USA. · Department of Radiology, Groupe Hospitalier Paris saint Joseph, Paris, France. · Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Houston, USA. ·Abdom Radiol (NY) · Pubmed #29198002.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is a relatively common malignancy that carries an overall poor prognosis, with five-year survival below 10%. Despite ongoing research, surgical resection remains the only potentially curative treatment. Therefore, accurate identification of those patients who would benefit from surgical resection is of paramount importance. High-quality imaging and image interpretation is central to this process. Radiology helps in the determination of whether patients are resectable, borderline resectable, or unresectable and guides treatment planning.

3 Review Imaging findings of recurrent pancreatic cancer following resection. 2018

Javadi, S / Karbasian, N / Bhosale, P / de Castro Faria, S / Le, O / Katz, M H / Koay, E J / Tamm, E P. ·Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St. Unit 1437, Houston, TX, 77030, USA. sanaz.javadi@mdanderson.org. · Department of Interventional Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA. · Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St. Unit 1437, Houston, TX, 77030, USA. · Department of Surgical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA. · Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA. ·Abdom Radiol (NY) · Pubmed #29198001.

ABSTRACT: Pancreatic cancer is a challenging malignancy to treat, largely due to aggressive regional involvement, early systemic dissemination, high recurrence rate, and subsequent low patient survival. Generally, 15-20% of newly diagnosed pancreatic cancers are candidates for possible curative resection. Eighty percent of these patients, however, will experience locoregional or distant recurrence in first 2 years. Although there is no strong evidence-based guideline for optimal surveillance after pancreatic cancer resection, careful comparison of surveillance follow-up multi-detector CT (MDCT) studies with a postoperative baseline MDCT examination aids detection of early recurrent pancreatic cancer. In this review article, we describe imaging findings suggestive of recurrent pancreatic cancer and review routine and alternative imaging options.

4 Review Genetics of pancreatic cancer and implications for therapy. 2018

Bhosale, Priya / Cox, Veronica / Faria, Silvana / Javadi, Sanaz / Viswanathan, Chitra / Koay, Eugene / Tamm, Eric. ·Department of Diagnostic Radiology, Unit 38, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. priya.bhosale@mdanderson.org. · Department of Diagnostic Radiology, Unit 38, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. · Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ·Abdom Radiol (NY) · Pubmed #29177925.

ABSTRACT: Pancreatic cancer is a highly lethal disease with a dismal 5-year prognosis. Knowledge of its genetics may help in identifying new methods for patient screening, and cancer treatment. In this review, we will describe the most common mutations responsible for the genesis of pancreatic cancer and their impact on screening, patterns of disease progression, and therapy.

5 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.

6 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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 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.

13 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 --

14 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.

15 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).

16 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.

17 Article First-Line Gemcitabine and Nab-Paclitaxel Chemotherapy for Localized Pancreatic Ductal Adenocarcinoma. 2019

Gulhati, Pat / Prakash, Laura / Katz, Matthew H G / Wang, Xuemei / Javle, Milind / Shroff, Rachna / Fogelman, David / Lee, Jeffrey E / Tzeng, Ching-Wei D / Lee, Jeffrey H / Weston, Brian / Tamm, Eric / Bhosale, Priya / Koay, Eugene J / Maitra, Anirban / Wang, Huamin / Wolff, Robert A / Varadhachary, Gauri R. ·Hematology/Oncology Fellowship Program, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 426, Houston, TX, 77030, USA. · Division of Internal Medicine, Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Pathology/Lab Medicine, Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 426, Houston, TX, 77030, USA. gvaradha@mdanderson.org. ·Ann Surg Oncol · Pubmed #30324485.

ABSTRACT: BACKGROUND: Preoperative chemotherapy provides early treatment of micro-metastases and guaranteed delivery of all components of multimodality therapy for localized pancreatic ductal adenocarcinoma (PDAC). For locally advanced (LA) PDAC, induction chemotherapy is the standard of care. This study evaluated the use of gemcitabine and nab-paclitaxel (Gem/nab-P) as first-line therapy for localized PDAC. METHODS: Clinicopathologic features, treatment, and outcomes were evaluated for 99 patients with localized PDAC. The patients were staged using previously published criteria as follows: potentially resectable (PR), borderline type A (BR-A) (anatomy amenable to vascular resection), BR-B (biology suspicious for metastatic disease including high CA19-9), BR-C (comorbidities requiring medical optimization), and LA. RESULTS: The 99 patients (PR/BR/LA: 45/14/40) were treated with Gem/nab-P. Clinical staging showed that 20 patients had PR or BR-A disease, whereas 39 patients had BR-B or BR-C disease. The BR-B+C cases included one or more of the following: age of 80 years or older (13%), Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 or more (13%), moderate to severe comorbidities (55%), CA19-9 of 1000 or higher (28%), and suspicion for metastases (21%). The majority of the patients received biweekly Gem/nab-P dosing, which was well tolerated. Pancreatectomy was performed for 12 (60%) of 20 patients with PR+BR-A, 2 (5%) of 39 patients with BR-B+C, and 1 (3%) of 40 patients with LA disease. During a median follow-up period of 26 months, the median overall survival (OS) period was 18 months (95% confidence interval [CI], 15.6-20.5 months) for all the patients, 17 months (95% CI, 14.6-19.5 months) for the unresected patients, and not reached for the resected patients (p = 0.028 for resected vs unresected patients). CONCLUSIONS: A significant number of patients with radiographically resectable PDAC albeit aggressive biology (BR-B), medically inoperable conditions (BR-C), or both received biweekly first-line Gem/nab-P. The resection rates were lower for the BR-B/BR-C patients than for the PR/BR-A patients (hazard ratio [HR], 0.43; 95% CI, 0.19-1.00; p = 0.05).

18 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.

19 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.

20 Article Multi-institutional survey on imaging practice patterns in pancreatic ductal adenocarcinoma. 2018

Kambadakone, Avinash R / Zaheer, Atif / Le, Ott / Bhosale, Priya / Meier, Jeffrey / Guimaraes, Alexander R / Shah, Zarine / Hough, David M / Mannelli, Lorenzo / Soloff, Erik / Friedman, Arnold / Tamm, Eric. ·Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA. akambadakone@mgh.harvard.edu. · Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA. · Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA. · Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA. · Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. · Department of Radiology, Mayo Clinic, Rochester, MN, USA. · Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. · Department of Radiology, University of Washington Medical Center, Seattle, WA, USA. · Veteran Affairs, University of California, San Francisco, Clovis, CA, USA. ·Abdom Radiol (NY) · Pubmed #29277858.

ABSTRACT: PURPOSE: To study the practice patterns for performance and interpretation of CT/MRI imaging studies in patients with pancreatic ductal adenocarcinoma (PDAC) at multiple institutions using a survey-based assessment. METHODS: In this study, abdominal radiologists/body imagers on the Society of Abdominal Radiology disease-focused panel for PDAC and from multiple institutions participated in an online survey. The survey was designed to investigate the imaging and reporting practice patterns for PDAC. The survey questionnaire addressed the experience of referring providers, choice of imaging modality for diagnosis and follow-up of PDAC, structured imaging templates utilization for PDAC, and experiences with the use of structured reports. RESULTS: The response rate was 89.6% (43/48), with majority of the respondents working in a teaching hospital or academic research center (95.4%). While 86% of radiologists reported use of structured reporting templates in their practice, only 60.5% used standardized templates specific to PDAC. This lower percentage was despite most of them (77%) being aware of existence of PDAC-specific templates and recognizing their benefits, such as preference by referring providers (83%), improved uniformity (100%), and higher accuracy of reports (76.2%). The common impediments to the use of PDAC-specific templates were interference with efficient workflow (67.5%), lack of interest (52.5%), and complexity of existing templates (47.5%). With regards to imaging practice, 92.7% (n = 40/43) of respondents reported performing dynamic multiphasic pancreatic protocol CT for evaluation of patients with initial suspicion or staging of PDAC. CONCLUSION: Structured reporting templates for PDAC are not universally utilized in subspecialty abdominal/body imaging practices due to concerns of interference with efficient workflow and complexity of templates. Multiphasic pancreatic protocol CT is most frequently performed for evaluation of PDAC.

21 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.

22 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.

23 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.

24 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.

25 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.

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