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Pancreatic Neoplasms: HELP
Articles by Atif Zaheer
Based on 18 articles published since 2010
(Why 18 articles?)
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Between 2010 and 2020, A. Zaheer wrote the following 18 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 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.

2 Review Imaging of post-operative pancreas and complications after pancreatic adenocarcinoma resection. 2018

Hafezi-Nejad, Nima / Fishman, Elliot K / Zaheer, Atif. ·Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. azaheer1@jhmi.edu. · Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. azaheer1@jhmi.edu. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Hal B164, Baltimore, MD, 21287, USA. azaheer1@jhmi.edu. ·Abdom Radiol (NY) · Pubmed #29094173.

ABSTRACT: Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc. The utility of dual-phase CT with multiplanar reconstruction and 3D rendering is increasingly recognized as a tool for the assessment of complications associated with vascular resection and reconstruction such as hemorrhage, pseudoaneurysm, vascular thrombosis, and ischemia. Prompt recognition of the complications and distinction from benign post-operative findings such as hepatic steatosis and mesenteric fat necrosis on imaging plays a key role in helping decrease the morbidity and mortality associated with surgery. We discuss, with case examples, some of such common and uncommon findings on imaging to familiarize the abdominal radiologists evaluating post-operative imaging in both acute and chronic post-operative settings.

3 Review Rare pancreatic tumors. 2018

Steinman, Jonathan / Zaheer, Atif / Kluger, Michael D / Remotti, Helen / Hecht, Elizabeth M. ·Columbia University Medical Center, 622 W. 168th Street, PB 1-301, New York, NY, 10032, USA. · Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA. · Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA. · Columbia University Medical Center, 630 West 168th Street, VC 14-215, New York, NY, 10032, USA. · Columbia University Medical Center, 622 W. 168th Street, PB 1-301, New York, NY, 10032, USA. eh2560@cumc.columbia.edu. ·Abdom Radiol (NY) · Pubmed #29022085.

ABSTRACT: In this review, we will focus on rare pancreatic tumors. Most of these tumors do not have distinct characteristic appearances so the key to diagnosis requires a combination of imaging appearance, laboratory data, patient demographics, and associated medical syndromes in order to narrow the differential diagnosis. Nonetheless, imaging plays a vital role in narrowing the differential and guiding management. While there are many variant pathologic entities that cannot be encompassed by a single review, we aim to illustrate the imaging appearance of less common pancreatic tumors highlighting key distinctive diagnostic characteristics and discuss the implications for management. While there is overlap in the imaging appearances of many of these entities, for educational purposes, lesions will be categorized into solid (hypoenhancing and hyperenhancing), cystic lesions, mesenchymal neoplasms, and neoplasms seen in younger patients (< 40 years).

4 Review Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT: Different Classification Systems and Their Influence on Treatment Planning. 2017

Zaky, Ahmed M / Wolfgang, Christopher L / Weiss, Matthew J / Javed, Ammar A / Fishman, Elliot K / Zaheer, Atif. ·From the Department of Surgery (A.M.Z., C.L.W., M.J.W., A.A.J.), the Russell H. Morgan Department of Radiology and Radiological Science (E.K.F., A.Z.), and the Pancreatitis Center (A.Z.), Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 3235 A, Baltimore, MD 21231. ·Radiographics · Pubmed #27885893.

ABSTRACT: Treatment of pancreatic ductal adenocarcinoma (PDAC) remains a challenge, given its propensity for early systemic spread and growth into the adjacent vital vascular structures. With the advent of newer surgical techniques and chemoradiation therapies, multidetector computed tomography (CT) plays a crucial role in the identification of patients with borderline resectable disease who may benefit from such treatments. Stage III PDAC is divided into two categories-locally advanced, defined by arterial encasement or nonreconstructible portovenous axis involvement; and borderline resectable, defined by limited arterial involvement and/or reconstructible portovenous involvement. A consensus definition for stage III borderline resectable PDAC has been proposed by the Americas Hepato-Pancreato-Biliary Association, the Society of Surgical Oncology, and the Society for Surgery of the Alimentary Tract and has gained widespread use. Evaluation of borderline resectable disease involves the identification of the circumferential and longitudinal relationship of the tumor with its neighboring vessels, markers of vascular invasion, and aberrant anatomic structures that alter the surgical approach. Furthermore, the use of template-based radiology reporting may increase the objectivity of the evaluation and mandate the provision of all of the key descriptors required for a comprehensive evaluation of the disease. In this review, the staging of PDAC at multidetector CT is described, with reference to the evaluation of the tumor-vessel interface as it guides treatment planning, along with a discussion of the key descriptors of PDAC at multidetector CT and their importance. Examples are provided of the imaging findings of borderline resectable disease and different surgical approaches, along with a discussion on the importance of standardized terminology and template-based reporting.

5 Review Pearls and pitfalls of imaging metastatic disease from pancreatic adenocarcinoma: a systematic review. 2015

Zaheer, Atif / Wadhwa, Vibhor / Oh, Joseph / Fishman, Elliot K. ·The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231; Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD 21231. Electronic address: azaheer1@jhmi.edu. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231. ·Clin Imaging · Pubmed #25981735.

ABSTRACT: Pancreatic adenocarcinoma is a systemic disease due to the presence of metastatic disease at the time of diagnosis and local recurrence as well as distant metastatic disease after treatment in a majority of patients. Recognition of these metastatic sites may help in accurate staging and assessment of therapeutic response. The authors discuss and illustrate imaging findings of metastatic disease from pancreatic adenocarcinoma in different organ systems with emphasis on entities that can mimic metastatic pancreatic cancer.

6 Review Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. 2013

Zaheer, Atif / Pokharel, Sajal S / Wolfgang, Christopher / Fishman, Elliot K / Horton, Karen M. ·Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA. azaheer1@jhmi.edu ·Abdom Imaging · Pubmed #22534872.

ABSTRACT: PURPOSE: To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management. METHODS: This article reviews pathophysiology, prevalence, significance, and recommendations for management of the various pancreatic cystic lesions. Illustrative cases are demonstrated. RESULTS: Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potential should undergo resection. CONCLUSIONS: A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management.

7 Clinical Trial Role of a multidisciplinary clinic in the management of patients with pancreatic cysts: a single-center cohort study. 2014

Lennon, Anne Marie / Manos, Lindsey L / Hruban, Ralph H / Ali, Syed Z / Fishman, Elliot K / Kamel, Ihab R / Raman, Siva P / Zaheer, Atif / Hutfless, Susan / Salamone, Ashley / Kiswani, Vandhana / Ahuja, Nita / Makary, Martin A / Weiss, Matthew J / Hirose, Kenzo / Goggins, Michael / Wolfgang, Christopher L. ·Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD. · Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD. · Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD. · Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, MD. · Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD. ·Ann Surg Oncol · Pubmed #24806116.

ABSTRACT: BACKGROUND: Incidental pancreatic cysts are common, a small number of which are premalignant or malignant. Multidisciplinary care has been shown to alter management and improve outcomes in many types of cancers, but its role has not been examined in patients with pancreatic cysts. We assessed the effect of a multidisciplinary pancreatic cyst clinic (MPCC) on the diagnosis and management of patients with pancreatic cysts. METHODS: The referring institution and MPCC diagnosis and management plan were recorded. Patient were placed into one of five categories-no, low, intermediate, or high risk of malignancy within the cyst, and malignant cyst-on the basis of their diagnosis. Patients were assigned one of four management options: surveillance, surgical resection, further evaluation, or discharge with no further follow-up required. The MPCC was deemed to have altered patient care if the patient was assigned a different risk or management category after the MPCC review. RESULTS: Referring institution records were available for 262 patients (198 women; mean age 62.7 years), with data on risk category available in 138 patients and management category in 225. The most common diagnosis was branch duct intraductal papillary mucinous neoplasm. MPCC review altered the risk category in 11 (8.0%) of 138 patients. The management category was altered in 68 (30.2%) of 225 patients. Management was increased in 52 patients, including 22 patients who were recommended surgical resection. Management was decreased in 16 patients, including 10 who had their recommendation changed from surgery to surveillance. CONCLUSIONS: MPCC is helpful and alters the management over 30% of patients.

8 Article Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer. 2019

Canto, Marcia Irene / Kerdsirichairat, Tossapol / Yeo, Charles J / Hruban, Ralph H / Shin, Eun Ji / Almario, Jose Alejandro / Blackford, Amanda / Ford, Madeline / Klein, Alison P / Javed, Ammar A / Lennon, Anne Marie / Zaheer, Atif / Kamel, Ihab R / Fishman, Elliot K / Burkhart, Richard / He, Jin / Makary, Martin / Weiss, Matthew J / Schulick, Richard D / Goggins, Michael G / Wolfgang, Christopher L. ·Division of Gastroenterology and Hepatology, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Blalock 407, Baltimore, MD, 21287, USA. mcanto1@jhmi.edu. · Division of Gastroenterology and Hepatology, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Blalock 407, Baltimore, MD, 21287, USA. · Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA. · Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA. ·J Gastrointest Surg · Pubmed #31197699.

ABSTRACT: BACKGROUND: Screening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. METHODS: Asymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. RESULTS: Among 354 HRI, 48 (13.6%) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5-11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5-7.6). Postoperative complications developed in 17 HRI (35%); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20% of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40%), with 90% 1-year survival and 60% 5-year survival, respectively. CONCLUSIONS: Screening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. CLINICAL TRIAL REGISTRATION NUMBER: NCT2000089.

9 Article Clinical and Radiographic Gastrointestinal Abnormalities in McCune-Albright Syndrome. 2018

Robinson, Cemre / Estrada, Andrea / Zaheer, Atif / Singh, Vikesh K / Wolfgang, Christopher L / Goggins, Michael G / Hruban, Ralph H / Wood, Laura D / Noë, Michaël / Montgomery, Elizabeth A / Guthrie, Lori C / Lennon, Anne Marie / Boyce, Alison M / Collins, Michael T. ·Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland. · Program in Developmental Endocrinology and Genetics, The Eunice Kennedy Shriver Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. · Department of Pediatrics, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut. · Division of Endocrinology and Diabetes, Children's National Health System, Washington, DC. · Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland. · Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland. · Departments of Surgery, Radiology, and Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland. · Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. ·J Clin Endocrinol Metab · Pubmed #30124968.

ABSTRACT: Context: McCune-Albright syndrome (MAS) is a rare disorder characterized by fibrous dysplasia of bone, café-au-lait macules, and hyperfunctioning endocrinopathies. It arises from somatic gain-of-function mutations in GNAS, which encodes the cAMP-regulating protein Gαs. Somatic GNAS mutations have been reported in intraductal papillary mucinous neoplasms (IPMNs) and various gastrointestinal (GI) tumors. The clinical spectrum and prevalence of MAS-associated GI disease is not well established. Objective: Define the spectrum and prevalence of MAS-associated GI pathology in a large cohort of patients with MAS. Design: Cross-sectional study. Setting: National Institutes of Health Clinical Center and The Johns Hopkins Hospital. Methods: Fifty-four consecutive subjects with MAS (28 males; age range, 7 to 67 years) were screened with magnetic resonance cholangiopancreatography (MRCP). Results: Thirty of 54 subjects (56%) had radiographic GI abnormalities. Twenty-five (46%) of the screened subjects had IPMNs (mean age of 35.1 years). Fourteen of the 25 had IPMNs alone, and 11 had IPMNs and abnormal hepatobiliary imaging. The 30 patients with MAS-associated GI pathology had a higher prevalence of acute pancreatitis, diabetes mellitus, and skeletal disease burden of fibrous dysplasia than patients without GI disease. Conclusions: A broad spectrum of GI pathology is associated with MAS. IPMNs are common and occur at a younger age than in the general population. Patients with MAS should be considered for screening with a focused GI history and baseline MRCP. Further determination of the natural history and malignant potential of IPMNs in MAS is needed.

10 Article Management of pancreatic intraductal papillary mucinous neoplasm. 2018

Hoshi, Hisakazu / Zaheer, Atif / El Abiad, Rami G / Maxwell, Jessica E / Chu, Linda C / Gerke, Henning / Chan, Carlos H. ·Division of Endocrine and Surgical Oncology, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address: hisakazu-hoshi@uiowa.edu. · Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD. · Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA. · Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. · Division of Endocrine and Surgical Oncology, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. ·Curr Probl Surg · Pubmed #29753366.

ABSTRACT: -- No abstract --

11 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.

12 Article Neutrophil-to-lymphocyte Ratio is a Predictive Marker for Invasive Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas. 2017

Gemenetzis, Georgios / Bagante, Fabio / Griffin, James F / Rezaee, Neda / Javed, Ammar A / Manos, Lindsey L / Lennon, Anne M / Wood, Laura D / Hruban, Ralph H / Zheng, Lei / Zaheer, Atif / Fishman, Elliot K / Ahuja, Nita / Cameron, John L / Weiss, Matthew J / He, Jin / Wolfgang, Christopher L. ·*Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD †Department of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD ‡Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD §Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD ¶Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD. ·Ann Surg · Pubmed #27631774.

ABSTRACT: OBJECTIVE: To evaluate the correlation between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values, and the presence of invasive carcinoma in patients with intraductal papillary mucinous neoplasm (IPMN). BACKGROUND: NLR and (PLR) are inflammatory markers that have been associated with overall survival in patients with invasive malignancies, including pancreatic cancer. METHODS: We retrospectively reviewed 272 patients who underwent surgical resection for histologically confirmed IPMN from January 1997 to July 2015. NLR and PLR were calculated and coevaluated with additional demographic, clinical, and imaging data for possible correlation with IPMN-associated carcinoma in the form of a predictive nomogram. RESULTS: NLR and PLR were significantly elevated in patients with IPMN-associated invasive carcinoma (P < 0.001). In the multivariate analysis, NLR value higher than 4 (P < 0.001), IPMN cyst of size more than 3 cm (P < 0.001), presence of enhanced solid component (P = 0.014), main pancreatic duct dilatation of more than 5 mm (P < 0.001), and jaundice (P < 0.001) were statistically significant variables. The developed statistical model has a c-index of 0.895. Implementation of the statistically significant variables in a predictive nomogram provided a reliable point system for estimating the presence of IPMN-associated invasive carcinoma. CONCLUSIONS: NLR is an independent predictive marker for the presence of IPMN-associated invasive carcinoma. Further prospective studies are needed to assess the predictive ability of NLR and how it can be applied in the clinical setting.

13 Article A novel approach for selecting combination clinical markers of pathology applied to a large retrospective cohort of surgically resected pancreatic cysts. 2017

Masica, David L / Dal Molin, Marco / Wolfgang, Christopher L / Tomita, Tyler / Ostovaneh, Mohammad R / Blackford, Amanda / Moran, Robert A / Law, Joanna K / Barkley, Thomas / Goggins, Michael / Irene Canto, Marcia / Pittman, Meredith / Eshleman, James R / Ali, Syed Z / Fishman, Elliot K / Kamel, Ihab R / Raman, Siva P / Zaheer, Atif / Ahuja, Nita / Makary, Martin A / Weiss, Matthew J / Hirose, Kenzo / Cameron, John L / Rezaee, Neda / He, Jin / Joon Ahn, Young / Wu, Wenchuan / Wang, Yuxuan / Springer, Simeon / Diaz, Luis L / Papadopoulos, Nickolas / Hruban, Ralph H / Kinzler, Kenneth W / Vogelstein, Bert / Karchin, Rachel / Lennon, Anne Marie. ·*Drs Masica and Dal Molin contributed equally as first authors. · Department of Biomedical Engineering and the Institute for Computational Medicine, The Johns Hopkins University, Baltimore, Maryland. · Departments of the Sol Goldman Pancreatic Cancer Research Center. · Departments of Pathology. · Departments of Surgery. · Departments of Oncology. · Departments of Medicine. · Departments of Biostatistics and Bioinformatics. · Departments of the Ludwig Center and Howard Hughes Medical Institute at the Sidney Kimmel Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland. · Departments of Radiology. · †Drs Lennon and Karchin contributed equally as senior authors amlennon@jhmi.edu karchin@jhu.edu. ·J Am Med Inform Assoc · Pubmed #27330075.

ABSTRACT: OBJECTIVE: Our objective was to develop an approach for selecting combinatorial markers of pathology from diverse clinical data types. We demonstrate this approach on the problem of pancreatic cyst classification. MATERIALS AND METHODS: We analyzed 1026 patients with surgically resected pancreatic cysts, comprising 584 intraductal papillary mucinous neoplasms, 332 serous cystadenomas, 78 mucinous cystic neoplasms, and 42 solid-pseudopapillary neoplasms. To derive optimal markers for cyst classification from the preoperative clinical and radiological data, we developed a statistical approach for combining any number of categorical, dichotomous, or continuous-valued clinical parameters into individual predictors of pathology. The approach is unbiased and statistically rigorous. Millions of feature combinations were tested using 10-fold cross-validation, and the most informative features were validated in an independent cohort of 130 patients with surgically resected pancreatic cysts. RESULTS: We identified combinatorial clinical markers that classified serous cystadenomas with 95% sensitivity and 83% specificity; solid-pseudopapillary neoplasms with 89% sensitivity and 86% specificity; mucinous cystic neoplasms with 91% sensitivity and 83% specificity; and intraductal papillary mucinous neoplasms with 94% sensitivity and 90% specificity. No individual features were as accurate as the combination markers. We further validated these combinatorial markers on an independent cohort of 130 pancreatic cysts, and achieved high and well-balanced accuracies. Overall sensitivity and specificity for identifying patients requiring surgical resection was 84% and 81%, respectively. CONCLUSIONS: Our approach identified combinatorial markers for pancreatic cyst classification that had improved performance relative to the individual features they comprise. In principle, this approach can be applied to any clinical dataset comprising dichotomous, categorical, and continuous-valued parameters.

14 Article Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). 2016

Jais, B / Rebours, V / Malleo, G / Salvia, R / Fontana, M / Maggino, L / Bassi, C / Manfredi, R / Moran, R / Lennon, A M / Zaheer, A / Wolfgang, C / Hruban, R / Marchegiani, G / Fernández Del Castillo, C / Brugge, W / Ha, Y / Kim, M H / Oh, D / Hirai, I / Kimura, W / Jang, J Y / Kim, S W / Jung, W / Kang, H / Song, S Y / Kang, C M / Lee, W J / Crippa, S / Falconi, M / Gomatos, I / Neoptolemos, J / Milanetto, A C / Sperti, C / Ricci, C / Casadei, R / Bissolati, M / Balzano, G / Frigerio, I / Girelli, R / Delhaye, M / Bernier, B / Wang, H / Jang, K T / Song, D H / Huggett, M T / Oppong, K W / Pererva, L / Kopchak, K V / Del Chiaro, M / Segersvard, R / Lee, L S / Conwell, D / Osvaldt, A / Campos, V / Aguero Garcete, G / Napoleon, B / Matsumoto, I / Shinzeki, M / Bolado, F / Fernandez, J M Urman / Keane, M G / Pereira, S P / Acuna, I Araujo / Vaquero, E C / Angiolini, M R / Zerbi, A / Tang, J / Leong, R W / Faccinetto, A / Morana, G / Petrone, M C / Arcidiacono, P G / Moon, J H / Choi, H J / Gill, R S / Pavey, D / Ouaïssi, M / Sastre, B / Spandre, M / De Angelis, C G / Rios-Vives, M A / Concepcion-Martin, M / Ikeura, T / Okazaki, K / Frulloni, L / Messina, O / Lévy, P. ·Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France. · The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy. · Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. · First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan. · Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. · Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. · Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea. · Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy. · NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. · Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy. · Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. · Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. · Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy. · Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. · Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China. · Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea. · Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK. · National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine. · Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. · Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA. · Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. · Hôpital Privé Mermoz, Gastroentérologie, Lyon, France. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Gastroenterology Department, Hospital de Navarra, Pamplona, Spain. · Department of Gastroenterology and Hepatology, University College Hospital, London, UK. · Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain. · Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy. · Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia. · Radiological Department, General Hospital Cá Foncello, Treviso, Italy. · Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy. · Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea. · Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia. · Department of Digestive Surgery, Timone Hospital, Marseille, France. · Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy. · Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. · The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan. · Department of Medicine, Pancreas Center, University of Verona, Verona, Italy. ·Gut · Pubmed #26045140.

ABSTRACT: OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER: IRB 00006477.

15 Article Liver transplant patients have a risk of progression similar to that of sporadic patients with branch duct intraductal papillary mucinous neoplasms. 2014

Lennon, Anne Marie / Victor, David / Zaheer, Atif / Ostovaneh, Mohammad Reza / Jeh, Jessica / Law, Joanna K / Rezaee, Neda / Molin, Marco Dal / Ahn, Young Joon / Wu, Wenchuan / Khashab, Mouen A / Girotra, Mohit / Ahuja, Nita / Makary, Martin A / Weiss, Matthew J / Hirose, Kenzo / Goggins, Michael / Hruban, Ralph H / Cameron, Andrew / Wolfgang, Christopher L / Singh, Vikesh K / Gurakar, Ahmet. ·Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD; Division of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD. ·Liver Transpl · Pubmed #25155689.

ABSTRACT: Intraductal papillary mucinous neoplasms (IPMNs) have malignant potential and can progress from low- to high-grade dysplasia to invasive adenocarcinoma. The management of patients with IPMNs is dependent on their risk of malignant progression, with surgical resection recommended for patients with branch-duct IPMN (BD-IPMN) who develop high-risk features. There is increasing evidence that liver transplant (LT) patients are at increased risk of extrahepatic malignancy. However, there are few data regarding the risk of progression of BD-IPMNs in LT recipients. The aim of this study was to determine whether LT recipients with BD-IPMNs are at higher risk of developing high-risk features than patients with BD-IPMNs who did not receive a transplant. Consecutive patients who underwent an LT with BD-IPMNs were included. Patients with BD-IPMNs with no history of immunosuppression were used as controls. Progression of the BD-IPMNs was defined as development of a high-risk feature (jaundice, dilated main pancreatic duct, mural nodule, cytology suspicious or diagnostic for malignancy, cyst diameter ≥3 cm). Twenty-three LT patients with BD-IPMN were compared with 274 control patients. The median length of follow-up was 53.7 and 24.0 months in LT and control groups, respectively. Four (17.4%) LT patients and 45 (16.4%) controls developed high-risk features (P = 0.99). In multivariate analysis, progression of BD-IPMNs was associated with age at diagnosis but not with LT. There was no statistically significant difference in the risk of developing high-risk features between the LT and the control groups.

16 Article Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. 2014

Coquia, Stephanie F / Kawamoto, Satomi / Zaheer, Atif / Bleich, Karen B / Blackford, Amanda L / Hruban, Ralph H / Fishman, Elliot K. ·From the *Department of Radiology, †Division of Biostatistics and Bioinformatics, Sidney Kimmel Cancer Center, and ‡Department of Pathology, the Sol Goldman Pancreatic Center Research Center, Johns Hopkins Hospital, Baltimore, MD. ·J Comput Assist Tomogr · Pubmed #24979264.

ABSTRACT: OBJECTIVE: The aim of this study was to evaluate the ability of computed tomography (CT) in differentiating between intrapancreatic accessory spleen (IPAS) from pancreatic neuroendocrine tumor (PanNET). METHODS: Eight IPASs and 12 PanNETs in the pancreatic tail were retrospectively evaluated by 2 radiologists. Readers assigned a diagnosis to each examination and evaluated for the presence or absence of 9 CT findings that may aid in the diagnosis. RESULTS: Reader 1 had a sensitivity of 0.83 and a specificity of 1; reader 2 had a sensitivity of 0.78 and a specificity of 0.86. Three of the 9 CT findings were found to be statistically significant in IPASs: the lesion present along the pancreatic dorsal surface, the lesion demonstrating the same enhancement as the spleen on venous phase, and heterogeneous enhancement during arterial phase. CONCLUSIONS: CT can be used to differentiate between IPAS and PanNET with good specificity and sensitivity. The IPAS mirrors the spleen's enhancement and is usually located along the dorsal surface of the pancreas.

17 Article Differentiating autoimmune pancreatitis from pancreatic adenocarcinoma using dual-phase computed tomography. 2014

Zaheer, Atif / Singh, Vikesh K / Akshintala, Venkata S / Kawamoto, Satomi / Tsai, Salina D / Gage, Kenneth L / Fishman, Elliot K. ·From the *The Russell H. Morgan Department of Radiology and Radiological Science, †Pancreatitis Center, and ‡Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD. ·J Comput Assist Tomogr · Pubmed #24424563.

ABSTRACT: OBJECTIVE: This article aimed to study features on dual-phase computed tomography (CT) that help differentiate autoimmune pancreatitis (AIP) from pancreatic adenocarcinoma (PA). METHODS: The CTs of 32 patients with AIP were matched with equal number of PA and were independently evaluated by 3 radiologists who assigned a diagnosis of AIP, PA, or unsure. Interobserver agreement between radiologists was evaluated using κ statistics. RESULTS: The mean accuracies for diagnosing AIP and PA were 68% and 83%, respectively. There was moderate agreement between radiologists (κ, 0.58; P < 0.0001). The most common findings for AIP were common bile duct (CBD) stricture (63%), bile duct wall hyperenhancement (47%), and diffuse parenchymal enlargement (41%). The most common findings for PA were focal mass (78%; κ, 0.58; P < 0.0001) and pancreatic ductal dilatation (69%; κ, 0.7; P < 0.0001). Findings helpful for diagnosing AIP were diffuse enlargement, parenchymal atrophy as well as absence of pancreatic duct dilatation and focal mass. Findings helpful for diagnosing PA were focal mass and pancreatic ductal dilatation. Misdiagnosis of PA in patients with AIP was due to focal mass, pancreatic duct dilatation, and pancreatic atrophy, whereas misdiagnosis of AIP in patients with PA was due to absence of atrophy, presence of diffuse enlargement, and peripancreatic halo. CONCLUSIONS: Diffuse enlargement, hypoenhancement, and characteristic peripancreatic halo are strong indicators for a diagnosis of AIP. Radiologists demonstrated moderate agreement in distinguishing AIP from PA on the basis of CT imaging.

18 Minor Metastatic Pancreatic Adenocarcinoma in a Patient With Chronic Calcific Pancreatitis and a Heterozygous SPINK1 c.194+2T>C Mutation. 2018

Boortalary, Tina / Jalaly, Niloofar Y / Moran, Robert A / Makary, Martin A / Walsh, Christi / Lennon, Anne Marie / Zaheer, Atif / Singh, Vikesh K. ·Division of Gastroenterology Department of Medicine Johns Hopkins Medical Institutions Baltimore, MD Division of Surgical Oncology Department of Surgery Johns Hopkins Medical Institutions Baltimore, MD Division of Gastroenterology Department of Medicine Johns Hopkins Medical Institutions Baltimore, MD Division of Abdominal Imaging Department of Radiology Johns Hopkins Medical Institutions Baltimore, MD Division of Gastroenterology Department of Medicine Johns Hopkins Medical Institutions Baltimore, MD vsingh1@jhmi.edu. ·Pancreas · Pubmed #29521951.

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