National Cancer Institute®
Last Modified: November 21, 2001
UI - 20452441
AU - Hirshberg B; Livi A; Bartlett DL; Libutti SK; Alexander HR; Doppman JL;
TI - Skarulis MC; Gorden P Forty-eight-hour fast: the diagnostic test for insulinoma.
SO - J Clin Endocrinol Metab 2000 Sep;85(9):3222-6
AD - Division of Intramural Research, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Insulinoma causes fasting hypoglycemia due to inappropriate insulin secretion. Its diagnosis is based on demonstrating Whipple's triad during a supervised 72-h fast. For 75 yr, the 72-h fast has been the cornerstone for the diagnosis; however, it has never been critically assessed using newer assays for insulin, C peptide, and proinsulin. Thus, the aim of the current study is to assess the need for a full 72-h fast for the diagnosis of insulinoma. Patients with suspected hypoglycemia with documented glucose concentrations below 45 mg/dL were admitted to the NIH. Data obtained during the supervised fast of patients with pathologically proven insulinoma over a 30-yr period (1970-2000) were reviewed. We identified 127 patients with insulinoma. The average age of patients was 42.7 +/- 15.9 yr, with a predominance of females (62%). 107 patients had a benign tumor, 20 had malignant insulinoma, and 15 patients had multiple endocrine neoplasia type 1. The fast was terminated due to hypoglycemia in 44 patients (42.5%) by 12 h, 85 patients (66.9%) by 24 h, and 120 (94.5%) by 48 h. Seven patients fasted beyond 48 h despite subtle neuroglycopenic symptoms and glucose and insulin concentrations diagnostic of insulinoma. Immunoreactive proinsulin was elevated at the beginning of the fast in 90% of 42 patients. Proinsulin in noninsulinoma, in contrast to insulinoma, patients is usually suppressible; therefore, samples taken in the suppressed state have the greatest diagnostic value. We conclude that with the current available insulin and proinsulin assays, the diagnosis of insulinoma can be made within 48 h. Thus, the 48-h fast should replace the 72-h fast in textbooks and hospital protocols as the new diagnostic standard.
UI - 21445653
AU - Vogel I; Kalthoff H
TI - Disseminated tumour cells. Their detection and significance for prognosis of gastrointestinal and pancreatic carcinomas.
SO - Virchows Arch 2001 Aug;439(2):109-17
AD - Department of General and Thoracic Surgery, University of Kiel, Germany. email@example.com
Metastatic spread is a major factor in the prognosis of cancer patients. Early detection and eradication of circulating tumour cells prior to the development of metastases could help to improve the outcome of patients after tumour resection. Disseminated tumour cells have been detected in different compartments of the body using cytological and immunostaining methods and, more recently, using different molecular biological techniques. The most frequently studied body compartments are the bone marrow, peritoneal cavity, blood and lymph nodes, but other body fluids such as urine, bile, pancreatic juice and sputum have also been analysed. At all of these sites, tumour cells have been detected. However, the specificity and sensitivity of the methods and their prognostic impact are still being debated. This review discusses the accuracy of the detection methods and the prognostic value of detecting disseminated tumour cells in the bone marrow, blood and peritoneal lavage of patients with colorectal, gastric and pancreatic carcinomas.
UI - 20581516
AU - Ji BT; Silverman DT; Stewart PA; Blair A; Swanson GM; Baris D; Greenberg
TI - RS; Hayes RB; Brown LM; Lillemoe KD; Schoenberg JB; Pottern LM; Schwartz AG; Hoover RN Occupational exposure to pesticides and pancreatic cancer.
SO - Am J Ind Med 2001 Jan;39(1):92-9
AD - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. firstname.lastname@example.org
BACKGROUND: An increased risk of exposure to pesticides for pancreatic cancer has been suggested in a number of epidemiologic studies. METHODS: Cases (N = 484), aged 30-79 years, were diagnosed in 1986-1989. Controls (N = 2,095) were a random sample of the general population. Information on usual occupation and potential confounding factors was obtained. A job-exposure matrix (JEM) approach was used to estimate the level of occupational exposure to pesticides. RESULTS: A significant trend in risk with increasing exposure level of pesticides was observed, with ORs of 1.3 and 1.4 for low and moderate/high exposure levels, respectively. Excess risks were found for occupational exposure to fungicides (OR = 1.5) and herbicides (OR = 1.6) in the moderate/high level after adjustment for potential confounding factors. An increased risk for insecticide exposure was disappeared after adjustment for fungicide and herbicide exposures. Results of our occupation-based analysis were consistent with those from the JEM-based analysis. CONCLUSIONS: Our results suggest that pesticides may increase risk of pancreatic cancer, and indicate the need for investigations that can evaluate risk by specific chemical exposures. Published 2001 Wiley-Liss, Inc.
UI - 21190933
AU - Tersmette AC; Petersen GM; Offerhaus GJ; Falatko FC; Brune KA; Goggins
TI - M; Rozenblum E; Wilentz RE; Yeo CJ; Cameron JL; Kern SE; Hruban RH Increased risk of incident pancreatic cancer among first-degree relatives of patients with familial pancreatic cancer.
SO - Clin Cancer Res 2001 Mar;7(3):738-44
AD - Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands.
It has been estimated that familial aggregation and genetic susceptibility play a role in as many as 10% of patients with pancreatic cancer (PC). The quantified prospective risk of PC among first-degree relatives of PC patients has not been investigated. Families enrolled in the National Familial Pancreas Tumor Registry (NFPTR) prior to September 1, 1998 were followed to estimate the risk and incidence of PC among first-degree relatives of patients with PC. Analyses were performed separately on kindreds with at least two first-degree relatives with PC (familial pancreatic carcinoma (PC); n = 150) at the time the kindred was enrolled in the NFPTR and on kindreds without a pair of affected first-degree relatives (sporadic PC; n = 191). A subanalysis was performed on familial PC kindreds containing three or more affected members at the time of enrollment in the NFPTR (n = 52). Risk was estimated by comparing observed new cases of PC during the observation period with expected numbers based on the United States population-based Surveillance, Epidemiology and End Results program data. Incidence was estimated using person-years risk analyses. During the observational period, six incident PCs developed in the first-degree relatives: two in the sporadic PC kindreds, and four in the familial PC kindreds. The PC risk in the sporadic PC kindreds was not significantly greater than expected [observed/expected = 6.5 (95% CI = 0.78-23.3)] with an incidence rate of 24.5/10(5)/ year. There was a significantly increased 18-fold risk (95% CI = 4.74-44.5) of PC among first-degree relatives in familial PC kindreds, with an incidence of 76.0/10(5)/year. In the subset of familial PC kindreds with three or more affected family members at the time of enrollment, there was a 57-fold (95% CI = 12.4-175) increased risk of PC and an incidence of 301.4/10(5)/year compared with the Surveillance, Epidemiology and End Result age-adjusted incidence of PC in the U.S. (8.8/10(5)/year). When stratified by age, the risk was largely confined to relatives over the age of 60. This study is the first analysis of incident PC occurring in familial PC kindreds. The risk and incidence of PC is exceptionally high among at-risk first-degree relatives in familial PC kindreds in which at least three first-degree relatives have already been diagnosed with PC. Familial PC kindreds are a reasonable high-risk group for PC screening and chemoprevention research.
UI - 21454835
AU - Fink C; Grenacher L; Hansmann HJ; Dux M; Leipold R; Spielhaupter E;
TI - Kauffmann GW; Richter GM [Prospective study to compare high-resolution computed tomography and magnetic resonance imaging in the detection of pancreatic neoplasms: use of intravenous and oral MR contrast media]
SO - Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001 Aug;173(8):724-30
AD - Abteilung Radiodiagnostik Radiologische Universitatsklinik Heidelberg.
PURPOSE: To compare thin-section hydro-CT and MRI in the detection of pancreatic neoplasms. Evaluation of an oral, superparamagnetic contrast agent (OMP) for pancreatic MRI. MATERIAL AND METHODS: 45 patients with suspected pancreatic neoplasms were examined with consecutive thin-section helical CT (Hydro-CT, 3/6/3, 130 ml Ultravist, Schering) and MRI (1.0 T, breath-holding, T1w-GRE, T1w-GRE fat-sat, T2w-TSE). The MRI protocol included precontrast studies, studies after oral administration of OMP (Abdoscan, Nycomed Amersham) and studies after administration of OMP and Gadodiamide i.v. (Omniscan, Nycomed Amersham). All images were assessed by two independent radiologists in a blinded fashion. Radiologic diagnosis was correlated with histology or clinical follow-up (> or = 3 month). RESULTS: 39 patients could be included in analysis. In 13 cases a pancreatic neoplasm was proven by histology. Thin-section hydro-CT and MRI showed no statistically significant differences for the detection of pancreatic neoplasia. The sensitivity of helical hydro-CT was superior compared to MRI (88.5% vs. 65.44/73.1%/76.9%). The specificity of MRI was superior compared to helical hydro-CT (86.5% vs. 94.2%/90.4%/88.5%). CONCLUSION: Thin-section hydro-CT and MRI show similar results for the detection of pancreatic neoplasms. Compared to thin-section helical CT, MRI still has the drawbacks of much more time consumption and, still, lower spatial resolution. The use of an oral, superparamagnetic contrast agent added no advantage for pancreatic MRI.
UI - 21450510
AU - Chatziioannou A; Kehagias D; Mourikis D; Antoniou A; Limouris G; Kaponis
TI - A; Kavatzas N; Tseleni S; Vlachos L Imaging and localization of pancreatic insulinomas.
SO - Clin Imaging 2001 Jul-Aug;25(4):275-83
AD - Department of Radiology, Areteion Hospital, University of Athens, 76 Vas. Sofias Street, Athens 11528, Greece.
For pancreatic insulinomas, the treatment of choice is surgical excision, which when successful is curative. Intraoperative palpation combined with ultrasonography theoretically depict almost all tumors, however the accuracy of palpation is improved by the preoperative localization. All recent advances in imaging have improved the likelihood for curative surgical resection. Our purpose is to demonstrate the characteristics of all modalities, which may be used in the preoperative localization algorithm.
UI - 21354723
AU - McCarty MF
TI - Insulin secretion as a determinant of pancreatic cancer risk.
SO - Med Hypotheses 2001 Aug;57(2):146-50
AD - Pantox Laboratories, 4622 Santa Fe St, San Diego, CA 92109, USA.
New epidemiology confirms that glucose intolerance is a risk factor for pancreatic cancer, and that this association cannot be accounted for by an adverse impact of early pancreatic cancer on beta cell function. Previous reports indicate that risk for pancreatic cancer is increased in adult-onset diabetics. Since streptozotocin diabetes inhibits carcinogen-mediated induction of pancreatic cancer in hamsters, the most reasonable interpretation of these findings is that insulin (or some other beta cell product) acts as a promoter for pancreatic carcinogenesis. This view is consistent with a report that human pancreatic adenocarcinomas express insulin receptors that can stimulate mitosis; an additional possibility is that high insulin levels indirectly promote pancreatic carcinogenesis by boosting effective IGF-I activity via hepatic actions. In international ecologic epidemiology, pancreatic cancer rates correlate tightly with dietary intake of animal products; this may reflect the fact that vegan diets are associated with low diurnal insulin secretion. There is also suggestive evidence that macrobiotic vegan diets, which are low in glycemic index, may increase mean survival time in pancreatic cancer. However, other types of diets associated with decreased postprandial insulin response, such as high-protein diets or 'Mediterranean' diets high in oleic acid, may also have the potential for pancreatic cancer prevention. The huge increases of age-adjusted pancreatic cancer mortality in Japan and among African-Americans during the last century imply that pancreatic cancer is substantially preventable; a low-insulin-response diet coupled with exercise training, weight control, and smoking avoidance, commendable for a great many other reasons, may slash pancreatic cancer mortality dramatically. Copyright 2001 Harcourt Publishers Ltd.
UI - 21413793
AU - Hahn M; Faigel DO
TI - Frequency of mediastinal lymph node metastases in patients undergoing EUS evaluation of pancreaticobiliary masses.
SO - Gastrointest Endosc 2001 Sep;54(3):331-5
AD - Division of Gastroenterology, Portland VA Medical Center and Oregon Health Sciences University, Portland, Oregon 97201, USA.
BACKGROUND: Mediastinal lymph node metastases have rarely been reported in patients with pancreatic cancer. Our aim was to determine the frequency of mediastinal lymph node metastases in patients with pancreaticobiliary masses by using EUS-guided fine needle aspiration. METHODS: Sixty-six consecutive patients with pancreatobiliary masses were evaluated on EUS for the presence of mediastinal lymph node metastases. All masses were staged by commonly used EUS criteria by using sector scanning echoendoscopes. Mediastinal lymph nodes with EUS features that suggested malignancy were aspirated. RESULTS: Of the 66 patients (mean age 65.6 years; 38 men), 4 had biliary masses, 5 had lesions of the major duodenal papilla, and 57 had pancreatic masses. Eleven patients (10 pancreatic masses, 1 biliary mass) had enlarged mediastinal lymph node (12-30 mm) on EUS; in 2 patients these had a benign appearance and were not aspirated. Nine patients underwent EUS-guided fine needle aspiration: in 1 the cytology was inconclusive (patient subsequently had a negative Whipple resection); in 4 the mediastinal lymph node cytology was benign; the remaining 4 patients had adenocarcinoma cells in the aspirate from mediastinal lymph node. These 4 pancreatic tumors were staged by EUS as T2N1M1 (1), as T4N0M1 (2, one later found to also have a lung mass), and T4N1M1 (1). CONCLUSION: Enlarged mediastinal lymph nodes were found on EUS in 16.6% (95% CI [7.7%, 25.6%]) of patients with pancreatobiliary masses and in 17.5% (95% CI [7.6%, 27.4%]) of patients with pancreatic masses. The frequency of mediastinal lymph node metastases in pancreatobiliary masses was 6.1% (95% CI [0.34%, 11.9%]) and in pancreatic masses 7.0% (95% CI [0.4%, 13.6%]). Routine EUS evaluation of the mediastinum in patients with pancreatic masses is warranted.
UI - 21415379
AU - Sohn TA; Yeo CJ; Cameron JL; Iacobuzio-Donahue CA; Hruban RH; Lillemoe
TI - KD Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity.
SO - Ann Surg 2001 Sep;234(3):313-21; discussion 321-2
AD - Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4606, USA.
OBJECTIVE: To assess the authors' experience with intraductal papillary mucinous neoplasms of the pancreas (IPMNs). SUMMARY BACKGROUND DATA: Intraductal papillary mucinous neoplasms of the pancreas are being recognized with increasing frequency. METHODS: All patients who underwent pancreatic resection for an IPMN at the Johns Hopkins Hospital compared with those of 702 concurrent patients with infiltrating ductal adenocarcinoma of the pancreas not associated with an IPMN resected by pancreaticoduodenectomy. RESULTS: In the 13-year time period, 60 patients underwent pancreatic resection for IPMNs, with 40 patients undergoing resection in the past 3 years. Mean age at presentation was 67.4 +/- 1.4 years. The most common presenting symptom in patients with IPMNs was abdominal pain (59%). Most IPMNs were in the head of the pancreas or diffusely involved the gland, with 70% being resected via pancreaticoduodenectomy, 22% via total pancreatectomy, and 8% via distal pancreatectomy. Twenty-two patients (37%) had IPMNs with an associated infiltrating adenocarcinoma. In a subset of IPMNs immunohistochemically stained for the Dpc4 protein (n = 50), all of the intraductal or noninvasive components strongly expressed Dpc4, whereas 84% of associated infiltrating cancers expressed Dpc4. The 5-year survival rate for all patients with IPMNs (n = 60) was 57%. CONCLUSION: Intraductal papillary mucinous neoplasms represent a distinct clinicopathologic entity being recognized with increasing frequency. IPMNs are clinically, histologically, and genetically disparate from pancreatic ductal adenocarcinomas. The distinct clinical features, the presumably long in situ or noninvasive phase, and the good long-term survival of patients with IPMNs offer a unique opportunity for early diagnosis, curative resection, and further studies of the molecular genetics and natural history of these unusual neoplasms.
UI - 21415382
AU - Balcom JH 4th; Keck T; Warshaw AL; Antoniu B; Graeme-Cook F;
TI - Fernandez-del Castillo C Telomerase activity in periampullary tumors correlates with aggressive malignancy.
SO - Ann Surg 2001 Sep;234(3):344-50; discussion 350-1
AD - Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
OBJECTIVE: To determine the presence of telomerase activity in a variety of periampullary malignancies and pancreatic diseases and quantify its activity to establish any association with the stage or aggressiveness of malignancy. SUMMARY BACKGROUND DATA: Progressive shortening of telomeres, repetitive DNA sequences at the ends of chromosomes, plays a role in cell senescence. Telomerase catalyzes conservation of telomeric repeats and may promote cell immortality and hence malignancy. It is absent in normal tissues but upregulated in more than 80% of cancers. METHODS: Fresh specimens of 62 periampullary tumors were snap-frozen in liquid nitrogen and adjacent tissue was formalin-fixed for histopathology. The telomerase repeat amplification protocol (TRAP) was used to obtain telomerase DNA products. These were separated with gel electrophoresis, stained with SYBR green, and quantified by densitometry. Findings were confirmed with a fluorometric TRAP assay in which fluorescent primers specific for telomerase were selectively amplified in its presence. RESULTS: Telomerase activity was upregulated in 26 of 33 periampullary malignancies (79%): 17 of 21 pancreatic adenocarcinomas (81%), 2 of 2 cholangiocarcinomas, 2 of 2 duodenal carcinomas, and 5 of 8 ampullary carcinomas (63%). Poorly differentiated periampullary tumors had significantly higher telomerase activity than well-differentiated tumors, and tumors larger than 2 cm had significantly higher telomerase activity than those 2 cm or smaller. Pancreatic ductal adenocarcinomas with lymph node metastases had significantly greater activity than node-negative cancers. Two of 11 intraductal papillary mucinous tumors were positive for telomerase activity, but only in foci of invasive carcinoma. Chronic pancreatitis (n = 7), serous cystadenomas (n = 5), benign mucinous cystic neoplasms (n = 4), neuroendocrine cancer (n = 1), and acinar cell carcinoma (n = 1) had no detectable telomerase activity. CONCLUSION: Telomerase activity is common in periampullary carcinomas. The magnitude of activity correlates with aggressiveness in pancreatic adenocarcinoma and may prove useful as a molecular index for biologic staging.
UI - 21438993
AU - Eibl G; Wente MN; Reber HA; Hines OJ
TI - Peroxisome proliferator-activated receptor gamma induces pancreatic cancer cell apoptosis.
SO - Biochem Biophys Res Commun 2001 Sep 21;287(2):522-9
AD - Gastrointestinal Surgery Section, Division of General Surgery, UCLA School of Medicine, 72-215 CHS, 10833 LeConte Avenue, Los Angeles, California 90095-6904, USA.
Peroxisome proliferator-activated receptor gamma (PPAR-gamma) decreases the growth of certain cancer cells. In the present study, we found that six different human pancreatic cancer cell lines (AsPC-1, BxPC-3, Capan-2, HPAF-II, MIA PaCa-2, and PANC-1) expressed PPAR-gamma m-RNA and synthesized the protein. The endogenous and exogenous PPAR-gamma ligands 15-deoxy-d12,14-prostaglandin J(2) (15-PGJ(2)) and ciglitazone decreased cell number, cell viability, and increased floating/attached ratio, in a time- and dose-dependent fashion. 15-PGJ(2) increased intracellular nucleosome concentration after 6 h, but did not increase caspase-3 activity even after 96 h. Combined treatment with both 15-PGJ(2) and the caspase-3 inhibitor DEVD-CHO had no effect on cell viability, but the general caspase inhibitor ZVAD-FMK reduced 15-PGJ(2)-induced apoptosis. We concluded that the six human pancreatic cancer cells tested all expressed PPAR-gamma receptor, and treatment with PPAR-gamma agonists decreased cell viability and growth in a time- and dose-dependent manner. These effects were partially mediated by induction of caspase-3 independent apoptosis. Copyright 2001 Academic Press.
UI - 21466978
AU - Novotny J; Petruzelka L; Vedralova J; Kleibl Z; Matous B; Juda L
TI - Prognostic significance of c-erbB-2 gene expression in pancreatic cancer patients.
SO - Neoplasma 2001;48(3):188-91
AD - Department of Oncology, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic. email@example.com
Molecular methods tend to belong to the standard armamentarium of modern pathology. In some instances, these methods are able to identify nosological entities with better accuracy than conventional technique. These methods give useful complementary information to choose appropriate therapeutic strategy. C-erbB-2 overexpression in pancreatic cancer vary widely between 17 to 82%. C-erbB-2 gene is perspective target of anticancer therapies. 57 histologically confirmed tumors (51 pancreatic adenocarcinoma, 5 pancreatic neuroendocrine tumors and 1 carcinoma of Vater's ampullae) were analyzed for the presence of c-erbB-2 expression by immunohistochemistry. Correlation with time from initial symptoms until diagnosis, tumor size and TNM stage at diagnosis, tumor grade, type of operation and overall survival were investigated. C-erbB-2 overexpression was detected in 19.6% samples of pancreatic adenocarcinoma and in one case of Vater's ampullae carcinoma. C-erbB-2 overexpression was found in two of four insulinomas. Univariate statistical correlation stage between c-erbB-2 overexpression and time from initial symptoms until diagnosis, tumor size and TNM at diagnosis, tumor grade, type of operation and overall survival did not reach statistical significans in any parameter studied. C-erbB-2 oncogene was not found to be prognostic factor in pancreatic cancer. Its value to predict therapeutical response remains to be determined in prospective clinical trials.
UI - 21341705
AU - Seki K; Suda T; Aoyagi Y; Sugawara S; Natsui M; Motoyama H; Shirai Y;
TI - Sekine T; Kawai H; Mita Y; Waguri N; Kuroiwa T; Igarashi M; Asakura H Diagnosis of pancreatic adenocarcinoma by detection of human telomerase reverse transcriptase messenger RNA in pancreatic juice with sample qualification.
SO - Clin Cancer Res 2001 Jul;7(7):1976-81
AD - Department of Molecular Genetics, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8122, Japan.
PURPOSE: We evaluated the diagnostic efficacy of detection of human telomerase reverse transcriptase (hTERT) message, a catalytic domain of human telomerase, in endoscopic retrograde pancreatography (ERP)-derived pancreatic juice. EXPERIMENTAL DESIGN: Both hTERT and CD25 expression were detected by reverse transcription-PCR (RT-PCR) in 17 patients with pancreatic adenocarcinoma (PC), 12 patients with chronic pancreatitis (CP), and 7 patients with no ERP abnormality (N). In the same patients, beta-actin message was semiquantified by competitive RT-PCR. K-ras codon 12 mutations were concomitantly analyzed by enriched PCR-SSCP in 11 and 7 PC and CP cases, respectively. RESULTS: Expression of hTERT was detected in 88% of PC cases and 17% of CP cases but not in the normal control (N). Alterations in K-ras were detected in 73% of PC cases and 57% of CP cases, respectively. beta-Actin mRNA was expressed in >3.0 x 10(1) copies/microl in all but two PC cases in which hTERT mRNA was not detected. CD25-positive and -negative peripheral lymphocytes were isolated from a normal volunteer using a fluorescent activating cell sorter. The hTERT message was detected in CD25-positive peripheral lymphocytes and in 18, 25, and 0% of the pancreatic juice samples from PC, CP, and N cases, respectively. All CP cases expressing hTERT message were also CD25 positive. CONCLUSIONS: These results suggest that detection of hTERT mRNA in pancreatic juice is a powerful tool to discriminate PC from CP, particularly when the samples are qualified against beta-actin mRNA levels and contaminating CD25-positive lymphocytes.
UI - 21473977
AU - Brandle M; Pfammatter T; Spinas GA; Lehmann R; Schmid C
TI - Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours.
SO - Clin Endocrinol (Oxf) 2001 Sep;55(3):357-62
AD - Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital Zurich, Switzerland. firstname.lastname@example.org
OBJECTIVE: Non-invasive localization modalities such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) often fail to localize insulinomas smaller than 2 cm in diameter. Recent studies have shown that the selective arterial stimulation and hepatic venous sampling (ASVS) technique using intra-arterial calcium as the insulin secretagogue facilitates the regionalization of such occult insulinomas. This study assesses the sensitivity of ASVS in localizing insulin-secreting tumours. SUBJECTS AND METHODS: Eleven consecutive patients (8 women), aged 29-82 years, were studied over the past 4 years at our hospital. Hyperinsulinaemic hypoglycaemia due to an insulin-secreting tumour was proven in all patients. Calcium gluconate (0.025 mEq/kg body weight) was injected directly into the arteries supplying the pancreas and the liver. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60 and 120 s after each injection. The ASVS technique was performed in all 11 patients; the results were compared with the surgical findings in 10 patients and the autopsy findings in 1 case. The ASVS results were also compared with the findings of other, previously performed imaging modalities. RESULTS: ASVS correctly localized 4 insulin-secreting tumours to the head, 3 to the body, 1 to the tail, 2 to the tail or body of the pancreas and 1 to the liver. Thus, the sensitivity was 100% (11/11) whereas other localization techniques were less sensitive: 7/11 tumours were detected by angiography, 4/8 by endosonography, 3/8 by CT and 1/6 by MRI. Insulinomas (confirmed by histological examination), sized 4-25 mm, were found in 10 patients. All were cured by selective surgery and remained free of hypoglycaemia over the next 1-4 years of follow-up. An insulin-secreting neuroendocrine tumour in the liver was documented in 1 case at autopsy. CONCLUSIONS: Arterial stimulation and hepatic venous sampling is a very sensitive technique for preoperative localization of insulin-producing tumours. It can help to plan minimally invasive surgery and to select an appropriate strategy for patients suffering from malignant tumours in others.
UI - 21233218
AU - Balci NC; Semelka RC
TI - Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma.
SO - Eur J Radiol 2001 May;38(2):105-12
AD - Department of Radiology, Florence Nightingale Hospital, Istanbul, Turkey. email@example.com
This article presents imaging modalities in the diagnosis and staging of pancreatic ductal adenocarcinoma. Magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) have the highest accuracy in detection of pancreatic cancer. MRI and EUS have similar accuracy in determining the local extent of pancreatic cancer. Angiography, computed tomography (CT) angiography and EUS are similarly accurate in evaluating peripancreatic vascular involvement. MRI is the superior method for detecting liver metastases and peritoneal implants of pancreatic ductal adenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are used to assess the biliary tract of patients with pancreatic cancer. Positron emission tomography (PET) is useful in distinguishing pancreatic cancer from focal pancreatic inflammation.
UI - 21233219
AU - Balci NC; Semelka RC
TI - Radiologic features of cystic, endocrine and other pancreatic neoplasms.
SO - Eur J Radiol 2001 May;38(2):113-9
AD - Department of Radiology, Florance Nightingale Hospital, Istanbul, Turkey. firstname.lastname@example.org
This article presents imaging features of cystic, endocrine and other pancreatic neoplasms. Microcystic adenoma which is composed of small cysts (<2 cm), its macrocystic subgroup contains solitary cyst. Multiple cysts larger than 2 cm are associated with mucinous cystic neoplasm. Swiss cheese appearence with central calcification is characteristic for microcystic adenomas. Septal and mural enhancement as well as larger size (>2 cm) are accounted for mucinous cystic neoplasms, its variant along pancreatic duct is ductectatic mucinous cystic neolasm. Endocrine tumors of pancreas are hypervascular and can be depicted on early dynamic enhanced crosssectional imaging modalities or on angiography when they are <1 cm. Pancreatic metastases and lymphomas are rare neoplasms which should also be included in differential diagnosis for pancreatic masses.
UI - 21233222
AU - Piironen A; Kivisaari R; Laippala P; Poutanen VP; Kivisaari L
TI - Pancreatic carcinoma and fast MR imaging: technical considerations for signal intensity difference measurements.
SO - Eur J Radiol 2001 May;38(2):137-45
AD - Department of Radiology, Tampere City Hospital, Tampere, Finland.
The aim of the study was to find the fast magnetic resonance imaging (MRI) sequence with the best conspicuity of pancreatic lesions at 1.0 T and 1.5 T. A total of 51 patients were studied. At 1.0 T, 22 patients with verified malignant pancreatic lesions were studied using the T1-weighted breath-hold spoiled Gradient Echo 2D FLASH(75) or FLASH(80) sequences, both non-enhanced and enhanced with gadolinium. The relative signal intensity difference (SIDR) between lesion and pancreas was measured. At 1.5 T, 20 patients with primary malignant lesions of the pancreas, and nine patients with 13 benign cystic lesions were examined with the breath-hold T2-weighted TrueFISP, HASTE, T1-weighted 2D FLASH(80) and FLASH(50) fat saturation sequences, the latter also enhanced. The signal intensity (SI) values of the pancreas and lesions as well as the pancreatic standard deviation (S.D.) were assessed, and the contrast-to-noise ratio (C/N) was determined. Statistical significances were calculated using an analysis of variance. No statistically significant difference between the sequences used in the conspicuity of cancer was found, either at 1.0 T or at 1.5 T. At 1.5 T, the T2-weighted TrueFISP and HASTE sequences could differentiate benign, cystic lesions from malignant lesions.
UI - 21233223
AU - Obuz F; Dicle O; Coker A; Sagol O; Karademir S
TI - Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging.
SO - Eur J Radiol 2001 May;38(2):146-50
AD - Dokuz Eylul University School of Medicine, Department of Radiology, Izmir, Turkey. email@example.com
OBJECTIVE: To compare the efficacy of dynamic contrast-enhanced MR imaging and spin-echo T1-weighted with and without fat-saturated MR imaging in the detection and staging of pancreatic adenocarcinoma. METHODS AND MATERIAL: Spin-echo T1-weighted, fat-saturated T1-weighted and dynamic breath-hold 2D-FLASH MR imaging were performed in 25 patients with pancreatic adenocarcinoma. MR images were analysed by calculating the CNR between tumor and normal portion of the pancreas. The CNRs calculated at each sequences were compared. A total of 16 out of 25 patients underwent surgery. Preoperative staging according to TNM classification was also done in patients undergoing surgery. RESULTS: The CNR was significantly different (P<0.05) in the arterial phase of dynamic MR images. The accuracy of 'T' staging was 75% for SE T1-W, fat-saturated T1-W and arterial phase of dynamic MR images. CONCLUSION: The CNRs between pancreatic carcinoma and normal pancreas is significantly higher in dynamic MR sequences than the SE T1-W, fat-saturated T1-W sequences. However, the accuracy of tumor staging according to TNM is equivocal to SE T1-W and fat-saturated T1-W images.
UI - 21233224
AU - Arslan A; Buanes T; Geitung JT
TI - Pancreatic carcinoma: MR, MR angiography and dynamic helical CT in the evaluation of vascular invasion.
SO - Eur J Radiol 2001 May;38(2):151-9
AD - Department of Radiology, Kocaeli University Hospital, Izmit, Turkey. firstname.lastname@example.org
OBJECTIVE: To assess the value of MR angiography in combination with contrast-enhanced MR imaging, and to compare MR imaging including MR angiography with dynamic contrast-enhanced dual phase helical CT in the preoperative assessment of vascular invasion in patients with suspected pancreatic carcinoma. METHODS AND MATERIAL: MR imaging only, MR imaging including MR angiography and dynamic contrast-enhanced dual phase helical CT images of 48 patients who were operated due to suspicion of pancreas cancer were correlated with the surgery results in terms of vascular invasion. Pathologic diagnosis were pancreatic adenocarcinoma in 31 patients of which nine had surgically confirmed vascular invasion. Sensitivity, specificity, predictive values (including 95% confidence intervals) and accuracy of MR imaging only, MR imaging including MR angiography and helical CT were calculated. RESULTS: Sensitivity, specificity, positive and negative predictive values and accuracy were 56, 100, 100, 85, 87%; 67, 100, 100, 88, 90% and 67, 100, 100, 88, 90%, respectively, for MR imaging only, MR imaging including MR angiography and helical CT in the adenocarcinoma group. The corresponding figures in the overall study group were 56, 97, 83, 90, 90%; 67, 97, 86, 93, 92% and 67, 97, 86, 93, 92%. Confidence intervals (95%) showed that the differences in the diagnostic efficacy of the techniques were not statistically significant in the overall study group, but the confidence intervals were undefined in the adenocarcinoma group due to the small sample size. CONCLUSION: Diagnostic efficacy of MR imaging when combined with MR angiography is equal to that of dynamic contrast-enhanced dual phase helical CT in the assessment of vascular invasion of pancreatic tumors.
UI - 21323621
AU - Jadvar H; Fischman AJ
TI - Evaluation of pancreatic carcinoma with FDG PET.
SO - Abdom Imaging 2001 May-Jun;26(3):254-9
AD - Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
BACKGROUND: To assess the diagnostic usefulness and clinical impact of positron emission tomography with [F-18]fluorodeoxyglucose (FDG PET) on the management of patients with known or suspected pancreatic carcinoma. METHODS: Attenuation-corrected FDG PET was performed in 20 patients (12 male, eight female) with pancreatic carcinoma at the time of initial diagnosis (n = 7), for tumor surveillance after Whipple surgery (n = 11), and for reevaluation after chemoradiation therapy (n = 2). Visual analysis of PET images were correlated with the results of abdominal computed tomography (CT) and carbohydrate antigen (CA) 19-9 serum tumor marker level that were obtained within 1 month of the PET study. Diagnostic validation was by histology in nine patients and by clinical or radiologic follow-up (5-48 months) in 11 patients. Changes in therapeutic management that were prompted by PET were tabulated. RESULTS: PET was concordant with the findings of abdominal CT in 14 patients (13 true positive, 1 true negative). PET detected clinically unsuspected lung lesions, confirmed subsequently by a chest CT, in one of these 14 patients. PET was discordant with CT in six patients. PET detected tumor recurrence in three patients in this group (15% of total) with nondiagnostic CT findings and elevated CA 19-9 serology. In two of these three patients, chemotherapy with gemcitabine was initiated based on PET localization of disease. Tumor was confirmed in the remaining one of the three patients at autopsy shortly after the PET study. FDG localization in a displaced loop of bowel resulted in an apparent false-positive hepatic lesion in one of six patients in the discordant group. PET underestimated the extent of metastatic disease in the remaining two of six patients due to hyperglycemia. CONCLUSION: In patients with suspected pancreatic carcinoma at the time of initial presentation, PET is complementary to abdominal CT and allows detection of unsuspected distant metastases. In patients with suspected recurrent pancreatic carcinoma, based on elevated or rising CA 19-9 serology, PET can localize the disease when abdominal CT is nondiagnostic as a result of posttherapy anatomic alteration. Imaging evaluation with PET may impact the clinical management of patients with pancreatic carcinoma.
UI - 21523834
AU - Hanley AJ; Johnson KC; Villeneuve PJ; Mao Y; Canadian Cancer Registries
TI - Epidemiology Research Group Physical activity, anthropometric factors and risk of pancreatic cancer: results from the Canadian enhanced cancer surveillance system.
SO - Int J Cancer 2001 Oct 1;94(1):140-7
AD - Division of Epidemiology and Biostatistics, Samuel Lunenfeld Research Institute, Mt. Sinai Hospital, 850-600 University Ave., Toronto, Ontario, M5G 1X5, Canada. email@example.com
To explore the hypothesis that insulin resistance may be an etiologic factor in pancreatic cancer, we assessed the pancreatic cancer risk associated with anthropometric factors and physical activity, both of which are important determinants of insulin sensitivity in humans. Three hundred and twelve patients with histologically confirmed pancreatic cancer were compared to 2,919 controls in a population-based, case-control study in 7 of the 10 Canadian provinces. Participants were asked to report their exposure status for the period 2 years before interview. Men in the highest quartile of body mass index (BMI, > or =28.3 kg/m(2)) were at increased risk of pancreatic cancer [adjusted odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.08-3.35]. In addition, men who reported a decrease in weight of at least 2.9% from their lifetime maximum were at reduced risk compared to those reporting a < or =2.9% loss (> or =10.2% loss, OR = 0.51, 95% CI 0.30-0.86). BMI 2 years before interview was not associated with pancreatic cancer risk among women, though those reporting a > or =12.5% decrease in weight from their lifetime maximum had substantially lower risk compared to those in the baseline quartile (OR = 0.53, 95% CI 0.29-0.99). After adjustment for age, province of residence, dietary intake and anthropometric factors, men in the highest quartile of the composite moderate and strenuous physical activity index were at reduced risk of pancreatic cancer (OR = 0.53, 95% CI 0.31-0.90). Physical activity did not appear to be associated with pancreatic cancer among women, though a tendency for reduced risk with increasing levels of strenuous activity was suggested (p for trend = 0.06). Our findings support the hypothesis that insulin resistance is an etiologic factor in the development of pancreatic neoplasms among men and possibly women. Copyright 2001 Wiley-Liss, Inc.
UI - 21444241
AU - Kullavanijaya P; Treeprasertsuk S; Thong-Ngam D; Kladcharoen N; Mahachai
TI - V; Suwanagool P Adenocarcinoma of the pancreas: the clinical experience of 45 histopathologically proven patients, a 6 year study.
SO - J Med Assoc Thai 2001 May;84(5):640-7
AD - Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
A retrospective study of 45 cases of adenocarcinoma of the pancreas at Chulalongkorn University Hospital from 1993 to 1998 was reviewed by clinical and histopathological criteria. Male and female ratio was 25:20. The mean age of the patients was 59.5 +/- 10.0 years. The common presenting symptoms and signs were epigastric discomfort (80.0%), weight loss (60.0%) and jaundice (51.1%). Twenty four patients (53.3%) were screened for a tumor marker (CA 19-9) and 87.5 per cent of these had high level of CA 19-9 (> 37 IU/ml). Thirty five patients (77.8%) had tumors located in the head of the pancreas. Most of the cases were investigated by using radiological imaging (ultrasonography or computerized tomography of the abdomen). Thirty five histopathological data (77.8%) were made by the operation, and the rest (22.2%) were performed by a fine needle aspiration from the pancreatic mass or liver metastasis. Whipple operation and the bypass procedure were the most common surgical procedures in our studies. Twenty five patients (55.6%) had post treatment complications from all modalities consisting of gastrointestinal bleeding, respiratory failure and infection. However, the mortality rate within 30 days postoperatively was 8.11 per cent which was due to blood loss during the operation and infections. The post treatment mortality rate from all modalities was 33.3 per cent. The average duration from the diagnosis until death was 82.3 days.
UI - 21451485
AU - Ahmad NA; Lewis JD; Ginsberg GG; Haller DG; Morris JB; Williams NN;
TI - Rosato EF; Kochman ML Long term survival after pancreatic resection for pancreatic adenocarcinoma.
SO - Am J Gastroenterol 2001 Sep;96(9):2609-15
AD - Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania, USA.
OBJECTIVE: The aim of this study was to determine the long term survival of patients with pancreatic adenocarcinoma who underwent surgical resection and to assess the association of clinical, pathological, and treatment features with survival. METHODS: Between January, 1990, and December, 1998, 125 patients underwent a pancreaticoduodenal or partial pancreatic resection for pancreatic ductal adenocarcinoma at our institution. The records of these patients were reviewed for demographics, tumor characteristics including size, histological grade, margin status, lymph node status, surgical TNM staging, and postoperative adjuvant therapy. The primary outcome variable analyzed was survival. RESULTS: A total of 116 patients had complete follow-up and were included in the final analysis. The median survival after surgery was 16 months. The 1-, 3-, 5-, and 7-yr survival rates for all 116 patients were 60%, 23%, 19%, and 11%, respectively. The 1-, 3-, 5-, and 7-yr survival rates for patients who received adjuvant therapy were 69%, 28%, 23%, and 18% compared with 20% and 0% in patients who did not receive adjuvant therapy (p < 0.0001). The 1-, 3-, 5-, and 7-yr survival rates for patients with negative lymph nodes were 73%, 38%, 26%, and 22% compared with survival rates of 52%, 14%, 14%, and 9% in patients with positive lymph nodes (p = 0.01). In multivariate analyses, adjuvant therapy was the only feature found to be strongly associated with survival (hazards ratio = 0.26, 95% CI = 0.15-0.44). CONCLUSIONS: The overall 5- and 7-yr survival rates of 19% and 11% in our study further validate that surgical resection in patients with pancreatic adenocarcinoma can result in long term survival, particularly when performed in association with adjuvant chemoradiation.
UI - 21451492
AU - Harewood GC; Wiersema MJ
TI - A cost analysis of endoscopic ultrasound in the evaluation of pancreatic head adenocarcinoma.
SO - Am J Gastroenterol 2001 Sep;96(9):2651-6
AD - Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
OBJECTIVE: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) biopsy of nonperitumoral (NPT) lymph nodes (LN) can be helpful in preoperative staging of pancreatic head adenocarcinoma. The economic impact of this staging strategy has not yet been described. The aim of this study was to apply a decision analysis model to compare the costs of three approaches to the management of nonmetastatic pancreatic head adenocarcinoma: EUS FNA versus CT-guided FNA versus surgery. A cost minimization approach was employed, as viewed from the perspective of the payer. METHODS: A decision analysis model was designed using DATA Version 3.5, taking the entry criteria as "resectable" pancreatic head adenocarcinoma as determined by helical CT. Detection of metastatic NPT LN on FNA signified unresectability and obviated the need for surgery. Baseline probabilities were varied through plausible ranges using sensitivity analysis. Cost inputs were based on Medicare professional plus facility fees. The endpoint was cost of management per patient. RESULTS: EUS FNA was the least costly strategy ($15,938) compared with CT FNA ($16,378) and surgery ($18,723). Sensitivity analysis revealed that EUS FNA remained the least costly option provided the frequency of NPT LN involvement was >4%; below this value, surgery became the least costly. CONCLUSIONS: EUS FNA is the least costly staging strategy in the workup of patients with nonmetastatic pancreatic head adenocarcinoma primarily because of confirmation of NPT LN involvement avoiding unnecessary surgery. These results support performing EUS in patients whose tumors are thought to be resectable on helical CT to enhance NPT LN assessment.
UI - 21453909
AU - Ichikawa T; Sou H; Araki T; Arbab AS; Yoshikawa T; Ishigame K; Haradome
TI - H; Hachiya J Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas.
SO - Radiology 2001 Oct;221(1):107-16
AD - Department of Radiology, Yamanashi Medical University, 1110 Shimokato, Tamaho, Nakakoma, Yamanashi 409-3815, Japan. firstname.lastname@example.org
PURPOSE: To define the duct-penetrating sign at magnetic resonance (MR) cholangiopancreatography (MRCP) and to assess the usefulness of this sign for distinguishing an inflammatory pancreatic mass (IPM) from a conventional pancreatic carcinoma (CPC) compared with arterial phase comp