20 results on '"FABBRI, Carlo"'
Search Results
2. Palliation of Gastric Outlet Obstruction in Case of Biliary Obstruction—A Retrospective, Multicenter Study: The B-GOOD Study.
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Fugazza, Alessandro, Andreozzi, Marta, Binda, Cecilia, Lisotti, Andrea, Tarantino, Ilaria, Vila, Juan J., Robles Medranda, Carlos, Amato, Arnaldo, Larghi, Alberto, Perez Cuadrado Robles, Enrique, Aragona, Giovanni, Di Matteo, Francesco, Badas, Roberta, Hassan, Cesare, Barbera, Carmelo, Mangiavillano, Benedetto, Crinò, Stefano, Colombo, Matteo, Fabbri, Carlo, and Fusaroli, Pietro
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GASTRIC outlet obstruction ,PALLIATIVE treatment ,LAPAROSCOPY ,PATIENT safety ,GASTROENTEROSTOMY ,TREATMENT effectiveness ,SURGICAL stents ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,MEDICAL records ,ACQUISITION of data ,RESEARCH ,DISEASE relapse ,BILE ducts - Abstract
Simple Summary: The aim of our retrospective study was to compare EUS-guided gastroenteroanastomosis (EUS-GE) and enteral stenting (ES) for the palliation of gastric outlet obstruction (GOO) in patients already treated with EUS-guided choledocoduodenostomy (EUS-CDS) for distal malignant biliary obstruction (DMBO). Our results on 77 patients demonstrated that both EUS-GE and ES are safe and effective for palliation of GOO, but EUS-GE is associated with less recurrence of symptoms. Background: EUS-guided gastroenterostomy (EUS-GE) is a novel and effective procedure for the management of malignant gastric outlet obstruction (GOO) with more durable results when compared to enteral stenting (ES). However, data comparing EUS-GE to ES in patients already treated with EUS-guided choledocoduodenostomy (EUS-CDS) for distal malignant biliary obstruction (DMBO) are lacking. We aimed to compare outcomes of EUS-GE and ES for the palliation of GOO in this specific population of patients. Methods: A multicenter, retrospective analysis of patients with DMBO treated by EUS-CDS and subsequent GOO treated by EUS-GE or ES from 2016 to 2021 was conducted. Primary outcomes were overall AEs rate and dysfunction of the EUS-CDS after GOO treatment. Secondary outcomes included clinical success, technical success, procedure duration, length of hospital stay and relapse of GOO symptoms. Results: A total of 77 consecutive patients were included in the study: 25 patients underwent EUS-GE and 52 underwent ES. AEs rate and patency outcomes of the EUS-CDS after GOO treatment were comparable between the two groups (12.5% vs. 17.3%; p = 0.74). No recurrence of GOO symptoms was registered in the EUS-GE group while 11.5% of ES patients had symptoms recurrence, even if not statistically significant (p = 0.16), after a mean follow-up period of 63.5 days. Conclusion: EUS-GE and ES are both effective and safe for the palliation of GOO in patients already treated by EUS-CDS for DMBO with no difference in the biliary stent dysfunction rate and overall AEs. EUS-GE is associated with less recurrence of GOO symptoms. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Repeated endoscopic ultrasound‐guided fine‐needle biopsy of solid pancreatic lesions after previous nondiagnostic or inconclusive sampling.
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Lisotti, Andrea, Cominardi, Anna, Conti Bellocchi, Maria Cristina, Crinò, Stefano Francesco, Larghi, Alberto, Facciorusso, Antonio, Arcidiacono, Paolo Giorgio, De Angelis, Claudio, Di Matteo, Francesco Maria, Fabbri, Carlo, Bertani, Helga, Togliani, Thomas, Rizzatti, Gianenrico, Brancaccio, Mario, Grillo, Antonino, Fantin, Alberto, Pezzoli, Alessandro, D'Errico, Francesca, Amato, Arnaldo, and Antonini, Filippo
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ENDOSCOPIC ultrasonography ,SURGICAL pathology ,BIOPSY ,NEEDLE biopsy ,MULTIVARIATE analysis ,MEDICAL referrals - Abstract
Objectives: Repeated endoscopic ultrasound (EUS)‐guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine‐needle biopsy (rEUS‐FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes. Methods: Consecutive patients undergoing rEUS‐FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6‐month follow‐up, and benign pathology together with ≥12‐month follow‐up were adopted as gold standards. Results: Among 462 patients, 56.5% were male, with a median age of 68 (59–75) years, malignancy prevalence 77.0%. Tumor size was 26 (20–35) mm. Second‐generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS‐FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false‐negative and 12 false‐positive results). On multivariate analysis, rEUS‐FNB performed at high‐volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10–3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00–1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second‐generation FNB needles (OR 5.42; 95% CI 2.30–12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31–7.06; P = 0.009) were independently related to sample adequacy. Conclusion: Repeated EUS‐FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high‐volume centers improved diagnostic accuracy. The use of second‐generation FNB needles significantly improved sample adequacy over standard EUS‐FNB needles. [ABSTRACT FROM AUTHOR]
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- 2024
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4. European' health care indicators and pancreatic cancer incidence and mortality: A mediation analysis of Eurostat data and Global Burden of Disease Study 2019.
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Cucchetti, Alessandro, Johnson, Philip, Capurso, Gabriele, Crippa, Stefano, Pacilio, Carlo Alberto, Fabbri, Carlo, Falconi, Massimo, and Ercolani, Giorgio
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To highlight correlations existing between incidence and mortality of pancreatic cancer, and health care indicators in 36 European countries. The Global Burden of Disease (GBD) and Eurostat databases were queried between 2004 and 2019. Incidence and mortality were age-standardized. From Eurostat, indicators regarding expenditure, hospital beds, medical technology, health personnel, physicians by medical specialty and unmet needs for medical examination were extracted. Correlations between GBD and Eurostat data were analysed through mediation analysis applying clustering for countries. Incidence increased by +0.6% per year (p = 0.001) and mortality by +0.3% (p = 0.001), being increasing for most of the European countries considered. Incidence and mortality were strongly positively correlated (p = 0.001). Higher current health expenditure, expenditure in inpatient curative care, the number of available beds, the number of computed tomography scan, magnetic resonance units, practising medical doctors were all related to higher incidence (p < 0.05), whereas the unmet need for medical examinations was related to lower incidence. When the mediator' effect of incidence was handled, these indicators, together with expenditure on outpatient curative cares, the number of pet scanners and of radiation therapy equipment, were related to lower mortality (p < 0.05). Health care environment correlates with reported incidence and mortality of pancreatic cancer. This highlights both that ameliorated socio-economic societies suffer from higher incidence but lower mortality, as well as the epidemiological bias originating from countries' diagnostic ability. [ABSTRACT FROM AUTHOR]
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- 2023
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5. The presence of rapid on-site evaluation did not increase the adequacy and diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions with core needle
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Fabbri, Carlo, Fuccio, Lorenzo, Fornelli, Adele, Antonini, Filippo, Liotta, Rosa, Frazzoni, Leonardo, Larghi, Alberto, Maimone, Antonella, Paggi, Silvia, Gusella, Paolo, Barresi, Luca, Polifemo, Anna Maria, Iovine, Elio, Macarri, Giampiero, Cennamo, Vincenzo, and Tarantino, Ilaria
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- 2017
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6. Trial sequential analysis of randomized controlled trials on neoadjuvant therapy for resectable pancreatic cancer.
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Cucchetti, Alessandro, Crippa, Stefano, Dajti, Elton, Binda, Cecilia, Fabbri, Carlo, Falconi, Massimo, and Ercolani, Giorgio
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SEQUENTIAL analysis ,NEOADJUVANT chemotherapy ,RANDOMIZED controlled trials ,PANCREATIC cancer ,FALSE positive error ,PANCREATIC surgery - Abstract
Meta-analyses of randomized controlled trials (RCTs) provide the highest level of evidence but can suffer from type I (false-positive) and II (false-negative) errors, which can be estimated through trial sequential analysis (TSA) demonstrating eventual credibility of results. Aim of the study was to establish through TSA which strategy between neoadjuvant approach or upfront surgery provides best results when treating potentially resectable pancreatic adenocarcinoma. RCTs were searched until September 2021. Intention-to-treat (ITT) overall survival, resection rate, ITT R0 and N0 rates and per-protocol R0 and N0 rates were the outcomes considered. Fixed-effect model was applied. TSA assumed an alpha = 5% and a power = 80%. Four RCTs were identified accruing 325 patients for the ITT analyses and 242 for the per-protocol analyses. Neoadjuvant did not improve survival (p = 0.167) and TSA supported that this result was underpowered, requiring additional 1514 patients to prove credibility. Neoadjuvant reduced resection rate (p = 0.044) but type I error was not avoided. Neoadjuvant credibly increased per-protocol R0 and N0 rates (p = 0.003 and p < 0.001), and TSA showed that these were true-positive findings. Neoadjuvant did not increase ITT R0 rate since randomization (p = 0.169) but TSA showed lack of power. Neoadjuvant credibly increased the ITT N0 rate (p < 0.001) and TSA supported that this was a true positive finding. Neoadjuvant strategy credibly demonstrated superiority over upfront surgery in determine per-protocol R0 resection and N0 rates, as well as ITT N0 rate. For the remaining outcomes, TSA suggested the need of larger samples to exclude type I and II errors. [ABSTRACT FROM AUTHOR]
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- 2022
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7. Concordance, intra- and inter-observer agreements between light microscopy and whole slide imaging for samples acquired by EUS in pancreatic solid lesions.
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Larghi, Alberto, Fornelli, Adele, Lega, Stefania, Ragazzi, Moira, Carlinfante, Gabriele, Baccarini, Paola, Fabbri, Carlo, Pierotti, Paola, Tallini, Giovanni, Bondi, Arrigo, and de Biase, Dario
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No study has compared the performance of light microscopy (LM) and whole slide imaging (WSI) for endoscopic ultrasound (EUS) histological acquired tissue samples from pancreatic solid lesions (PSLs). We evaluated the concordance between LM and WSI and the inter- and intra-observer agreements among pathologists on PSLs EUS acquired samples. LM and WSI from 60 patients with PSLs were evaluated by five expert pathologists to define: diagnostic classification, presence of a core, number and percentage of lesional cells. Washout period between evaluations was 3 months. Time of the procedures was also assessed. Forty-eight cell-block and 12 biopsy samples were evaluated. A high concordance between LM and WSI was found. Inter- and intra-observer agreements for diagnostic classification were substantial and complete, respectively. For all the other parameters, the inter-observer agreement was usually higher for LM. For the intra-observer, a substantial agreement was reached regarding the presence of tissue core and the number and the percentage of malignant cells. Median time for performing LM was significantly shorter than for WSI (p < 0.0001). LM and WSI of cell-block and biopsy samples acquired by EUS in PSLs were highly concordant, with a substantial inter-observer and a complete intra-observer agreements regarding diagnostic classification. [ABSTRACT FROM AUTHOR]
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- 2019
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8. Long-term survivors of pancreatic adenocarcinoma show low rates of genetic alterations in KRAS, TP53 and SMAD4.
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Masetti, Michele, Acquaviva, Giorgia, Visani, Michela, Tallini, Giovanni, Fornelli, Adele, Ragazzi, Moira, Vasuri, Francesco, Grifoni, Daniela, Di Giacomo, Simone, Fiorino, Sirio, Lombardi, Raffaele, Tuminati, David, Ravaioli, Matteo, Fabbri, Carlo, Bacchi-Reggiani, Maria Letizia, Pession, Annalisa, Jovine, Elio, and de Biase, Dario
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ADENOCARCINOMA ,CANCER patients ,IMMUNOHISTOCHEMISTRY ,PANCREATIC cancer ,METHYLATION ,CANCER genes ,PREVENTION - Abstract
BACKGROUND: Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is currently the only effective treatment for PDAC, most patients survive less than 20 months after tumor resection. OBJECTIVE: The primary goal was to investigate alterations in KRAS, TP53, SMAD4 and CDKN2A/p16 in tumors from patients with exceptionally long survival after surgery. METHODS: Tumors from 15 patients with PDAC that survived more than 55 months after surgery ("LS") were analyzed for KRAS, TP53, IDH1, NRAS and BRAF using next-generation sequencing. SMAD4 and CDKN2A/p16 was tested using immunohistochemistry. MGMT promoter methylation was investigated. RESULTS: Tumors from "LS" have a lower prevalence of KRAS and TP53 mutations and had more frequently SMAD4 retained expression, if compared with that of patients died within 24 months from surgery. The survival of patients with wild-type KRAS and TP53 tumors was more than twice longer than that of patients bearing KRAS and TP53 mutations (90.2 vs. 41.1 months). Patients with KRAS wild-type tumors and that retained SMAD4 expression had a survival twice longer than cases with alterations in both genes (83.8 vs. 36.7 months). Eleven tumors (39.3%) showed MGMT methylation. CONCLUSIONS: Our data indicate that absence of KRAS, TP53 and SMAD4 genetic alterations may identify a subset of pancreatic carcinomas with better outcome. [ABSTRACT FROM AUTHOR]
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- 2018
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9. Biliary plastic stent does not influence the accuracy of endoscopic ultrasound-guided sampling of pancreatic head masses performed with core biopsy needles.
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Antonini, Filippo, Fuccio, Lorenzo, Giorgini, Sara, Fabbri, Carlo, Frazzoni, Leonardo, Scarpelli, Marina, and Macarri, Giampiero
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Objective While the presence of biliary stent significantly decreases the accuracy of endoscopic ultrasound (EUS) for pancreatic head cancer staging, its impact on the EUS-guided sampling accuracy is still debated. Furthermore, data on EUS-fine needle biopsy (EUS-FNB) using core biopsy needles in patients with pancreatic mass and biliary stent are lacking. The aim of this study was to evaluate the influence of biliary stent on the adequacy and accuracy of EUS-FNB in patients with pancreatic head mass. Methods All patients who underwent EUS-guided sampling with core needles of solid pancreatic head masses causing obstructive jaundice were retrospectively identified in a single tertiary referral center. Adequacy, defined as the rate of cases in which a tissue specimen for proper examination was achieved, with and without biliary stent, was the primary outcome measure. The diagnostic accuracy and complication rate were the secondary outcome measures. Results A total of 130 patients with pancreatic head mass causing biliary obstruction were included in the study: 74 cases of them were sampled without stent and 56 cases with plastic stent in situ . The adequacy was 96.4% in the stent group and 90.5% in the group without stent (p = 0.190). No significant differences were observed for sensitivity (88.9% vs. 85.9%), specificity (100% for both groups), and accuracy (89.3% vs . 86.5%) between those with and without stent, respectively. The accuracy was not influenced by the timing of stenting (<48 h or ≥48 h before EUS). No EUS-FNB related complications were recorded. Conclusion The presence of biliary stent does not influence the tissue sampling adequacy, the diagnostic accuracy and the complication rate of EUS-FNB of pancreatic head masses performed with core biopsy needles. [ABSTRACT FROM AUTHOR]
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- 2017
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10. Endoscopic ultrasound-guided fine-needle biopsy of small solid pancreatic lesions using a 22-gauge needle with side fenestration.
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Fabbri, Carlo, Luigiano, Carmelo, Maimone, Antonella, Tarantino, Ilaria, Baccarini, Paola, Fornelli, Adele, Liotta, Rosa, Polifemo, Annamaria, Barresi, Luca, Traina, Mario, Virgilio, Clara, and Cennamo, Vincenzo
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PANCREATIC cancer , *ENDOSCOPY , *PANCREATIC injuries , *SURGICAL complications ,TUMOR surgery - Abstract
Background: Early detection of small pancreatic cancer is important because expected survival is markedly better for tumors ≤2 cm. A new endoscopic ultrasound-(EUS) guided biopsy needle with side fenestration has been recently developed to enable fine-needle biopsy (FNB) under EUS guidance. The aim of this study was to evaluate the outcome of EUS-FNB using a 22-gauge ProCore needle in solid pancreatic lesions ≤2 cm, in terms of diagnostic accuracy and yield. Methods: From January 2011 to December 2012, all consecutive EUS-guided tissue sampling of small pancreatic lesions (≤2 cm) were performed using 22-gauge ProCore needles; the data of these patients were analyzed retrospectively. Results: Sixty-eight patients with a mean age of 65.7 years were included. The mean lesion size was 16.5 mm (range 5-20). None of the patients developed complications. On pathological examination, the tissue retrieved was judged adequate in 58 out of 68 cases (85.3 %) and the presence of a tissue core was recorded in 36 out of 68 cases (52.9 %). The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80, 100, 100, 40, and 82 %, respectively. Conclusion: Our results suggested that EUS-FNB of small pancreatic lesions using a 22-gauge ProCore needle is effective and safe, and supports our hypothesis that EUS-FNB is highly useful in establishing the nature of small pancreatic lesions. [ABSTRACT FROM AUTHOR]
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- 2015
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11. Next Generation Sequencing Improves the Accuracy of KRAS Mutation Analysis in Endoscopic Ultrasound Fine Needle Aspiration Pancreatic Lesions.
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de Biase, Dario, Visani, Michela, Baccarini, Paola, Polifemo, Anna Maria, Maimone, Antonella, Fornelli, Adele, Giuliani, Adriana, Zanini, Nicola, Fabbri, Carlo, Pession, Annalisa, and Tallini, Giovanni
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PANCREATIC diseases ,GENETIC mutation ,NUCLEOTIDE sequence ,ENDOSCOPIC ultrasonography ,NEEDLE biopsy ,MOLECULAR biology ,POLYMERASE chain reaction ,DIAGNOSIS - Abstract
The use of endoscopic ultrasonography has allowed for improved detection and pathologic analysis of fine needle aspirate material for pancreatic lesion diagnosis. The molecular analysis of KRAS has further improved the clinical sensitivity of preoperative analysis. For this reason, the use of highly analytical sensitive and specific molecular tests in the analysis of material from fine needle aspirate specimens has become of great importance. In the present study, 60 specimens from endoscopic ultrasonography fine needle aspirate were analyzed for KRAS exon 2 and exon 3 mutations, using three different techniques: Sanger sequencing, allele specific locked nucleic acid PCR and Next Generation sequencing (454 GS-Junior, Roche). Moreover, KRAS was also tested in wild-type samples, starting from DNA obtained from cytological smears after pathological evaluation. Sanger sequencing showed a clinical sensitivity for the detection of the KRAS mutation of 42.1%, allele specific locked nucleic acid of 52.8% and Next Generation of 73.7%. In two wild-type cases the re-sequencing starting from selected material allowed to detect a KRAS mutation, increasing the clinical sensitivity of next generation sequencing to 78.95%. The present study demonstrated that the performance of molecular analysis could be improved by using highly analytical sensitive techniques. The Next Generation Sequencing allowed to increase the clinical sensitivity of the test without decreasing the specificity of the analysis. Moreover we observed that it could be useful to repeat the analysis starting from selectable material, such as cytological smears to avoid false negative results. [ABSTRACT FROM AUTHOR]
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- 2014
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12. Outcomes of a 3-Year Prospective Surveillance in Individuals at High Risk of Pancreatic Cancer.
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Paiella, Salvatore, Capurso, Gabriele, Carrara, Silvia, Secchettin, Erica, Casciani, Fabio, Frigerio, Isabella, Zerbi, Alessandro, Archibugi, Livia, Bonifacio, Cristiana, Malleo, Giuseppe, Martina Cavestro, Giulia, Barile, Monica, Larghi, Alberto, Assisi, Daniela, Fantin, Alberto, Caterina Milanetto, Anna, Fabbri, Carlo, Casadei, Riccardo, Donato, Giulio, and Sassatelli, Romano
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PANCREATIC cancer , *DISEASE risk factors , *PUBLIC health surveillance , *PANCREATIC tumors , *PANCREATIC cysts , *PANCREATIC surgery , *NEUROENDOCRINE tumors , *ENDOSCOPIC ultrasonography , *ENDOSCOPIC retrograde cholangiopancreatography - Abstract
INTRODUCTION: Pancreatic cancer (PC) surveillance of high-risk individuals (HRI) is becoming more common worldwide, aiming at anticipating PC diagnosis at a preclinical stage. In 2015, the Italian Registry of Families at Risk of Pancreatic Cancer was created. We aimed to assess the prevalence and incidence of pancreatic findings, oncological outcomes, and harms 7 years after the Italian Registry of Families at Risk of Pancreatic Cancer inception, focusing on individuals with at least a 3-year follow-up or developing events before. METHODS: HRI (subjects with a family history or mutation carriers with/without a family history were enrolled in 18 centers). They underwent annual magnetic resonance with cholangiopancreatography or endoscopic ultrasound (NCT04095195). RESULTS: During the study period (June 2015-September 2022), 679 individuals were enrolled. Of these, 524 (77.2%) underwent at least baseline imaging, and 156 (29.8%) with at least a 3-year follow-up or pancreatic malignancy/premalignancy-related events, and represented the study population. The median age was 51 (interquartile range 16) years. Familial PC cases accounted for 81.4% of HRI and individuals with pathogenic variant for 18.6%. Malignant (n58) and premalignant (1 PanIN3) lesions were found in 9 individuals. Five of these 8 cases occurred in pathogenic variant carriers, 4 in familial PC cases (2 tested negative at germline testing and 2 others were not tested). Three of the 8 PC were stage I. Five of the 8PC were resectable, 3 Stage I, all advanced cases being prevalent. The 1-, 2-, and 3-year cumulative hazard of PC was 1.7%, 2.5%, and 3%, respectively. Median overall and disease-free survival of patients with resected PC were 18 and 12 months (95% CI not computable). Considering HRI who underwent baseline imaging, 6 pancreatic neuroendocrine neoplasms (1 resected) and 1 lowyield surgery (low-grade mixed-intraductal papillary mucinous neoplasm) were also reported. DISCUSSION: PC surveillance in a fully public health care system is feasible and safe, and leads to early PC or premalignant lesions diagnoses, mostly at baseline but also over time. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Macroscopic on-site evaluation (MOSE) of specimens from solid lesions acquired during EUS-FNB: multicenter study and comparison between needle gauges
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Francesco Auriemma, Silvia Carrara, Leonardo Henry Eusebi, Luca De Luca, Thomas Togliani, Milena Di Leo, Cecilia Binda, D. Paduano, Teresa Staiano, Alessandro Repici, Lorenzo Fuccio, Ilaria Tarantino, Leonardo Frazzoni, Benedetto Mangiavillano, Carlo Fabbri, Laura Lamonaca, Marianna Signoretti, Mangiavillano, Benedetto, Frazzoni, Leonardo, Togliani, Thoma, Fabbri, Carlo, Tarantino, Ilaria, De Luca, Luca, Staiano, Teresa, Binda, Cecilia, Signoretti, Marianna, Eusebi, Leonardo H, Auriemma, Francesco, Lamonaca, Laura, Paduano, Danilo, Di Leo, Milena, Carrara, Silvia, Fuccio, Lorenzo, and Repici, Alessandro
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Original article ,medicine.diagnostic_test ,business.industry ,pancreatic cancer ,RC799-869 ,Endoscopic ultrasonography ,Diseases of the digestive system. Gastroenterology ,Endoscopic ultrasound ,Site evaluation ,Confidence interval ,Endoscopy ,Multicenter study ,Biopsy ,medicine ,Pharmacology (medical) ,Nuclear medicine ,business ,fine needle biopsy ,Large size - Abstract
Background and study aims The standard method for obtaining samples during endoscopic ultrasonography (EUS) is fine-needle aspiration (FNA), the accuracy of which can be affected by the presence of a cytopathologist in endoscopy room (rapid on-site evaluation [ROSE]). With the introduction of fine-needle biopsy (FNB), macroscopic on-site evaluation (MOSE) of a acquired specimen has been proposed. Only a few studies have evaluated the role of MOSE and in all except one, a 19G needle was used. Our primary aim was to evaluate the diagnostic yield and accuracy of MOSE with different needle sizes and the secondary aim was to identify factors influencing the yield of MOSE. Patients and methods Data from patients who underwent EUS-FNB for solid lesions, with MOSE evaluation of the specimen, were collected in six endoscopic referral centers. Results A total of 378 patients (145 F and 233 M) were enrolled. Needles sizes used during the procedures were 20G (42 %), 22G (45 %), and 25G (13 %). The median number of needle passes was two (IQR 2–3). The overall diagnostic yield of MOSE was of 90 % (confidence interval [CI] 86 %–92 %). On multivariable logistic regression analysis, variables independently associated with the diagnostic yield of MOSE were a larger needle diameter (20G vs. 25G, OR 11.64, 95 %CI 3.5–38.71; 22G vs. 25G, OR 6.20, 95 %CI 2.41–15.90) and three of more needle passes (OR 3.39, 95 %CI 1.38–8.31). Conclusions MOSE showed high diagnostic yield and accuracy. Its yield was further increased if performed with a large size FNB needles and more than two passes.
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- 2021
14. Matricellular proteins and survival in patients with pancreatic cancer: A systematic review
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Maria Letizia Bacchi-Reggiani, Raffaele Lombardi, Andrea Domanico, Paolo Leandri, Paolo Emilio Orlandi, Francesco Monetti, Fabio Grizzi, Luca Di Tommaso, Vincenzo Cennamo, Michele Imbriani, Giorgia Acquaviva, Salomone Di Saverio, Matteo Zanello, Federica Patrinicola, Arrigo Bondi, Michele Masetti, Elena Siopis, Laura Mastrangelo, Michela Visani, Elio Jovine, Silvia Giovanelli, Andrea Tura, Claudia Benini, Dario de Biase, Esterita Accogli, Stefano Sbrignadello, Chiara Birtolo, Sirio Fiorino, Adele Fornelli, Daniela Grifoni, Carlo Fabbri, Fiorino, Sirio, Bacchi-Reggiani, Maria Letizia, Birtolo, Chiara, Acquaviva, Giorgia, Visani, Michela, Fornelli, Adele, Masetti, Michele, Tura, Andrea, Sbrignadello, Stefano, Grizzi, Fabio, Patrinicola, Federica, Zanello, Matteo, Mastrangelo, Laura, Lombardi, Raffaele, Benini, Claudia, Di Tommaso, Luca, Bondi, Arrigo, Monetti, Francesco, Siopis, Elena, Orlandi, Paolo Emilio, Imbriani, Michele, Fabbri, Carlo, Giovanelli, Silvia, Domanico, Andrea, Accogli, Esterita, Di Saverio, Salomone, Grifoni, Daniela, Cennamo, Vincenzo, Leandri, Paolo, Jovine, Elio, and de Biase, Dario
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0301 basic medicine ,Endocrinology, Diabetes and Metabolism ,Matricellular proteins ,Review ,medicine.disease_cause ,Bioinformatics ,Matricellular protein ,Extracellular matrix ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Cell surface receptor ,Pancreatic cancer ,Cancer ,Pancreas ,Pancreatic adenocarcinoma ,Diabetes and Metabolism ,Hepatology ,medicine ,Extracellular ,Humans ,Pancrea ,In patient ,business.industry ,Gastroenterology ,medicine.disease ,Survival Analysis ,Extracellular Matrix ,Gene Expression Regulation, Neoplastic ,Pancreatic Neoplasms ,030104 developmental biology ,Systematic review ,030220 oncology & carcinogenesis ,Carcinogenesis ,business ,Homeostasis - Abstract
Extracellular matrix (ECM) plays a fundamental role in tissue architecture and homeostasis and modulates cell functions through a complex interaction between cell surface receptors, hormones, several bioeffector molecules, and structural proteins like collagen. These components are secreted into ECM and all together contribute to regulate several cellular activities including differentiation, apoptosis, proliferation, and migration. The so-called "matricellular" proteins (MPs) have recently emerged as important regulators of ECM functions. The aim of our review is to consider all different types of MPs family assessing the potential relationship between MPs and survival in patients with pancreatic ductal adenocarcinoma (PDAC). A systematic computer-based search of published articles, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement issued in 2009 was conducted through Ovid interface, and literature review was performed in May 2017. The search text words were identified by means of controlled vocabulary, such as the National Library of Medicine's MESH (Medical Subject Headings) and Keywords. Collected data showed an important role of MPs in carcinogenesis and in PDAC prognosis even though the underlying mechanisms are still largely unknown and data are not univocal. Therefore, a better understanding of MPs role in regulation of ECM homeostasis and remodeling of specific organ niches may suggest potential novel extracellular targets for the development of efficacious therapeutic strategies.
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- 2018
15. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis
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Malay Sharma, Jonathan Wyse, Evangelos Kalaitzakis, Jan Werner Poley, Douglas G. Adler, Jintao Guo, Mouen A. Khashab, Carlo Fabbri, Anand V. Sahai, Girish Mishra, Mohamad A. Eloubeidi, Siyu Sun, Masayuki Kitano, Silvia Carrara, Juan J. Vila, Manoop S. Bhutani, Ang Tiing Leong, Adrian Saftoiu, Vinay Dhir, Nam Q. Nguyen, Sammy Ho, Hussein Hassan Okasha, Linda S. Lee, Erwin Santo, Everson L.A. Artifon, Brenda Lucia Arturo Arias, Ali A. Siddiqui, Peter Vilmann, Surinder Singh Rana, Robert Battat, Payal Saxena, Sundeep Lakhtakia, Marc Giovannini, Pietro Fusaroli, Subbaramiah Sridhar, Shuntaro Mukai, Pramod Kumar Garg, Wyse, Jonathan M., Battat, Robert, Sun, Siyu, Saftoiu, Adrian, Siddiqui, Ali A., Leong, Ang Tiing, Arias, Brenda Lucia Arturo, Fabbri, Carlo, Adler, Douglas G., Santo, Erwin, Kalaitzakis, Evangelo, Artifon, Everson, Mishra, Girish, Okasha, Hussein Hassan, Poley, Jan Werner, Guo, Jintao, Vila, Juan J., Lee, Linda S., Sharma, Malay, Bhutani, Manoop S., Giovannini, Marc, Kitano, Masayuki, Eloubeidi, Mohamad Ali, Khashab, Mouen A., Nguyen, Nam Q., Saxena, Payal, Vilmann, Peter, Fusaroli, Pietro, Garg, Pramod Kumar, Ho, Sammy, Mukai, Shuntaro, Carrara, Silvia, Sridhar, Subbaramiah, Lakhtakia, Sundeep, Rana, Surinder S., Dhir, Vinay, Sahai, Anand V., Gastroenterology & Hepatology, and Internal Medicine
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Endoscopic ultrasound ,medicine.medical_specialty ,Radiology, Nuclear Medicine and Imaging ,Celiac Plexus Neurolysis ,MEDLINE ,Guideline ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Medical physics ,Celiac plexus neurolysi ,Grading (education) ,Celiac plexus neurolysis ,medicine.diagnostic_test ,Hepatology ,business.industry ,Gastroenterology ,Pancreatic cancer ,Individual level ,Clinical Guideline ,Quality of evidence ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Cancer pain ,business - Abstract
OBJECTIVES: The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN).METHODS: Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence.RESULTS: Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one.CONCLUSIONS: EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.
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- 2017
16. The presence of rapid on-site evaluation did not increase the adequacy and diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition of solid pancreatic lesions with core needle
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Giampiero Macarri, Luca Barresi, Vincenzo Cennamo, Adele Fornelli, Lorenzo Fuccio, Filippo Antonini, Silvia Paggi, Rosa Liotta, Antonella Maimone, Ilaria Tarantino, Carlo Fabbri, Anna Maria Polifemo, Alberto Larghi, Elio Iovine, Leonardo Frazzoni, Paolo Gusella, Fabbri, Carlo, Fuccio, Lorenzo, Fornelli, Adele, Antonini, Filippo, Liotta, Rosa, Frazzoni, Leonardo, Larghi, Alberto, Maimone, Antonella, Paggi, Silvia, Gusella, Paolo, Barresi, Luca, Polifemo, Anna Maria, Iovine, Elio, Macarri, Giampiero, Cennamo, Vincenzo, and Tarantino, Ilaria
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Endoscopic ultrasound ,Core needle ,Male ,medicine.medical_specialty ,Diagnostic accuracy ,Site evaluation ,Adenocarcinoma ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,medicine ,Humans ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Pancreas ,EUS ,Aged ,Retrospective Studies ,Fine-needle aspiration ,ROSE ,medicine.diagnostic_test ,business.industry ,Rapid on-site evaluation ,medicine.disease ,digestive system diseases ,Carcinoma, Neuroendocrine ,Tissue acquisition ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Surgery ,Radiology ,business - Abstract
Background: Rapid on-site evaluation (ROSE) improves the adequacy and accuracy of EUS-guided tissue acquisition, although it is not routinely widely available. Evidence suggested that core needles might overcome the absence of ROSE. The aim of this study was to evaluate the influence of ROSE on the adequacy and accuracy of EUS-guided tissue acquisition with core needles in patients with pancreatic solid lesions. Methods: Patients who underwent EUS-guided tissue acquisition of pancreatic mass lesions were retrospectively identified at three tertiary referral centers and those performed with the core needle were included. Adequacy, defined as the rate of cases in which a tissue specimen for proper examination was achieved, with and without ROSE was the primary outcome measure. The diagnostic accuracy and tissue core acquisition were the secondary outcome measures. Results: A total of 333 patients with pancreatic solid mass lesions were included in the study; 140 cases sampled with ROSE and 193 cases without ROSE. The adequacy was 92.1 % in the group sampled with ROSE and 88.1 % in the group without ROSE (p = 0.227). In the ROSE group sensitivity, specificity, and accuracy were 90.7, 100 and 92.1 %, respectively. In the group without ROSE, sensitivity, specificity, and accuracy were 87.2, 100, and 88.1 %, respectively. No difference for all these figures was observed between the two groups. The tissue core was available in 61.4 and 53.4 % of cases with and without ROSE, respectively (p = 0.143). Conclusion: In the absence of ROSE, EUS-based tissue acquisition with Core needle should be considered since it achieves comparable tissue sampling adequacy and accuracy.
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- 2017
17. Biliary plastic stent does not influence the accuracy of endoscopic ultrasound-guided sampling of pancreatic head masses performed with core biopsy needles
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Lorenzo Fuccio, Filippo Antonini, Sara Giorgini, Leonardo Frazzoni, Giampiero Macarri, Carlo Fabbri, Marina Scarpelli, Antonini, Filippo, Fuccio, Lorenzo, Giorgini, Sara, Fabbri, Carlo, Frazzoni, Leonardo, Scarpelli, Marina, and Macarri, Giampiero
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Endoscopic ultrasound ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Biopsy ,Biliary stent ,Sensitivity and Specificity ,Fine needle aspiration ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,Pancreatic mass ,medicine ,Humans ,Sampling (medicine) ,Plastic stent ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Pancreas ,Accuracy ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,Hepatology ,business.industry ,Gastroenterology ,Stent ,Middle Aged ,medicine.disease ,equipment and supplies ,digestive system diseases ,Pancreatic Neoplasms ,Biliary Tract Surgical Procedures ,Jaundice, Obstructive ,Fine-needle aspiration ,Italy ,030220 oncology & carcinogenesis ,EUS-FNA ,Multivariate Analysis ,Regression Analysis ,030211 gastroenterology & hepatology ,Female ,Stents ,Radiology ,business ,Plastics - Abstract
Objective: While the presence of biliary stent significantly decreases the accuracy of endoscopic ultrasound (EUS) for pancreatic head cancer staging, its impact on the EUS-guided sampling accuracy is still debated. Furthermore, data on EUS-fine needle biopsy (EUS-FNB) using core biopsy needles in patients with pancreatic mass and biliary stent are lacking. The aim of this study was to evaluate the influence of biliary stent on the adequacy and accuracy of EUS-FNB in patients with pancreatic head mass. Methods: All patients who underwent EUS-guided sampling with core needles of solid pancreatic head masses causing obstructive jaundice were retrospectively identified in a single tertiary referral center. Adequacy, defined as the rate of cases in which a tissue specimen for proper examination was achieved, with and without biliary stent, was the primary outcome measure. The diagnostic accuracy and complication rate were the secondary outcome measures. Results: A total of 130 patients with pancreatic head mass causing biliary obstruction were included in the study: 74 cases of them were sampled without stent and 56 cases with plastic stent in situ. The adequacy was 96.4% in the stent group and 90.5% in the group without stent (p = 0.190). No significant differences were observed for sensitivity (88.9% vs. 85.9%), specificity (100% for both groups), and accuracy (89.3% vs. 86.5%) between those with and without stent, respectively. The accuracy was not influenced by the timing of stenting (
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- 2017
18. Team work and cytopathology molecular diagnosis of solid pancreatic lesions
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Stefania Ghersi, Adele Fornelli, Daniela Grifoni, Giorgia Acquaviva, Vincenzo Cennamo, Giovanni Tallini, Dario de Biase, Elio Jovine, Marco Bassi, Carlo Fabbri, Matteo Fassan, Antonio Gasbarrini, Silvia Giovanelli, G. Gibiino, Michela Visani, Sirio Fiorino, Fabbri, Carlo, Gibiino, Giulia, Fornelli, Adele, Cennamo, Vincenzo, Grifoni, Daniela, Visani, Michela, Acquaviva, Giorgia, Fassan, Matteo, Fiorino, Sirio, Giovanelli, Silvia, Bassi, Marco, Ghersi, Stefania, Tallini, Giovanni, Jovine, Elio, Gasbarrini, Antonio, and DE BIASE, Dario
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Endoscopic ultrasound ,Male ,Pathology ,Radiology, Nuclear Medicine and Imaging ,Key genes ,endocrine system diseases ,Molecular marker ,Bioinformatics ,medicine.disease_cause ,Endosonography ,0302 clinical medicine ,CDKN2A ,Nuclear Medicine and Imaging ,Smad4 Protein ,medicine.diagnostic_test ,Gastroenterology ,molecular diagnostic ,Immunohistochemistry ,Molecular Diagnostic Techniques ,Pancreatic Ductal ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,KRAS ,Radiology ,Carcinoma, Pancreatic Ductal ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,molecular markers ,Settore MED/12 - GASTROENTEROLOGIA ,review ,pancreatic ductal adenocarcinoma ,Sensitivity and Specificity ,03 medical and health sciences ,Endoscopic ultrasound-guided fine-needle aspiration ,Molecular diagnostic ,Molecular markers ,Review ,Pancreatic cancer ,medicine ,Cyclin-Dependent Kinase Inhibitor p18 ,Humans ,endoscopic ultrasound-guided fine-needle aspiration ,Neoplasm Invasiveness ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Cyclin-Dependent Kinase Inhibitor p16 ,Neoplasm Staging ,Patient Care Team ,business.industry ,Pancreatic Neoplasms ,Carcinoma ,medicine.disease ,digestive system diseases ,Cytopathology ,Carcinogenesis ,business - Abstract
Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second leading cause of cancer-associated death in the next decade or so. It is widely accepted that tumorigenesis is linked to specific alterations in key genes and pancreatic neoplasms are some of the best characterized at the genomic level. Recent whole-exome and whole-genome sequencing analyses confirmed that PDAC is frequently characterized by mutations in a set of four genes among others: KRAS, TP53, CDKN2A/p16, and SMAD4. Sequencing, for example, is the preferable technique available for detecting KRAS mutations, whereas in situ immunochemistry is the main approach for detecting TP53 gene alteration. Nevertheless, the diagnosis of PDAC is still a clinical challenge, involving adequate acquisition of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and specific pathological assessment from tissue architecture to specific biomolecular tests. The aim of the present review is to provide a complete overview of the current knowledge of the biology of pancreatic cancer as detected by the latest biomolecular techniques and, moreover, to propose a paradigm for strict teamwork collaboration in order to improve the correct use of diagnostic sources.
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- 2017
19. Which approach should be used for endoscopic ultrasound-guided biliary drainage?
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Alberto Larghi, Carlo Fabbri, Rastislav Kunda, Lorenzo Fuccio, Fabbri, Carlo, Fuccio, Lorenzo, Kunda, Rastislav, and Larghi, Alberto
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Endoscopic ultrasound ,medicine.medical_specialty ,Biliary drainage ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Endoscopy ,Pancreatic cancer ,Endosonography ,medicine ,Drainage ,Humans ,Endoscopic Ultrasound ,Radiology ,business ,Cancer - Abstract
NA
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- 2016
20. Possible association between hepatitis C virus and malignancies different from hepatocellular carcinoma: A systematic review
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Carlo Fabbri, Giorgia Acquaviva, Raffaele Lombardi, Laura Pontoriero, Fabio Grizzi, Andrea Cuppini, Elio Jovine, Luca Di Tommaso, Arrigo Bondi, Sergio Sabbatani, Michele Masetti, Michela Visani, Andrea Tura, Adele Fornelli, Annalisa Pession, Laura Mastrangelo, Matteo Zanello, Sirio Fiorino, Letizia Bacchi-Reggiani, Dario de Biase, Fiorino, Sirio, Bacchi Reggiani, Maria Letizia, De Biase, Dario, Fornelli, Adele, Masetti, Michele, Tura, Andrea, Grizzi, Fabio, Zanello, Matteo, Mastrangelo, Laura, Lombardi, Raffaele, Acquaviva, Giorgia, Di Tommaso, Luca, Bondi, Arrigo, Visani, Michela, Sabbatani, Sergio, Pontoriero, Laura, Fabbri, Carlo, Cuppini, Andrea, Pession, Annalisa, and Jovine, Elio
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Oncology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Systematic Reviews ,Hepatocellular carcinoma ,Hepatitis C virus ,macromolecular substances ,Hepacivirus ,medicine.disease_cause ,Risk Assessment ,Cholangiocarcinoma ,Breast cancer ,Risk Factors ,Internal medicine ,Pancreatic cancer ,Neoplasms ,Medicine ,Humans ,Thyroid cancer ,Cancer ,business.industry ,Liver Neoplasms ,Gastroenterology ,virus diseases ,General Medicine ,Hepatitis C ,Extra-hepatic malignancie ,medicine.disease ,digestive system diseases ,Neoplasm ,Risk factor ,business ,Hepatitis C viru ,Kidney cancer - Abstract
AIM: To summarize the current knowledge about the potential relationship between hepatitis C virus (HCV) infection and the risk of several extra-liver cancers. METHODS: We performed a systematic review of the literature, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement. We extracted the pertinent articles, published in MEDLINE and the Cochrane Library, using the following search terms: neoplasm/cancer/malignancy/tumor/carcinoma/adeno-carcinoma and non-Hodgkin lymphomas, kidney/renal-, cholangio-, pancreatic-, thyroid-, breast-,oral-, skin-, prostate-, lung-, colon-, stomach-, haematologic. Case series, case-series with control-group, case-control, cohort-studies as well as meta-analyses, written in English were collected. Some of the main characteristics of retrieved trials, which were designed to investigate the prevalence of HCV infection in each type of the above-mentioned human malignancies were summarised. A main table was defined and included a short description in the text for each of these tumours, whether at least five studies about a specific neoplasm, meeting inclusion criteria, were available in literature. According to these criteria, we created the following sections and the corresponding tables and we indicated the number of included or excluded articles, as well as of meta-analyses and reviews: (1) HCV and haematopoietic malignancies; (2) HCV and cholangiocarcinoma; (3) HCV and pancreatic cancer; (4) HCV and breast cancer; (5) HCV and kidney cancer; (6) HCV and skin or oral cancer; and (7) HCV and thyroid cancer. RESULTS: According to available data, a clear correlation between regions of HCV prevalence and risk of extra-liver cancers has emerged only for a very small group of types and histological subtypes of malignancies. In particular, HCV infection has been associated with: (1) a higher incidence of some B-cell Non-Hodgkin-Lymphoma types, in countries, where an elevated prevalence of this pathogen is detectable, accounting to a percentage of about 10%; (2) an increased risk of intra-hepatic cholangiocarcinoma; and (3) a correlation between HCV prevalence and pancreatic cancer (PAC) incidence. CONCLUSION: To date no definitive conclusions may be obtained from the analysis of relationship between HCV and extra-hepatic cancers. Further studies, recruiting an adequate number of patients are required to confirm or deny this association.
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- 2015
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