ATP assay-guided chemosensitivity testing for gemcitabine with biopsy specimens obtained from unresectable pancreatic cancer using endoscopic ultrasonography-guided fine-needle aspiration

Wakatsuki, Takeru; Irisawa, Atsushi; Terashima, Masanori; Shibukawa, Goro; Takagi, Tadayuki; Imamura, Hidemichi; Takahashi, Yuta; Sato, Ai; Satō, Masaki; Ikeda, Tsunehiko; Suzuki, Rei; Hikichi, Takuto; Obara, Katsutoshi; Ohira, Hiromasa

doi:10.1007/s10147-011-0197-3

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…First, EUS-FNA often requires the presence of an on-site cytopathologist to assess the adequacy of samples and improve diagnostic yield. [25][26][27] is also useful in providing a histologically complete specimen for evaluation of tumor biology with a higher diagnostic accuracy than samples collected by EUS-guided FNA. [22][23][24] Lastly, EUS-FNA is associated with a low negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound guided fine‐needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency

Syed

Babich

Rao

et al. 2019

Diagnostic Cytopathology

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Background: Endoscopic ultrasound (EUS) guided core needle biopsies (CNB) are increasingly being performed to diagnose solid pancreatic lesions. However, studies have been conflicting in terms of CNB improving diagnostic accuracy and procedural efficiency vs fine-needle aspiration (FNA), which this study aims to elucidate.Methods: Data were prospectively collected on consecutive patients with solid pancreatic or peripancreatic lesions at a single tertiary care center from November 2015 to November 2016 that underwent either FNA or CNB. Patient demographics, characteristics of lesions, diagnostic accuracy, final and follow-up pathology, use of rapid on-site evaluation (ROSE), complications, and procedure variables were obtained.Results: A total of 75 FNA and 48 CNB were performed; of these, 13 patients had both. Mean passes were lower with CNB compared to FNA (2.4 vs 2.9, P = .02). Use of ROSE was higher for FNA (97.3% vs 68.1%, P = .001). Mean procedure time was shorter with CNB (34.1 minutes vs 51.2 minutes, P = .02) and diagnostic accuracy was similar (89.2% vs 89.4%, P = .98). There was no difference in diagnostic accuracy when ROSE was performed for CNB vs not performed (93.5% vs 85.7%, P = .58).Additionally, diagnostic accuracy of combined FNA and CNB procedures was 92.3%, which was comparable to FNA (P = .73) or CNB (P = .52) alone.Conclusion: FNA and CNB had comparable safety and diagnostic accuracy. Use of CNB resulted in less number of passes and shorter procedure time as compared to FNA. Moreover, diagnostic accuracy for CNB with or without ROSE was similar.K E Y W O R D S core biopsy, endoscopic ultrasound, fine-needle aspiration, pancreatic cancer, pancreatic mass

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Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound guided fine‐needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency

Syed

Babich

Rao

et al. 2019

Diagnostic Cytopathology

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“…Radiotherapy dose escalation for this subset of patients may delay or prevent recurrence, and thereby improve survival. Another possibility would be to test tumor tissue obtained at the time of biopsy for radiosensitivity, similar to a recent study that evaluated sensitivity to gemcitabine in vitro [25], to select patients most likely to benefit from aggressive local therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have demonstrated that CA 19–9 levels can predict response to CRT and can be prognostic for outcome in the unresectable setting [11,25,27,28]. Yoo et al [11] recently demonstrated that a CA 19–9 level <100 U/mL before or after CRT for unresectable pancreatic cancer is prognostic for overall survival.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose ≥54 Gy and CA 19–9 response are associated with improved survival for unresectable, non-metastatic pancreatic cancer treated with chemoradiation

et al. 2012

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BackgroundUnresectable pancreatic cancer (UPC) has low survival. With improving staging techniques and systemic therapy, local control in patients without metastatic disease may have increasing importance. We investigated whether the radiation dose used in chemoradiation (CRT) as definitive treatment for UPC and the CA 19–9 response to therapy have an impact on overall survival (OS).MethodsFrom 1997–2009 46 patients were treated with CRT for non-metastatic UPC. Median prescribed RT dose was 54 Gy (range 50.4-59.4 Gy). All patients received concurrent chemotherapy (41: 5-fluorouracil, 5: other) and 24 received adjuvant chemotherapy.Results41 patients were inoperable due to T4 disease and 5 patients with T3 disease were medically inoperable. Five patients did not complete CRT due to progressive disease or treatment-related toxicity (median RT dose 43.2 Gy). Overall, 42 patients were dead of disease at the time of last follow-up. The median and 12 month OS were 8.8 months and 35%, respectively. By univariate analysis, minimum CA 19–9 post-CRT <90 U/mL was favorably associated with OS (12.3 versus 8.8 months, p = 0.012). Radiotherapy dose ≥54 Gy trended towards improved OS (11.3 versus 6.8 months, p = 0.089). By multivariable analysis, a delivered RT dose of ≥54 Gy (HR 0.47, p = 0.028) and minimum CA 19–9 post-CRT of <90 U/mL (HR 0.35, p = 0.008) were associated with OS.ConclusionsCRT as definitive treatment for UPC had low survival. However, our retrospective data suggest that patients treated to ≥54 Gy or observed to have a minimum post-CRT CA 19–9 <90 U/mL had improved likelihood of long-term survival.

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“…Moreover, tissue specimens for histological examination also provide the opportunity (i) to easily immunostain the tissue, further improving differential diagnostic capabilities; (ii) to reach a specific diagnosis for benign diseases not always possible with a cytological sample, thus sparing patients from more invasive and risky procedures or costly and unnecessary follow up examinations; (iii) to potentially perform tissue profiling and/or cell culture needed to guide targeted therapies for individualized treatment of patients with cancer of the gastrointestinal tract [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Accuracy and inter-observer agreement of the Procore™ 25 gauge needle for endoscopic ultrasound-guided tissue core biopsy

Attili

Petrone

Abdulkader

et al. 2015

Digestive and Liver Disease

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ATP assay-guided chemosensitivity testing for gemcitabine with biopsy specimens obtained from unresectable pancreatic cancer using endoscopic ultrasonography-guided fine-needle aspiration

Abstract: Chemosensitivity testing by use of EUS-FNA samples in patients with unresectable pancreatic cancer is feasible. This definition emphasizes the possibility of selecting patients for whom favorable results from gemcitabine treatment can be expected.

Cited by 16 publications

References 33 publications

Endoscopic ultrasound guided fine‐needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency

Endoscopic ultrasound guided fine‐needle aspiration vs core needle biopsy for solid pancreatic lesions: Comparison of diagnostic accuracy and procedural efficiency

Radiation dose ≥54 Gy and CA 19–9 response are associated with improved survival for unresectable, non-metastatic pancreatic cancer treated with chemoradiation

Accuracy and inter-observer agreement of the Procore™ 25 gauge needle for endoscopic ultrasound-guided tissue core biopsy

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