Direct histological processing of EUS biopsies enables rapid molecular biomarker analysis for interventional pancreatic cancer trials

Brais, Rebecca; Davies, Susan; O’Donovan, Maria; Simpson, Ben; Cook, Natalie; Darbonne, Walter C.; Chilcott, Sian; Lolkema, Martijn P.; Neeße, Albrecht; Lockley, Michelle; Corrie, Pippa; Jodrell, Duncan I.; Praseedom, Raaj K.; Huguet, Emmanuel; Jah, Asif; Jamieson, Neville V.; Sauvage, Frédéric J. de; Tuveson, David A.; Carroll, Nicholas

doi:10.1016/j.pan.2011.12.009

Cited by 53 publications

(43 citation statements)

References 27 publications

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“…Criteria for diagnosing AIP in core biopsy specimens have been proposed,66 67 but need to be validated in larger series. Establishing histopathological diagnosis on minute biopsy specimens such as micro-tissue core fragments aspirated in EUS-FNA, as previously suggested for pancreatic cancer,68 may be a clue to optimising the diagnosis of AIP. The fact that, after a complete diagnostic workup, a few cases still require a diagnostic steroid trial and the risk of misdiagnosing or delaying the diagnosis of even a single case of the far more common pancreatic cancer underscore the necessity for novel diagnostic approaches.…”

Section: Type 1 Aipmentioning

confidence: 97%

Republished: Recent advances in autoimmune pancreatitis: type 1 and type 2

Kamisawa

Chari

Lerch

et al. 2013

Postgraduate Medical Journal

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Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis characterised clinically by frequent presentation with obstructive jaundice, histologically by a lymphoplasmacytic infiltrate with fibrosis, and therapeutically by a dramatic response to steroids. When so defined, AIP can be sub-classified into two subtypes, 1 and 2. Recent international consensus diagnostic criteria for AIP have been developed for diagnosis of both forms of AIP. Type 1 AIP is the pancreatic manifestation of a multiorgan disease, recently named IgG4-related disease. Little is known about the pathogenesis of either form of AIP. Despite frequent association of type 1 AIP with elevated serum IgG4 levels and infiltration with IgG4-positive plasma cells, it is unlikely that IgG4 plays a pathogenic role in AIP. Type 1 AIP responds to steroids, but there needs to be consensus on treatment regimens for induction and therapeutic end points. Relapses are common, but can be reduced by long-term use of low-dose steroids. Recent reports suggest that immunomodulators (azathioprine, 6-mercaptopurine and mycophenolate mofetil), as well biological agents (the antibody to CD20, rituximab) may have a role in maintaining remission in relapsing type 1 AIP. Future studies should clarify the best management options for treatment of relapses and maintenance of remission. Type 2 AIP is a pancreas-specific disorder not associated with IgG4. It presents in younger individuals equally with obstructive jaundice and pancreatitis. The inflammatory process responds to steroid therapy; relapses are uncommon. The clinical spectrum and long-term outcomes of medically treated type 2 AIP are still being evaluated.

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Section: Type 1 Aipmentioning

confidence: 97%

Republished: Recent advances in autoimmune pancreatitis: type 1 and type 2

Kamisawa

Chari

Lerch

et al. 2013

Postgraduate Medical Journal

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“…On the other hand, when ROSE is not available or if histology is deemed to be more appropriate than cytology for clinical reasons to reach a definitive diagnosis (mediastinal and abdominal masses/lymphadenopathy of unknown origin, subepithelial lesions, suspicious autoimmune pancreatitis), EUS-FNB is favoured [32,33]. Moreover, in the era of individualized medicine, tissue core biopsy specimens seem to be more adequate than cytological ones to test for predictive molecular markers, and may become of paramount importance to guide the choice of personalized therapies [34,9].…”

Section: Discussionmentioning

confidence: 99%

“…First, we did not include the availability of an onsite cytopathologist. However, one of the advantages of EUS-FNB over EUS-FNA is that it does not need the expertise of the on-site cytopathologist, and thereby, saves the cost and time for the procedure [9]. Secondly, our study was performed in two tertiary centres for EUS previously involved in studies on EUS-FNB [22,24], thus representing a best case-scenario for this type of procedure.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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“…High volume centers clearly have improved surgical outcomes [Lieberman et al 1995;Birkmeyer et al 2002] and similar expertise in the endoscopy suite is likely to also improve patient care. Indeed, a recent report described the diagnostic and financial advantages of direct histological processing of fine needle aspiration (FNA) samples rather than use of cytology [Brais et al 2012]. The recent introduction of endoscopic core biopsy needles has also improved the ability to acquire samples for both diagnostic and experimental purposes.…”

Section: Future Therapeutic Optionsmentioning

confidence: 99%

Pancreatic cancer: why is it so hard to treat?

Oberstein

Olive

2013

Therap Adv Gastroenterol

274

201

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Abstract:No common malignancy is as rapidly and inevitably fatal as pancreatic ductal adenocarcinoma (PDA). This grim fact has driven substantial research efforts into this disease in recent decades. Unfortunately, the investment has yet to result in a meaningful increase in 5-year survival. This has prompted many pancreatic cancer researchers and advocates to redouble their efforts, but also requires one to step back and ask why the previous efforts were lacking and to consider why pancreatic cancer is so difficult to treat. The difficulties are legion. PDA is characterized by an insidious clinical syndrome, but is rarely diagnosed at a time when surgical resection is feasible. We lack markers of early detection and screening programs remain unproven even in high risk populations. The location of the tumor in the retroperitoneum, the advanced age of patients, and the systemic effects of disease limit the options for local therapy. Chemotherapy may provide a small benefit, but most efforts to improve on the current regimens consistently and stubbornly fail in advanced clinical trials. The molecular and cellular features of ductal pancreatic tumors are aggressive and underlay multiple levels of therapeutic resistance. Non-cell-autonomous features including stromal proliferation, reduced vascular density and immune suppression also contribute to therapeutic resistance. Growing awareness of these the fundamental features of PDA has begun to guide ongoing research efforts. Clinical trials are now specifically targeting these tumor properties and actively focusing on the therapeutic implications of tumor stroma. As reviewed here, reflecting on the fundamental question of why pancreatic cancer is so difficult to treat is a necessary and informative exercise that will aid our efforts to improve patient outcomes. These efforts will lead to improvements in clinical trial design, expand our focus to include the molecular and histologic implications of novel treatment paradigms, and ultimately change the lives of our patients.

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Direct histological processing of EUS biopsies enables rapid molecular biomarker analysis for interventional pancreatic cancer trials

Cited by 53 publications

References 27 publications

Republished: Recent advances in autoimmune pancreatitis: type 1 and type 2

Republished: Recent advances in autoimmune pancreatitis: type 1 and type 2

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

Pancreatic cancer: why is it so hard to treat?

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