Rapid immunohistochemical analysis of pancreatic cytology from endoscopic ultrasound-guided fine-needle aspirates: A prospective clinical trial.

400 Background: Acquisition of pancreatic cancer (PC) tissue specimens from endoscopic ultrasound-guided fine needle aspirates (EUS-FNA) is crucial to investigational pancreatic cancer trials seeking to utilize molecular profile directed therapy. Methods: In an ongoing prospective clinical trial we have utilized molecular profiling of EUS-FNA specimens from patients with resectable and borderline resectable pancreatic cancers. Cytologic specimens were evaluated for six biomarkers to guide the choice of neoadjuvant therapy: secreted protein acid rich in cysteine (SPARC), thymidylate synthase (TYMS), ribonucleotide reductase M1 (RRM1), human equilibrative nucleoside transporter 1 (ENT1), excision repair cross-complementing 1 (ERCC), and topoisomerase 1 (TOPO). Final immunohistochemical (IHC) interpretation was scored by a single pathologist using both staining intensity and percent immunochemically reactive cells. Results: The trial has enrolled 99 patients to date; 47 (47%) resectable patients and 52 (52%) borderline resectable patients. No patient experienced a EUS-FNA related complication. IHC profiling was reported in a median of 5 business days (IQR:3). Of the 99 patient samples, 73 (74%) had adequate cellularity for IHC profiling and this was not affected by stage of disease (n = 35, resectable; n = 38 borderline resectable; p = 0.82). Analysis of SPARC expression was limited to specimens with adequate stromal cells for analysis (n = 50, 51%). Among the 73 patients with adequate tissue for profiling, expression profiling was interpreted to be favorable for the following therapeutic agents: nab-paclitaxel, (SPARC, n = 35, 48%), 5-fluorouracil (TYMS, n = 68, 93%), gemcitabine (RRM1, n = 34, 47%; ENT1, n = 38, 52%), platinum agents (ERCC, n = 30, 41%), and irinotecan (TOPO, n = 62, 85%). Conclusions: The use of EUS-FNA specimens for molecular diagnostics is feasible and IHC analysis was possible in 74% of patient specimens, with preservation of stromal components in over 50%. Further refinement of molecular techniques may expand the breadth of analysis which may be performed, to include quantitative polymerase chain reaction and genetic sequencing Clinical trial information: NCIT01726582.

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Phase II clinical trial of biomarker-directed therapy for localized pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.tps4147 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. TPS4147-TPS4147

Author(s):

Susan Tsai ◽

Paul S. Ritch ◽

Beth Erickson ◽

Tracy R. Kelly ◽

Edward Quebbeman ◽

...

Keyword(s):

Pancreatic Cancer ◽

Clinical Trial ◽

Neoadjuvant Therapy ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Resected Specimen ◽

Ultrasound Guided ◽

Borderline Resectable ◽

Fine Needle

TPS4147 Background: Several candidate biomarkers exist for the common chemotherapeutic agents used to treat pancreatic cancer (PC) (Table). The predictive value of these markers in the treatment of PC has not been established. This is the first prospective clinical trial utilizing biomarker-directed therapy for localized pancreatic cancer. Methods: Patients with localized pancreatic cancer undergo endoscopic ultrasound-guided fine needle aspiration (FNA) for confirmation of diagnosis and immunohistochemical profiling . Six biomarkers (STREET profile) were selected based on their relevance to accepted pancreatic chemotherapy regimens (table). The treatment algorithm selected for each individual patient is based on the clinical stage of resectability (resectable/borderline resectable) and the STREET profile results. Neoadjuvant therapy is followed by restaging (CT and serum Ca19-9) and in the absence of disease progression, patients undergo surgery. Post-surgical (adjuvant) therapy is determined by the STREET profile of the resected specimen. The primary endpoint is an increase in the rate of surgical resection 20% compared with historical controls treated with best available neoadjuvant therapy which was not biomarker-directed. Secondary endpoints include assessment of overall and progression-free survival, comparative STREET profiling of pre- and post-treatment specimens, and changes in radiographic response. Eligbility Criteria: Patients with resectable or borderline resectable pancreatic cancer undergo endoscopic ultrasound-guided fine needle aspiration (FNA) for confirmation of diagnosis and immunohistochemical profiling. Enrollment: 26 of planned 100 patients have been enrolled. Clinical trial information: NCT01726582. [Table: see text]

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Efficiency of stylet capillary suction and standard suction technique of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in solid pancreatic cancer

10.26226/morressier.57c53840d462b80296c9c1b7 ◽

2016 ◽

Author(s):

Zoltan Gabor Szepes

Keyword(s):

Pancreatic Cancer ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Capillary Suction ◽

Fine Needle

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Infected Pancreatic Necrosis Mimicking Pancreatic Cancer

Case Reports in Gastroenterology ◽

10.1159/000510161 ◽

2020 ◽

Vol 14 (2) ◽

pp. 436-442

Author(s):

Jun Heo

Keyword(s):

Pancreatic Cancer ◽

Abdominal Pain ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Pancreatic Necrosis ◽

Necrotizing Pancreatitis ◽

Needle Aspiration ◽

Infected Pancreatic Necrosis ◽

Ultrasound Guided ◽

Fine Needle

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.

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