Myosteatosis to predict postoperative morbidity in pancreatic ductal adenocarcinoma patients receiving neoadjuvant chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16754-e16754
Author(s):  
Raphael Louie ◽  
Gabriel Aleixo ◽  
Allison Mary Deal ◽  
Emily Damone ◽  
Jaclyn Tremont-Portelli ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Postoperative Morbidity ◽  
Tube Feeding ◽  
Ct Scans ◽  
Ductal Adenocarcinoma ◽  
Baseline Body Mass Index ◽  
Cross Sectional ◽  
Student’S T ◽  
Morbidity Risk

e16754 Background: Myosteatosis (adipose deposits in muscle) can be detected on cross-sectional imaging through variations in Skeletal Muscle Density (SMD). Patients with myosteatosis tend to have lower overall survival, increased chemotherapy toxicity, and shorter progression-free intervals across cancer types. We investigated whether changes in myosteatosis during neoadjuvant chemotherapy can predict postoperative morbidity risk in patients with pancreatic ductal adenocarcinoma (PDAC). Methods: This is a retrospective cohort study from 2014-2019 of patients with biopsy-proven PDAC who completed neoadjuvant chemotherapy and R0/1 resection (R1: margin < 1mm or microscopically positive). We obtained preoperative patient (age at diagnosis, baseline body mass index (BMI), sex, race, comorbidities) and treatment data (neoadjuvant chemotherapy regimen and duration, time from completion of systemic therapy to surgery, type of operation). Primary outcomes were postoperative complications and 90-day readmission. Average SMD was measured using imaging analysis software at the L3 level on axial abdominal CT scans at the time of diagnosis and at completion of neoadjuvant therapy (SliceOmatic TomoVision QC, Can). We defined SMDΔ as the decrease in SMD during neoadjuvant chemotherapy. Descriptive statistics and Student’s t-test were performed with STATA. Results: We identified 44 patients who received neoadjuvant chemotherapy, achieved a R0/1 resection, and had available CT scans for body composition evaluation. The postoperative complication rate was 43% (n = 19) and 90-day readmission rate was 30% (n = 13). Lower SMD at diagnosis was associated with increased postoperative delirium (p < 0.01) and 90-day readmission (p = 0.02). Greater SMDΔ was associated with increased ICU utilization (p < 0.01) and tube feeding upon discharge (p = 0.03). There was no significant association between preoperative BMI or albumin and our primary outcomes. Conclusions: Preoperative SMD and SMDΔ, rather than albumin or BMI, can predict postoperative morbidity in PDAC patients who received neoadjuvant chemotherapy. This study provides the framework for future studies to develop and validate a tool to predict postoperative morbidity risk in these patients.

scholarly journals Is neoadjuvant chemotherapy always justified in clinical T1 pancreatic ductal adenocarcinoma?

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S233
Author(s):  
H.S. Kim ◽  
K. Nakagawa ◽  
T. Akahori ◽  
K. Nakamura ◽  
T. Takagi ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma

Characterization of undiagnosed pancreatic ductal adenocarcinoma on CT scans.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 380-380
Author(s):  
John Chang ◽  
Madelyn Bartels ◽  
Kelsey Beyer ◽  
Ashley Maitland ◽  
Richard Taft Peterson ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
The Body ◽  
Ct Scans ◽  
Ductal Adenocarcinoma ◽  
Imaging Features ◽  
Cognitive Errors ◽  
Radiologic Findings ◽  
Stage 1 ◽  
Improved Technology ◽  
Radiologic Features

380 Background: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths. At present, the best 5-year survival is 25% for resectable PDAC. For small (1 cm) stage 1 PDAC, resection has resulted in much better survival. The goal of this study was to evaluate the appearance and location of early undiagnosed PDAC on computed tomography scans (CT) prior to diagnosis with the goal of minimizing missing early PDAC. We also categorize the errors as either perceptive or cognitive. Methods: PDAC cases were retrospectively reviewed from 1/1/2012 through 12/31/2018 from our tumor registry, identifying 81 cases with paired CT scans both at the time of and prior to diagnosis. Among these, 31 contained imaging features considered diagnostic or suspicious for early PDAC(38%). These “errors” were classified by radiologic features and as well as by location. In addition, errors were classified into “perceptive errors" when the first study was read as normal, and as “cognitive errors” when the report noted an abnormality but failed to note suspicion for malignancy. Results: Among the 31 undiagnosed PDAC, 18 had features of an identifiable mass (58%), 9 had pancreatic ductal dilatation (29%), and 4 had evidence of perivascular soft tissue (13%). 44% of undiagnosed tumors were located in the head-neck, 39% in the body, and 17% in the tail. Perceptive errors were found in 58% and 42% were cognitive. No significant differences were seen between perceptive and cognitive errors based on suspicious features. Conclusions: Radiologic findings of early PDAC was retrospectively evident in more than one third of cases in which prior imaging was performed. These findings are most often masses or ductal dilatation. Location of these undiagnosed tumors were distributed throughout the gland. This study identifies the radiologic features of undiagnosed PDAC which may provide an opportunity for future prospective studies and improved technology which may improve early detection of pancreatic cancer.

scholarly journals Imaging-Based Subtypes of Pancreatic Ductal Adenocarcinoma Exhibit Differential Growth and Metabolic Patterns in the Pre-Diagnostic Period: Implications for Early Detection

2020 ◽  
Vol 10 ◽  
Author(s):  
Mohamed Zaid ◽  
Dalia Elganainy ◽  
Prashant Dogra ◽  
Annie Dai ◽  
Lauren Widmann ◽  
...  
Keyword(s):  
Growth Rate ◽  
Early Detection ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Cross Validation ◽  
Abdominal Fat ◽  
Metabolic Effects ◽  
Ct Scans ◽  
Ductal Adenocarcinoma ◽  
Tumor Growth Rate ◽  
Average Growth

BackgroundPreviously, we characterized subtypes of pancreatic ductal adenocarcinoma (PDAC) on computed-tomography (CT) scans, whereby conspicuous (high delta) PDAC tumors are more likely to have aggressive biology and poorer clinical outcomes compared to inconspicuous (low delta) tumors. Here, we hypothesized that these imaging-based subtypes would exhibit different growth-rates and distinctive metabolic effects in the period prior to PDAC diagnosis.Materials and methodsRetrospectively, we evaluated 55 patients who developed PDAC as a second primary cancer and underwent serial pre-diagnostic (T0) and diagnostic (T1) CT-scans. We scored the PDAC tumors into high and low delta on T1 and, serially, obtained the biaxial measurements of the pancreatic lesions (T0-T1). We used the Gompertz-function to model the growth-kinetics and estimate the tumor growth-rate constant (α) which was used for tumor binary classification, followed by cross-validation of the classifier accuracy. We used maximum-likelihood estimation to estimate initiation-time from a single cell (10-6 mm3) to a 10 mm3 tumor mass. Finally, we serially quantified the subcutaneous-abdominal-fat (SAF), visceral-abdominal-fat (VAF), and muscles volumes (cm3) on CT-scans, and recorded the change in blood glucose (BG) levels. T-test, likelihood-ratio, Cox proportional-hazards, and Kaplan-Meier were used for statistical analysis and p-value &lt;0.05 was considered significant.ResultsCompared to high delta tumors, low delta tumors had significantly slower average growth-rate constants (0.024 month−1 vs. 0.088 month−1, p&lt;0.0001) and longer average initiation-times (14 years vs. 5 years, p&lt;0.0001). α demonstrated high accuracy (area under the curve (AUC)=0.85) in classifying the tumors into high and low delta, with an optimal cut-off of 0.034 month−1. Leave-one-out-cross-validation showed 80% accuracy in predicting the delta-class (AUC=0.84). High delta tumors exhibited accelerated SAF, VAF, and muscle wasting (p &lt;0.001), and BG disturbance (p&lt;0.01) compared to low delta tumors. Patients with low delta tumors had better PDAC-specific progression-free survival (log-rank, p&lt;0.0001), earlier stage tumors (p=0.005), and higher likelihood to receive resection after PDAC diagnosis (p=0.008), compared to those with high delta tumors.ConclusionImaging-based subtypes of PDAC exhibit distinct growth, metabolic, and clinical profiles during the pre-diagnostic period. Our results suggest that heterogeneous disease biology may be an important consideration in early detection strategies for PDAC.

scholarly journals Morphometric Assessment of Confocal Laser Endomicroscopy for Pancreatic Ductal Adenocarcinoma, an Ex-Vivo Pilot Study

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 923
Author(s):  
Bogdan Silviu Ungureanu ◽  
Daniel Pirici ◽  
Simona Olimpia Dima ◽  
Irinel Popescu ◽  
Gheorghe Hundorfean ◽  
...  
Keyword(s):  
Image Analysis ◽  
Pilot Study ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ex Vivo ◽  
Ductal Adenocarcinoma ◽  
Confocal Laser Endomicroscopy ◽  
Resection Margins ◽  
Confocal Laser ◽  
Cross Sectional ◽  
Hole Area

Ex-vivo freshly surgical removed pancreatic ductal adenocarcinoma (PDAC) specimens were assessed using pCLE and then processed for paraffin embeding and histopathological diagnostic in an endeavour to find putative image analysis algorithms that might recognise adenocarcinoma. Methods: Twelve patients diagnosed with PDAC on endoscopic ultrasound and FNA confirmation underwent surgery. Removed samples were sprayed with acriflavine as contrast agent, underwent pCLE with an experimental probe and compared with previous recordings of normal pancreatic tissue. Subsequently, all samples were subjected to cross-sectional histopathology, including surgical resection margins for controls. pCLE records, as well as corespondant cytokeratin-targeted immunohistochemistry images were processed using the same morphological classifiers in the Image ProPlus AMS image analysis software. Specific morphometric classifiers were automatically generated on all images: Area, Hole Area (HA), Perimeter, Roundness, Integrated Optical Density (IOD), Fractal Dimension (FD), Ferret max (Fmax), Ferret mean (Fmean), Heterogeneity and Clumpiness. Results: After histopathological confirmation of adenocarcinoma areas, we have found that the same morphological classifiers could clearly differentiate between tumor and non-tumor areas on both pathology and correspondand pCLE (area, roundness, IOD, ferret and heterogeneity (p < 0.001), perimeter and hole area (p < 0.05). Conclusions: This pilot study proves that classical morphometrical classifiers can clearly differentiate adenocarcimoma on pCLE data, and the implementation in a live image-analysis algorithm might help in improving the specificity of pCLE in vivo diagnostic.

Malignant Lesions of the Pancreas

2016 ◽  
Author(s):  
Omer Basar ◽  
Abdurrahman Kadayifci ◽  
William R. Brugge
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Neuroendocrine Tumors ◽  
Needle Aspiration ◽  
Ductal Adenocarcinoma ◽  
Key Words Pancreatic Cancer ◽  
Cross Sectional ◽  
Painless Jaundice ◽  
Cross Sectional Imaging ◽  
Malignant Lesions

Malignant lesions of pancreas are the fourth most common cause of cancer death in men and women. The majority of pancreatic cancer results from malignant transformation of the exocrine pancreas, and nearly 90% are ductal adenocarcinomas (pancreatic ductal adenocarcinoma, PDAC). Patients typically present at an advanced stage with a poor prognosis. PDAC is acquired through the accumulation of multiple genetic mutations. The major risk factors for PDAC include age, smoking, chronic pancreatitis, diabetes mellitus (DM), male gender, and African American race. Less commonly, hereditary syndromes may be implicated. The clinical presentation may involve weight loss, abdominal discomfort, and or jaundice. Painless jaundice, depression, and new-onset DM can suggest the diagnosis. Cross-sectional imaging has utility in diagnosis and staging. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is a standard approach to tissue diagnosis. Endoscopic retrograde cholangiopancreaticography with palliative stenting can relieve obstructive jaundice. Surgical resection is the only potentially curative option in the management of PDAC but only a minority of patients are candidates for resection. The prognosis for most patients with pancreatic adenocarcinoma is poor. Less common pancreatic malignant lesions such as neuroendocrine tumors (NETs) have a much more favorable prognosis.   Key words: Pancreatic cancer; Pancreatic ductal adenocarcinoma; Pancreatic NETs (PNETs); Pancreatic neuroendocrine tumors

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