Evaluating Pancreatic and Biliary Neoplasms with Small Biopsy-Based Next Generation Sequencing (NGS): Doing More with Less

Pancreatic cancer and cholangiocarcinoma are lethal diseases mainly diagnosed at an inoperable stage. As pancreatobiliary surgical specimens are often unavailable for further molecular testing, this review aimed to highlight the diagnostic, prognostic, and therapeutic impact of next-generation sequencing (NGS) performed on distinct small biopsies, including endoscopic ultrasound fine-needle aspirations and biopsies of pancreatic solid and cystic lesions, biliary duct brushings, and also “liquid biopsies” such as the pancreatic juice, bile, and blood. NGS could clarify indeterminate pancreatic lesions or biliary strictures, for instance by identifying TP53 or SMAD4 mutations indicating high-grade dysplasia or cancer. It could also stratify pancreatic cystic lesions, by distinguishing mucinous from non-mucinous cysts and identifying high-risk cysts that should be excised in surgically fit patients, whereas the combination of cytology, elevated cystic CEA levels and NGS could improve the overall diagnostic accuracy. When NGS is performed on the pancreatic juice, it could stratify high-risk patients under surveillance. On the plasma, it could dynamically monitor the disease course and response to therapy. Notably, the circulating tumor DNA (ctDNA) levels have been associated with staging, grading, and survival. Lastly, NGS has shown potential in identifying potentially actionable molecular alterations. In conclusion, NGS applied on small biopsies could carry significant diagnostic, prognostic, and therapeutic value.

The Clinical and Prognostic Factors for Biliary Neuroendocrine Neoplasm: A Study Based on the SEER Database

Background: In this study, we aimed at elucidating the postoperative survival and prognostic factors in patients with biliary neuroendocrine neoplasm (NEN).Methods: Cases of biliary system NEN and adenocarcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A propensity score matching (PSM) method was used to adjust baseline differences in clinicopathological characteristics in our analysis. The Kaplan-Meier analysis was carried out for survival analysis. Results：A total of 243 patients with biliary system NEN were enrolled in this study, of which 119 patients’ lesions located in gallbladder, while the others’ located in bile duct. The postoperative overall survival of bile duct NEN is significantly longer than that of gallbladder NEN (P<0.001). For GB-NENs, surgery method (P=0.020) and lymph node metastasis (P=0.018) were identified as independent prognostic factors. In terms of AOV NENs, age (P=0.017) and lymph node metastasis (P=0.006) were identified was independent prognostic factor, while grade (P=0.002) and lymph node metastasis (P=0.036) were identified as independent prognostic factors for EBD NENs. PSM analysis indicated that patients with biliary duct NENs have better postoperative prognosis than biliary duct adenocarcinoma.Conclusions: Patients with NEN have better overall survival than patients with adenocarcinoma. Gallbladder NEN has adverse prognosis than that of biliary tract NEN. Pathological subtype, differentiation, lymph node metastasis, surgery method and lymph node resection could affect postoperative prognosis of gallbladder and biliary tract NEN.

The Effect of Aerobic Exercise against D-galactose and AlCl3-induced Hepatosteatosis in Mus Musculus C57BL/6J

In the 21st century, sedentary habits and consumption of caramelized food packed in aluminium foil made the oxidative state on the body. There are differences in opinions about aerobic exercise and its effects on inflammation and oxidative stress. This research aims to compare the liver histologic pattern between the group which was given aerobic exercise and not given after being induced with D-galactose and AlCl3. .: This research used an experimental method using two groups of Mus musculus C57BL/ which was injected with D-galactose (90 mg/kg body weight) and AlCl3 (40 mg/kg body weight). The control group was only injected with those substances. The aerobic group was intervened with swimming for 30 minutes each day (6 days a week). After being sacrificed, HE staining was done in the liver specimens to evaluate the bile duct proliferation and steatosis changes. There were significant differences in biliary duct proliferation (p = 0.043) and steatosis changes (p = 0.043) in an aerobic group compared to the control group. Aerobic exercise which was conducted 30 minutes for 6 days a week showed more bile duct proliferation and increased steatosis changes.

‘It’s always in the back of my mind’: understanding the psychological impact of recovery following pancreaticoduodenectomy for cancer: a qualitative study

ObjectivesTen per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. There is limited previous research focusing on psychological well-being; unmet support needs impact negatively on quality of life. This paper reports the psychological impact of a pancreatic cancer diagnosis and subsequent pancreaticoduodenectomy, exploring how patients’ lives alter following surgery and how they seek support.DesignInductive qualitative study involving in-depth semistructured interviews with 20 participants who had undergone pancreaticoduodenectomy for pancreatic or distal biliary duct cancer. Interviews were audiorecorded, transcribed and anonymised, and thematic analysis used principles of constant comparison.SettingSingle National Health Service Trust in Northwest England.ParticipantsPatients were eligible for inclusion if they had had pancreaticoduodenectomy for head of pancreas cancer, periampullary cancer or distal cholangiocarcinoma between 6 months and 6 years previously, and had completed adjuvant chemotherapy.ResultsAnalysis identified the following main themes: diagnosis and decision making around surgery; recovery from surgery and chemotherapy; burden of monitoring and ongoing symptoms; adjusting to ‘a new normal’; understanding around prognosis; support-seeking. Participants seized the chance to have surgery, often without seeming to absorb the risks or their prognosis. They perceived that they were unable to control their life trajectory and, although they valued close monitoring, experienced anxiety around their appointments. Participants expressed uncertainty about whether they would be able to return to their former activities. There were tensions in their comments about support-seeking, but most felt that emotional support should be offered proactively.ConclusionsPatients should be made aware of potential psychological sequelae, and that treatment completion may trigger the need for more support. Clinical nurse specialists (CNSs) were identified as key members of the team in proactively offering support; further training for CNSs should be encouraged. Understanding patients’ experience of living with cancer and the impact of treatment is crucial in enabling the development of improved support interventions.

Outcome and Complications of Percutaneous Transhepatic Biliary Drainage: Influence of Liver Entry Site

Objective: To determine the outcome and complications of percutaneous transhepatic biliary drainage (PTBD) performed via right lobe and left lobe duct puncture. Study Design: Cross-sectional study. Place and Duration of Study: Department of Interventional Radiology, Dow Institute of Radiology, Dow University of Health Sciences from July 2020 to March 2021. Methodology: Both adult male and female patients with obstructive jaundice having dilated intrahepatic biliary ducts on ultrasound were included. PTBD was performed under ultrasound guidance. Following intrahepatic biliary duct puncture, a guide wire was inserted followed by placement of 8 Fr or 10 Fr pigtail drainage catheter. Total bilirubin level was measured before and one day after the procedure. Cholangiogram was performed 48 hours after the procedure to check the drain placement and residual dilatation. Results: 130 patients were included with mean age of 55.3 ± 12.3 years. Success rate was same in patients with right and left lobe puncture i.e. 96.9%. The frequency of complication in right lobe puncture was higher (37.5%). Mean procedure time was significantly higher in patients who developed complications (75.92 ± 19.20 minutes) as well as mean exposure time was also significantly higher in patients who developed complications (12.00 ± 6.87 minutes) as compared to patients who did not develop any complication (8.08 ± 3.43 minutes) (p <0.05). Conclusion: It was concluded that the success rate in right and left lobe puncture was equal and complication rate in right lobe puncture was observed to be high as compared to left lobe puncture. Keywords: Biliary drainage, Complications, Effect, Liver