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Gastrointestinal cancers
Published in Ruijiang Li, Lei Xing, Sandy Napel, Daniel L. Rubin, Radiomics and Radiogenomics, 2019
Gastrointestinal (GI) cancer refers to a spectrum of cancers of the GI tract and accessory organs of digestion, including cancers of the esophagus, stomach, small intestine, colon, rectum, pancreas, and gallbladder. Gastric cancer (GC) and colorectal cancer (CRC) are the two most common gastrointestinal malignancies and the third and fourth leading causes of cancer-related fatality globally, respectively. Esophagus cancer (EC) is the sixth most common gastrointestinal cancer in the world, and its incidence is increasing. Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor and the third most frequent reason for cancer-related mortality (Forner et al. 2012). Meanwhile, the liver is the most common metastasis site for CRC (developed in approximately 50% of patients) (Al Bandar and Kim 2017). Pancreatic adenocarcinoma (PA) is the most common malignant tumor of the pancreas, with a low overall 5-year survival rate of 8% (Chiaravalli et al. 2017). Intraductal papillary mucinous neoplasm (IPMN) is the precursor of PA (Fong and Fernandez-Del Castillo 2016).
Through-the-needle biopsy of pancreatic cystic lesions: current evidence and implications for clinical practice
Published in Expert Review of Medical Devices, 2021
Antonio Facciorusso, Daryl Ramai, Paraskevas Gkolfakis, Alexandra Shapiro, Marianna Arvanitakis, Andrea Lisotti, Konstantinos Triantafyllou, Pietro Fusaroli, Ioannis S Papanikolaou, Stefano Francesco Crinò
As previously mentioned, several series and recent meta-analyses confirmed the favorable diagnostic accuracy and sensitivity of EUS-TTNB [43–47]. While efficacy of EUS-TTNB technique has proven favorable, the safety of the procedure remains equivocal. Recent concerns have been raised regarding safety, particularly in a European retrospective report, where a case of death due to post-EUS-TTNB pancreatitis was registered [42]. Perception of EUS-TTNB technique is likely influenced by the reported AEs and this effect may contribute to hesitation regarding implementation into clinical practice, given that clinical utility is not yet well-established. However, as highlighted by an editorial to the previously mentioned study, many AEs were reported in the context of broadened inclusion criteria. This study expanded the indications to include cysts ≥ 15 mm regardless of morphological characteristics. Properly refined indications use EUS-TTNB technique on PCLs of this size range only if worrisome morphological features are detected [42,49]. Use of EUS-TTNB technique is advisable when morphological features are equivocal, and definitive histological analysis has potential to add high-value diagnostic information to the clinical picture. Less stringent indications result in use of EUS-TTNB testing in scenarios where results are unlikely to contribute any further diagnostic benefit while exposing patients to unnecessary risk. Management of intraductal papillary mucinous neoplasm (IPMN) is primarily derived from appraisal of morphological features. In this study, cases where morphological features suggested IPMN still underwent EUS-TTNB procedure due to the broad indications. Ultimately, 40% of biopsy results supported the original diagnosis of IPMN, which was reached without subjecting patients to invasive testing. Expansion of indications allowed for rapid enrollment of a larger quantity of patients. Specifically, over a 19-month time period, 101 patients were deemed eligible and included out of 521 patients that were assessed for eligibility [42]. While this approach enables higher volume of data collection, it does so at the expense of proper patient selection. Improper patient selection for EUS-TTNB in this study likely contributed to the higher rate of AE as well as the lower percentage of disease detection. Proper patient selection is an important consideration when interpreting data and when evaluating clinical utility. Patient selection conducted with less stringent indications creates a scenario in which the use of EUS-TTNB in several cases of IPMN may have had limited beneficial impact, yet still exposed the patient to increased risk of pancreatitis and other severe events.