Characterizing indeterminate liver lesions in patients with localized pancreatic cancer at the time of diagnosis

Bhalla, Manav; Aldakkak, Mohammed; Kulkarni, Naveen M.; O’Connor, Stephen S.; Griffin, Michael O.; Christians, Kathleen K.; Evans, Douglas B.; Tsai, Susan; Tolat, Parag

doi:10.1007/s00261-017-1404-0

Cited by 11 publications

(3 citation statements)

References 15 publications

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“…Our study also attempted to elucidate clinicopathological variables that could assist in predicting malignancy in ILLs; however, due to only a single lesion proving to be malignant, no statistically significant conclusion can be drawn from this. A classification system that further stratifies ILLs by malignant potential can assist clinicians in determining an optimal treatment plan and is associated with a high negative predictive value …”

Section: Discussionmentioning

confidence: 99%

Indeterminate liver lesions – a virtual epidemic: a cohort study over 8 years

Kuan

Mavilakandy

Oyebola

et al. 2020

ANZ Journal of Surgery

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Background: Within the last decade, advances and availability in radiological imaging have led to an increase in the detection of incidental liver lesions (ILLs) in the asymptomatic patient population. This poses a diagnostic conundrum. This study was undertaken to review the outcome of liver lesions labelled as 'indeterminate' in asymptomatic patients without a biopsy-proven concomitant primary tumour. The secondary aim was to assess the impact on healthcare resources and cost-effectiveness with regards to the frequency and modality of radiological scans, multidisciplinary team discussions and clinic reviews. Methods: The study consisted of a retrospective analysis of prospectively collected data from the University Hospitals of Leicester multidisciplinary team database. The study period ranged from 2010 to 2015. All patients were followed-up for 3 years to ensure no late re-occurrences with malignancy. Results: A total of 92 patients with ILL were identified. The median age was 72 years. The median size of these ILLs was 10 mm. Eighty-seven patients required supplementary imaging and 42 required a third imaging. Ninety-one patients had benign lesions. Only one case was biopsy proven to be malignant. Conclusion: Small (<15 mm) hepatic lesions discovered incidentally in patients with no known primary malignancy and risk factors are virtually always benign, with a 1% risk of malignancy. There is a need for a classification system, which stratifies ILLs by malignant potential based on a standardized and evidence-based approach. This is important to prevent unnecessary investigations. A multidisciplinary approach in an experienced hepatobiliary and pancreatic centre is recommended until such a classification exists.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 791-795

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Section: Discussionmentioning

confidence: 99%

Indeterminate liver lesions – a virtual epidemic: a cohort study over 8 years

Kuan

Mavilakandy

Oyebola

et al. 2020

ANZ Journal of Surgery

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“…The patients did not have liver tumor infiltration. The hepatic dysfunction could be due to liver lesions that were not identified at the time of diagnosis [30]. The lack of glucose metabolism control (hyperglycemia) is a common condition of PC and accompanies 85% PC patients [31].…”

Section: Patients' Characteristicsmentioning

confidence: 99%

Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State

et al. 2021

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Pancreatic Carcinoma (PC) cells have the ability to induce patient immunosuppression and to escape immunosurveillance. Low circulating lymphocytes are associated with an advanced stage of PC and reduced survival. Blood lymphocytes expressed as a percentage of Total White Blood Cells (L% TWBC) could predict chemotolerance (n° of tolerated cycles), survival time and Body Weight (BW) more effectively than lymphocytes expressed as an absolute value (LAB > 1500 n°/mm3) or lymphocytes >22%, which is the lowest limit of normal values in our laboratory. Forty-one patients with advanced PC, treated with chemotherapy, were selected for this observational retrospective study. Patients were evaluated at baseline (pre-chemotherapy), and at 6, 12 and 18 months, respectively, after diagnosis of PC. The study found L ≥ 29.7% to be a better predictor of survival (COX model, using age, sex, BW, serum creatinine, bilirubin and lymphocytes as covariates), chemotolerance (r = +0.50, p = 0.001) and BW (r = +0.35, p = 0.027) than LAB > 1500 or L > 22%. BW did not significantly correlate with chemotolerance or survival. The preliminary results of this study suggest that L ≥ 29.7% is more effective than LAB > 1500 or L > 22% at predicting chemotolerance, survival time and nutritional status. A possible impact of nutritional status on chemotherapy and survival seems to be lymphocyte-mediated given the association between BW and L%. This study may serve as the basis for future research to explore whether nutritional interventions can improve lymphopenia, and if so, how this may be possible.

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“…Although PDAC may be detected at ultrasound (US), contrast-enhanced computed tomography (CT) is the recommended imaging technique for dedicated pancreatic imaging for diagnosis, staging, and follow-up (Figure 1) [6]. About 30% of patients with localized, non-metastatic PDAC may have indeterminate liver lesions at the time of diagnosis and may require further investigations [9]. Dual-energy CT or magnetic resonance imaging (MRI) may be helpful for characterization of indeterminate liver lesions [6,10].…”

Section: Introductionmentioning

confidence: 99%

Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine

Vernuccio

Messina²,

Merz

et al. 2021

Diagnostics

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The incidence and mortality of pancreatic ductal adenocarcinoma are growing over time. The management of patients with pancreatic ductal adenocarcinoma involves a multidisciplinary team, ideally involving experts from surgery, diagnostic imaging, interventional endoscopy, medical oncology, radiation oncology, pathology, geriatric medicine, and palliative care. An adequate staging of pancreatic ductal adenocarcinoma and re-assessment of the tumor after neoadjuvant therapy allows the multidisciplinary team to choose the most appropriate treatment for the patient. This review article discusses advancement in the molecular basis of pancreatic ductal adenocarcinoma, diagnostic tools available for staging and tumor response assessment, and management of resectable or borderline resectable pancreatic cancer.

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Characterizing indeterminate liver lesions in patients with localized pancreatic cancer at the time of diagnosis

Cited by 11 publications

References 15 publications

Indeterminate liver lesions – a virtual epidemic: a cohort study over 8 years

Indeterminate liver lesions – a virtual epidemic: a cohort study over 8 years

Peripheral Blood Lymphocyte Percentage May Predict Chemotolerance and Survival in Patients with Advanced Pancreatic Cancer. Association between Adaptive Immunity and Nutritional State

Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine

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