The use of intraoperative ultrasound for diagnosis and stadiation in pancreatic head neoformations

Werra, Carlo De; Quarto, Gennaro; Aloia, Sergio; Perrotta, S.; Giudice, Roberto Del; Filippo, Gabriele Di; Furino, Ermenegildo; Amato, Bruno; Benassai, Giacomo

doi:10.1016/j.ijsu.2015.04.091

Cited by 14 publications

(3 citation statements)

References 16 publications

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“…However, the available imaging diagnostic techniques, such as ultrasound (US), computed tomography (CT) scanning, and magnetic resonance imaging (MRI), have low diagnostic sensitivity and high requirements on operating skills. [ 2,6–8 ] Normally, histopathological biopsy is a gold standard for disease diagnosis. [ 9 ] However, due to the deep position of the pancreas, biopsy will bring great harm to patients, and it needs to be punctured under the guidance of imaging and is not suitable for screening of the general population.…”

Section: Introductionmentioning

confidence: 99%

Highly Sensitive Exosome Detection for Early Diagnosis of Pancreatic Cancer Using Immunoassay Based on Hierarchical Surface‐Enhanced Raman Scattering Substrate

Chen

et al. 2022

Small Methods

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5 year survival rate of just 6% and a median survival of fewer than 6 months due to difficulties in the early diagnosis, PaC will be the second leading cause of cancer death by 2030. [3][4][5] Clinical diagnostic methods for PaC mainly include imaging and pathological biopsy. However, the available imaging diagnostic techniques, such as ultrasound (US), computed tomography (CT) scanning, and magnetic resonance imaging (MRI), have low diagnostic sensitivity and high requirements on operating skills. [2,[6][7][8] Normally, histopathological biopsy is a gold standard for disease diagnosis. [9] However, due to the deep position of the pancreas, biopsy will bring great harm to patients, and it needs to be punctured under the guidance of imaging and is not suitable for screening of the general population. [10,11] Moreover, the sensitivity and specificity of the widely used clinical screening biomarker carbohydrate antigen19-9 (CA19-9) are not high, and its serum level is significantly increased in inflammatory diseases of the pancreas and biliary tract, which leads its capacity for early diagnosis is not be evaluated. [12,13] Therefore, it is urgent and necessary to identify new and better biomarkers for the early diagnosis of PaC.Exosomes have emerged as potential biomarkers for pancreatic cancer (PaC). However, it is still challenging to get quantitative detection of exosomes with the specific surface receptors. In this study, a highly sensitive detection system is first constructed for the direct quantitation of specific exosomes in real samples using hierarchical surface-enhanced Raman scattering substrate (H-SERS substrate) and rapid enrichment strategy magnetic beads @ exosomes @ SERS detection probes (MEDP). It is found that the detection system (MEDP @ H-SERS substrate) could provide a 3.5 times higher SERS intensity compared with MEDP sandwich immunocomplex only. Moreover, LRG1-positive exosomes (LRG1-Exos) and GPC1-positive exosomes (GPC1-Exos) are chosen to distinguish PaC through exosome proteomics and database screening. The lower limit of detection (LOD) is 15 particles µL -1 using the MEDP @ H-SERS substrate. Significantly, the detection in clinical samples shows that the innovative combination of LRG1-Exos and GPC1-Exos could improve the diagnostic efficiency of PaC, with an area under the operating characteristic curve (AUC) of 0.95. Even for the early-stage PaC, the diagnostic accuracy is still high (AUC = 0.95). Collectively, the findings indicate that the MEDP @ H-SERS substrate has great potential for the early diagnosis of PaC.The ORCID identification number(s) for the author(s) of this article can be found under https://doi.org/10.1002/smtd.202200154.

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Section: Introductionmentioning

confidence: 99%

Highly Sensitive Exosome Detection for Early Diagnosis of Pancreatic Cancer Using Immunoassay Based on Hierarchical Surface‐Enhanced Raman Scattering Substrate

Chen

et al. 2022

Small Methods

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“…Lane reported in The Lancet that intraoperative ultrasound was a useful, noninvasive method of evaluating pancreatic disease [14] . Studies have continued to con rm the value of laparoscopic ultrasound in pancreatic tumor surgery [15,16,17,18] .…”

Section: Discussionmentioning

confidence: 99%

The value of fluorescence imaging in the intraoperative localization of small neuroendocrine tumors of the pancreas

Xi,

Jiang,

Zheng

et al. 2024

Preprint

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Objective To explore the effectiveness and safety of fluorescence imaging technology in the intraoperative localization of small neuroendocrine tumors of the pancreas. Methods Indocyanine green fluorescence imaging technology was used in operation, and the specific process of indocyanine green administration was as follows: 25 mg of indocyanine green was dissolved in 10 ml of sterilized water for injection, and 1 ml of indocyanine green was injected rapidly through the peripheral vein during the laparoscopic exploration of the tumor, and the tumor was observed to show green fluorescence about 1 min later, and the tumor showed green fluorescence, which was regarded as the success of development, and laparoscopic pancreatic tumor local excision surgery was carried out under the guidance of the real-time fluorescence imaging, and postoperative monitoring of the amylase index of drainage fluid to observe whether there was a pancreatic fistula. Under the real-time guidance of fluorescence imaging, laparoscopic pancreatic tumor local resection was performed, and the amylase index of the drainage fluid was monitored after surgery to observe whether pancreatic fistula occurred or not and to record the tumor grade, surgical margins, and other pathological conditions. RESULTS The fluorescence imaging effect of the two patients was good, the lesion boundary was clear, and both of them completed the local resection of the tumor laparoscopically without pancreatic fistula, and the pathology suggested that the pancreatic neuroendocrine tumors were grade G1, and the margins of the surgery were negative. CONCLUSION Fluorescence imaging technology helps to localize small pancreatic neuroendocrine tumors intraoperatively with good safety.

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“…Thereby, it may improve staging and guide resection. 12,13 Our group previously published two smaller studies suggesting that IOUS can be useful during surgical exploration of pancreatic cancer, but larger studies were recommended. 14,15 The current prospective multicenter study investigated the impact of IOUS in assessing resectability status of patients with pancreatic cancer, with focus on the assessment of vascular involvement.…”

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confidence: 99%

Intraoperative Ultrasound During Surgical Exploration in Patients with Pancreatic Cancer and Vascular Involvement (ULTRAPANC): A Prospective Multicenter Study

et al. 2023

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Background Determining the resectability of pancreatic cancer with vascular involvement on preoperative computed tomography imaging remains challenging, especially following preoperative chemotherapy and chemoradiotherapy. Intraoperative ultrasound (IOUS) may provide real-time additional information, but prospective multicenter series confirming its value are lacking. Patients and Methods This prospective multicenter study included patients undergoing surgical exploration for pancreatic cancer with vascular involvement. All patients underwent IOUS at the start of explorative laparotomy. Primary outcomes were resectability status as defined by the National Comprehensive Cancer Network and the extent of vascular involvement. Results Overall, 85 patients were included, of whom 74 (87%) were post preoperative chemotherapy, and mostly following FOLFIRINOX regimen (n = 57; 76%). On the basis of preoperative imaging, 34 (40%) patients were staged as resectable (RPC), 32 (38%) borderline resectable (BRPC), and 19 (22%) locally advanced pancreatic cancer (LAPC). IOUS changed the resectability status in 32/85 (38%) patients (p < 0.001), including 8/19 (42%) patients with LAPC who were downstaged (4 to BRPC, 4 to RPC), and 22/32 (69%) patients with BRPC who were downstaged to RPC. Among patients with presumed superior mesenteric artery (SMA) involvement, 20/28 (71%) had no SMA involvement on IOUS. In 15 of these 20 patients a pancreatic resection was performed, all with R0 SMA margin. Conclusion IOUS during surgical exploration for pancreatic cancer and vascular involvement downstaged the resectability status in over one-third of patients, which could facilitate progress during surgical exploration. This finding should be confirmed by larger studies, including detailed pathology assessment. Trial Registrationwww.trialregister.nl (NL7621).

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The use of intraoperative ultrasound for diagnosis and stadiation in pancreatic head neoformations

Abstract: We suggest to perform in every patients undergone to pancreatic surgery an intraoperative ultrasound exam, to detect unresecable and unpredicted lesions.

Cited by 14 publications

References 16 publications

Highly Sensitive Exosome Detection for Early Diagnosis of Pancreatic Cancer Using Immunoassay Based on Hierarchical Surface‐Enhanced Raman Scattering Substrate

Highly Sensitive Exosome Detection for Early Diagnosis of Pancreatic Cancer Using Immunoassay Based on Hierarchical Surface‐Enhanced Raman Scattering Substrate

The value of fluorescence imaging in the intraoperative localization of small neuroendocrine tumors of the pancreas

Intraoperative Ultrasound During Surgical Exploration in Patients with Pancreatic Cancer and Vascular Involvement (ULTRAPANC): A Prospective Multicenter Study

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