Chung Yung Nio

Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage.

Objective:To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. Background:Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of surgery can lead to more advanced cancer stages at surgical exploration, affecting resection rate and survival. Methods:We conducted a multicenter, randomized controlled clinical trial to compare PBD with early surgery (ES) for pancreatic head cancer for complications. We obtained Kaplan-Meier estimates of overall survival for patients with pathology-proven malignancy and compared survival functions of ES and PBD groups using log-rank test statistics. Multivariable Cox regression analyses were performed to evaluate the prognostic role of time to surgery for overall survival. Results:Mean times from randomization to surgery were 1.2 (0.9-1.5) and 5.1 (4.8-5.5) weeks in the ES and PBD groups, respectively (P < 0.001). In the ES group, 60 (67%) of 89 patients underwent resection, versus 53 (58%) of 91 patients in the PBD group (P = 0.20). Median survival after randomization was 12.2 (9.1-15.4) months in the ES group versus 12.7 (8.9-16.6) months in the PBD group (P = 0.91). A longer time to surgery was significantly associated with slightly lower mortality rate after surgery (hazard ratio = 0.90, 95% CI, 0.83-0.97), when taking into account resection, bilirubin, complications, pancreatic adenocarcinoma, tumor-positive lymph nodes, and microscopically residual disease. Conclusions:In patients with pancreatic head cancer, the delay in surgery associated with PBD does not impair or benefit survival rate.

A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals.

Objective Endoscopic ultrasonography (EUS) and MRI are promising tests to detect precursors and early-stage pancreatic ductal adenocarcinoma (PDAC) in high-risk individuals (HRIs). It is unclear which screening technique is to be preferred. We aimed to compare the efficacy of EUS and MRI in their ability to detect clinically relevant lesions in HRI. Design Multicentre prospective study. The results of 139 asymptomatic HRI (>10-fold increased risk) undergoing first-time screening by EUS and MRI are described. Clinically relevant lesions were defined as solid lesions, main duct intraductal papillary mucinous neoplasms and cysts ≥10u2005mm. Results were compared in a blinded, independent fashion. Results Two solid lesions (mean size 9u2005mm) and nine cysts ≥10u2005mm (mean size 17u2005mm) were detected in nine HRI (6%). Both solid lesions were detected by EUS only and proved to be a stage I PDAC and a multifocal pancreatic intraepithelial neoplasia 2. Of the nine cysts ≥10u2005mm, six were detected by both imaging techniques and three were detected by MRI only. The agreement between EUS and MRI for the detection of clinically relevant lesions was 55%. Of these clinically relevant lesions detected by both techniques, there was a good agreement for location and size. Conclusions EUS and/or MRI detected clinically relevant pancreatic lesions in 6% of HRI. Both imaging techniques were complementary rather than interchangeable: contrary to EUS, MRI was found to be very sensitive for the detection of cystic lesions of any size; MRI, however, might have some important limitations with regard to the timely detection of solid lesions.

Protrusion Method for Automated Estimation of Polyp Size on CT Colonography

OBJECTIVEnThe purpose of this study was to assess the accuracy and measurement variability of automated lesion measurement on CT colonography in comparison with manual 2D and 3D techniques under varying scanning conditions.nnnMATERIALS AND METHODSnThe study included phantoms (23 phantom objects) and patients (16 polyps). Measurement with sliding calipers served as the reference for the phantom data. The mean of two independent colonoscopic measurements was the reference for the polyps. The automated measurement was developed for a computer-aided detection scheme, and the size of any detected object was obtained from measurement of its largest diameter. The automated measurement was compared with manual 2D and 3D measurements by two experienced observers.nnnRESULTSnFor phantom data, the measurement variability of the automated method was significantly less than that of the two observers (p < 0.05), except for the 3D measurement by observer 1, as follows: automated, 0.86 mm; observer 1, 1.76 mm (2D), 0.96 (3D); observer 2, 1.34 mm (2D), 1.45 mm (3D). The variability of the automated method did not differ significantly from that of manual methods in measurement with patient data. The automated method had a systematic error for phantom data (1.9 mm).nnnCONCLUSIONnFor phantoms, the automated method has less measurement variability than manual 2D and 3D techniques. For true polyps, the measurement variability of the automated method is comparable with that of manual methods. The automated method does not suffer from intraobserver variability. Because systematic error can be calibrated, automated size measurement may contribute to a practical evaluation strategy.

Incidental extracolonic findings on bright lumen MR colonography in a population at increased risk for colorectal carcinoma

PURPOSEnIncidental extracolonic findings affect patient treatment and cost. Therefore, to consider magnetic resonance colonography (MRC) as a tool for colorectal cancer and polyps screening, more knowledge is needed on extracolonic findings. In this study, we sought to determine the prevalence and the spectrum of extracolonic findings in patients with an increased risk colorectal cancer that underwent bright lumen MRC.nnnMATERIALS AND METHODSnMRC examinations were performed in 210 patients. A gadolinium solution was administered rectally for distension of the colon. Extracolonic findings were scored by two radiologists and classified by using C-RADS Reporting System. All findings (with advice regarding work-up) were reported to the patients physician and followed up for 4.5 years on average.nnnRESULTSnExtracolonic findings were found in 125 (59.5%) patients. Ten (4.8%) had potentially important findings (C-RADS category E4). Twenty-five patients (11.9%) had likely unimportant findings (E3), 90 (42.8%) had clinically unimportant findings (E2) and 85 (40.5%) had a normal exam (E1). In 14 (6.7%) patients additional work-up was performed for their incidentally discovered lesions. In three of them surgery was performed. After work-up, only in two (1.0%) patients a malignancy was found.nnnCONCLUSIONnThe number of new relevant extracolonic findings is small and the required additional work-up is limited. This should be considered for implementation of bright lumen MRC as a screening tool.