Giulia Cristel

Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery

Analytical morphometric assessment has recently been proposed to improve preoperative risk stratification. However, the relationship between body composition and outcomes following pancreaticoduodenectomy is still unclear. The aim of this study was to assess the impact of body composition on outcomes in patients undergoing pancreaticoduodenectomy for cancer.

Tailored Breast Cancer Screening Program with Microdose Mammography, US, and MR Imaging: Short-term Results of a Pilot Study in 40–49-Year-Old Women

PURPOSE To evaluate the feasibility, performance, and cost of a breast cancer screening program aimed at 40-49-year-old women and tailored to their risk profile with supplemental ultrasonography (US) and magnetic resonance (MR) imaging. MATERIALS AND METHODS The institutional review board approved this study, and informed written consent was obtained. A total of 3017 40-49-year-old women were invited to participate. The screening program was tailored to lifetime risk (Gail test) and mammographic density (according to Breast Imaging Reporting and Data Systems [BI-RADS] criteria) with supplemental US or MR imaging and bilateral two-view microdose mammography. The indicators suggested by European guidelines, US incremental cancer detection rate (CDR), and estimated costs were evaluated. RESULTS A total of 1666 women (67.5% participation rate) were recruited. The average lifetime risk of breast cancer was 11.6%, and nine women had a high risk of breast cancer; 917 women (55.0%) had a high density score (BI-RADS density category 3 or 4). The average glandular dose for screening examinations was 1.49 mGy. Screening US was performed in 835 study participants (50.1%), mostly due to high breast density (800 of 1666 women [48.0%]). Screening MR imaging was performed in nine women (0.5%) at high risk for breast cancer. Breast cancer was diagnosed in 14 women (8.4 cases per 1000 women). Twelve diagnoses were made with microdose mammography, and two were made with supplemental US in dense breasts (2.4 cases per 1000 women). All patients were submitted for surgery, and 10 underwent breast-conserving surgery. The sentinel lymph node was evaluated in 11 patients, resulting in negative findings in six. Pathologic analysis resulted in the diagnosis of four ductal carcinomas in situ and 10 invasive carcinomas (five at stage I). CONCLUSION A tailored breast cancer screening program in 40-49-year-old women yielded a greater-than-expected number of cancers, most of which were low-stage disease.

Association Between Changes in Body Composition and Neoadjuvant Treatment for Pancreatic Cancer

Importance Sarcopenia and sarcopenic obesity have been associated with poor outcomes in unresectable pancreatic cancer (PC). Neoadjuvant treatment (NT) is used increasingly to improve resectability; however, its effects on fat and muscle body composition have not been characterized. Objectives To evaluate whether NT affects muscle mass and adipose tissue in patients with borderline resectable PC (BRPC) and locally advanced PC (LAPC) and determine whether there were potential differences between patients who ultimately underwent resection and those who did not. Design, Setting, and Participants In this retrospective cohort study conducted at 4 academic medical centers, 193 patients with BRPC and LAPC undergoing surgical exploration after NT who had available computed tomographic scans (both at diagnosis and preoperatively) and confirmed pancreatic ductal adenocarcinoma were evaluated. The study was conducted from January 2013 to December 2015. Data analysis was performed from September 2016 to May 2017. Measurement of body compartments was evaluated with volume assessment software before and after NT. A radiologist blinded to the patient outcome assessed the areas of skeletal muscle, total adipose tissue, and visceral adipose tissue through a standardized protocol. Exposures Receipt of NT. Main Outcomes and Measures Achievement of pancreatic resection at surgical exploration after the receipt of NT. Results Of the 193 patients with complete radiologic imaging available after NT, 96 (49.7%) were women; mean (SD) age at diagnosis was 64 (11) years. Most patients received combined therapy with fluorouracil, irinotecan, oxaliplatin, leucovorin, and folic acid (124 [64.2%]) and 86 (44.6%) received chemoradiotherapy as well. The median interval between pre-NT and post-NT imaging was 6 months (interquartile range [IQR], 4-7 months). All body compartments significantly changed. The adipose compound decreased (median total adipose tissue area from 284.0 cm2; IQR, 171.0-414.0 to 250.0 cm2; IQR, 139.0-363.0; P < .001; median visceral adipose tissue area from 115.2 cm2; IQR, 59.9-191.0 to 97.7 cm2; IQR, 48.0-149.0 cm2; P < .001), whereas the lean mass slightly improved (median skeletal muscle from 122.1 cm2; IQR, 99.3-142.0 to 123 cm2; IQR 104.8-152.5 cm2; P = .001). Surgical resection was achievable in 136 (70.5%) patients. Patients who underwent resection had experienced a 5.9% skeletal muscle area increase during NT treatment, whereas those who did not undergo resection had a 1.7% decrease (P < .001). Conclusions and Relevance Patients with PC experience a significant loss of adipose tissue during neoadjuvant chemotherapy, but no muscle wasting. An increase in muscle tissue during NT is associated with resectability.

Monitoring of central retinal artery and vein with color doppler ultrasound during heart surgery as an alternative to transcranial doppler ultrasonography: A case report

Cardiac surgery can have severe neurologic complications. The noninvasive monitoring of intracranial circulation during heart surgery is usually performed with transcranial Doppler ultrasonography. We present the case of a 66‐year‐old man who underwent elective cardiac surgery for aortic valve replacement and coronary artery bypass graft, in whom monitoring was performed by simultaneously assessing blood flow velocity in the central retinal artery and vein.

Preoperative multiparametric MRI of the prostate for the prediction of lymph node metastases in prostate cancer patients treated with extended pelvic lymph node dissection

AbstractObjectivesTo assess the role of preoperative multiparametric MRI (mpMRI) of the prostate in the prediction of nodal metastases in patients treated with radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND).MethodsWe retrospectively analyzed 101 patients who underwent both preoperative mpMRI of the prostate and RP with ePLND at our institution. For each patient, complete preoperative clinical data and tumour characteristics at mpMRI were recorded. Final histopathologic stage was considered the standard of reference. Univariate and multivariate logistic regression analyses were performed.ResultsNodal metastases were found in 23/101 (22.8%) patients. At univariate analyses, all clinical and radiological parameters were significantly associated to nodal invasion (all p<0.03); tumour volume at MRI (mrV), tumour ADC and tumour T-stage at MRI (mrT) were the most accurate predictors (AUC = 0.93, 0.86 and 0.84, respectively). A multivariate model including PSA levels, primary Gleason grade, mrT and mrV showed high predictive accuracy (AUC = 0.956). Observed prevalence of nodal metastases was very low among tumours with mrT2 stage and mrV<1cc (1.8%).ConclusionPreoperative mpMRI of the prostate can predict nodal metastases in prostate cancer patients, potentially allowing a better selection of candidates to ePLND.Key points• Multiparametric-MRI of the prostate can predict nodal metastases in prostate cancer • Tumour volume and stage at MRI are the most accurate predictors • Prevalence of nodal metastases is low for T2-stage and <1cc tumours • Preoperative mpMRI may allow a better selection of candidates to lymphadenectomy

MP03-13 MULTIPARAMETRIC MRI CANNOT PREDICT CLINICALLY SIGNIFICANT PROSTATE CANCER OUTSIDE THE INDEX LESION: IMPLICATIONS FOR EXTENDED BIOPSY TEMPLATES

RESULTS: Prostate cancers were identified in 52% of cases. Among patients diagnosed with prostate cancer, 80% were clinically significant. The detection rates of csPCa using FB when a PIRADS 3, 4, or 5 index lesion was present on mpMRI were 6%, 46%, and 66%, respectively. PI-RADS v2 score had a predictive accuracy (AUC) of 0.79 for csPCa detection. Institutional experience over time, MRI-estimated prostate volume, and PI-RADS v2 score were independent predictors of success at detecting csPCa. CONCLUSIONS: Since FB is a highly technical and experience-driven process, development of internal quality measures to assess the institutional learning curve and the quality of PI-RADS v2 scoring is critical with adoption of this technology.

MP77-20 MULTIPARAMETRIC MRI REPRESENTS AN ADDED VALUE BUT NOT A SUBSTITUTE OF FOLLOW-UP BIOPSIES IN PATIENTS ON ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: While serial biopsies are a key component of most active surveillance (AS) programs, surveillance protocols differ as to when the first surveillance biopsy should be performed. Some protocols mandate a confirmatory biopsy while in others, the first surveillance biopsy is performed at 1 year. In the present study we sought to determine differential impact of obtaining the first surveillance biopsy either within 6 months or at 9-15 months after diagnosis. METHODS: We retrospectively identified patients who enrolled in a prostate cancer active surveillance (AS) program during 2004-2015 and underwent a biopsy either 6 months or between 9-15 months after their initial diagnostic biopsy. Eligibility for enrollment in AS was defined according to MSK criteria (biopsy Gleason: 6; biopsy T stage: cT1c or cT2a, diagnostic PSA <10, % positive for each core 50%, 3 positive cores, or if number of total cores >12, then number of positive cores 25% of the total cores). We compared MSK-defined eligibility for AS in patients who received a second biopsy at either 6 or 9-15 months after their initial diagnostic biopsy. RESULTS: A total of 115 patients on AS were identified within the study period. 62 (53.9) and 53 (46.1%) of patients underwent a second biopsy at 6 or 9-15 months after their initial diagnostic biopsy, respectively (table). Age, number of biopsy cores and positive cores, serum PSA, and eligibility for AS by MSK criteria were similar between groups. 56(90.3%) and 42 (79.2%) of patients initially met MSK AS criteria. Of these, those rebiopsied at 9-15 months appear more apt to be reclassified as ineligible than patients rebiopsied at 6 months (42.9 v. 25.0%, p1⁄40.082). Patients biopsied at 6 months had more cores taken at the second biopsy (15(IQR 12-16) vs. 12 (12-12), p<.001) CONCLUSIONS: Surveillance protocols differ as to when the first surveillance biopsy is performed. In patients initially meeting AS inclusion criteria, a delay in confirmatory biopsy may be associated with a higher rate (42.9% v 25.0%) of AS ineligibility. Just as important, 25% of patients immediately learn they do not meet AS criteria. These findings may be due to disease progression rather than under sampling, as patients who were biopsied at 6 months had more biopsies performed. These data may be helpful in patient counseling prior to AS enrollment. Source of Funding: none

MP77-15 INCLUSION OF MPMRI INTO THE EUROPEAN RANDOMIZED STUDY OF SCREENING FOR PROSTATE CANCER (ERSPC) RISK CALCULATOR: A NEW PROPOSAL TO IMPROVE THE ACCURACY OF PROSTATE CANCER DETECTION

INTRODUCTION AND OBJECTIVES: Chemoprevention of prostate cancer has long been an interesting topic. Data have shown that Metformin is associated with lower prostate specific antigen levels. A recent study showed that Metformin can modify gene expression in prostate cancer cells. Literature is controversial on the role of metformin in prostate cancer prevention. This study was designed to assess relationship of diabetes mellitus and metformin with prostate cancer. METHODS: A database of patients with prostate cancer was searched for patients with diabetes mellitus taking medications. Patients with diabetes mellitus prior to prostate cancer detection were detected. Data were imported into SPSS v. 21 for analysis. After primary analysis, patients taking metformin were compared to diabetic patients not taking metformin and non-diabetic patients. RESULTS: Between March 2003 and October 2016, there were 3,645 patients in the database of which 228 (6.2%) were diagnosed with diabetes mellitus prior to the time of prostate cancer detection. In diabetic group, 139 patients were using metformin products prior to surgery. There were additional 35 patients who were taking metformin for other conditions rather than diabetes mellitus. A general comparison of characteristics of diabetic and non-diabetic patients in the study is shown in table 1. Diabetic patients were more commonly black, had higher BMI, Higher D’Amico risk and higher American Society of Anesthesiologist risk classification (all p<0.05). There was no significant difference between diabetic patients taking metformin and diabetic patients on other treatment plans. Analysis of patients taking metformin with other patients (diabetic and non-diabetic) showed no significant difference in terms of prostate cancer characteristics. CONCLUSIONS: Diabetes mellitus might impact the course of prostate cancer development. The results of the study does not support the protective effect of metformin on prostate cancers in diabetic or nondiabetic.