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Histological and immunohistochemical evaluation using endoscopic ultrasound-guided fine-needle aspiration in solid masses
Abstracts / Pancreatology 13 (2013) S1–S80
Background/aim: Distinguishing pancreatic adenocarcinomas from other pancreatic masses remains challenging in clinical practice. Contrastenhanced harmonic endoscopic ultrasound (CEH-EUS) is a promising method for characterizing pancreatic lesions due to its noninvasiveness. The clinical significance according to the change of enhancement pattern from arterial to venous phases was not established. The purpose of this study is to investigate the accuracy of CEH-EUS in the differentiation of pancreatic solid lesions by visualizing enhancement pattern during contrast infusion time. Methods: Between July, 2011 and March, 2013, 116 patients who referred for EUS examination of pancreatic lesions were consecutively enrolled. CEH-EUS was performed with a conventional radial echoendoscope after intravenous bolus injection of contrast agent (SonoVue). Enhancement pattern of target lesion was classified into three groups (hypo-, iso- or hyper-enhancement) and also described as contrast injection time; early (10 w 30 seconds), late (30 w 60 seconds) and delay phase (60 w 90 seconds). The enhancement pattern of pancreatic adenocarcinoma was compared with that of other pancreatic lesions. Results: A total of 83 patients (51 male, median age 68, range 25–91) were evaluated for pancreatic solid lesions. The final diagnoses were pancreatic adenocarcinoma in 63 (75.9%), neuroendocrine tumor in 8 (9.6%), chronic pancreatitis in 3 (3.6%), autoimmune pancreatitis in 3 (3.6%), pancreatic metastasis in 2 (2.4%), malignant lymphoma in 2 (2.4%) and each cases of pancreatic abscess and solid pseudopapillary neoplasm (2.4%). In 63 pancreatic lesions with adenocarcinoma, hypoenhancement during arterial, late and delay phase was observed in 52 (82.5%), 59 (93.7%), and 62 (98.4%), respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for adenocarcinoma as hypoenhancement at CEH-EUS showed at table 1. Conclusions: CEH-EUS could characterize pancreatic mass lesions with relatively high accuracy during late phase and may be useful for distinguishing adenocarcinomas from other pancreatic masses.
Keywords: EUS, Contrast enhanced, Harmonic, Pancreas, Solid lesion
[P-078]. Histological and immunohistochemical evaluation using endoscopic ultrasound-guided fine-needle aspiration in solid masses Jae Gu Jung 1, Ki Joo Kang 2, Cho Rong Oh 1, Jong Kyun Lee 1, Kyu Taek Lee 1, Kee Taek Jang 3, Jong Hak Choi 1, Sang Mo Park 4, Kwang Hyuck Lee 1 1
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 2 Department of Medicine, Hallym University College of Medical School, Hallym University Sacred Heart Hospital, Anyang, South Korea 3 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 4 Department of Pathology, Soon Chun Hyang University Bucheon Hospital, Bucheon, South Korea
Background/aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been demonstrated to be useful in the diagnosis of lesions adjacent to the gastrointestinal tract. The aim was to evaluate the clinical utility of histological and immunohistochemical (IHC) analyses of specimens obtained by EUS-FNA. Methods: This study consisted of retrospective and prospective analyses. The retrospective study was performed on 116 patients who
S45
underwent EUS-FNA of solid masses for cytological smear, histological analysis, and combined analysis including IHC staining. In the prospective study, 79 patients were enrolled to evaluate the quality and accuracy of EUS-FNA histological analysis and feasibility of IHC staining. Results: The final diagnoses of all patients included pancreatic cancer (n¼126), non-pancreatic cancer (n¼21), other neoplasm (n¼27), and benign lesions (n¼21). In our retrospective study, the combined analysis was more sensitive than cytological analysis alone (P < 0.01). The overall sensitivity of cytology, histology, and combined analysis was 69.8%, 67.2%, and 81.8% respectively. In the prospective analysis, 64.2% of all punctures were helpful for determining a diagnosis and 40.7% provided sufficient tissue for IHC staining. Histological analysis was helpful for diagnosis in 74.7% of patients. IHC staining was necessary for a definite diagnosis in 11.4% of patients, especially in the cases of non-malignant pancreatic mass. Conclusions: Histological analysis and IHC study of EUS-FNA specimens was useful for the accurate diagnosis of pancreatic and peripancreatic lesions. Combined analysis showed significantly higher sensitivity than cytology alone because IHC staining was helpful for a diagnosis in some patients. Keywords: EUS-FNA, Histology, Pancreatic mass, Peripancreatic mass
[P-079]. Phase II clinical trial to evaluate the efficacy and safety of activated Tlymphocyte cell therapy in gemcitabine refractory advanced pancreatic cancer Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Jae Bock Chung, Si Young Song Division of Gastroenterology, Yonsei Institute of Gastroenterology, Seoul, South Korea Background/aim: Standard second-line chemotherapy in gemcitabine refractory patients with advanced pancreatic cancer is not established due to rapid disease progression and performance deterioration. In a previous randomized phase III trial, patients treated with 5-FU/FA plus oxaliplatin as second-line chemotherapy showed a median progression-free survival (PFS) of 13 weeks and a median overall survival (OS) of 26 weeks. The aim of this phase II trial was to evaluate the efficacy and safety of the activated T-lymphocyte cell therapy (ATLCT) (Immuncell-LC, INNOCELL Corporation) in gemcitabine refractory advanced pancreatic cancer. Methods: Patients with advanced pancreatic cancer who showed disease progression during gemcitabine-based chemotherapy were enrolled in this study. For generation of activated T-lymphocyte cells, peripheral bloods were collected from each patient and were cultured with anti-CD3 monoclonal antibody and IL-2. Patients received autologous T-lymphocytes intravenously every week for 5 weeks and then every other week for 10 weeks. Results: Twenty cases were enrolled between November 2009 and September 2010. A total of 127 cycles of ATLCT were delivered and a mean number of cells transferred per infusion was 7.3 x 109 ( 2.4 x 109). The disease control rate were 15 % (3/20 patients). The median PFS was 11 weeks (95% CI, 8.7–13.3) and median OS was 26.1 weeks (95% CI, 18.3– 33.9). Grade 3 toxicities included general weakness in 2 patients and thrombocytopenia in 1 patient. Grade 4 hematologic or non-hematologic toxicity was not observed. Conclusions: ATLCT showed comparable PFS and OS to survival data of previous trials assessing conventional chemotherapies while maintaining tolerability in gemcitabine refractory advanced pancreatic cancer. (Funded by Innocell Corporation; ClinicalTrials.gov numbers, NCT00965718.). Keywords: Pancreatic cancer, Gemcitabine refractory, Activated Tlymphocyte cell therapy
[P-080]. Risk factors for second primary pancreatic cancer in colorectal cancer patients Joo Won Chung 1, Moon Jae Chung 2, Seungmin Bang 2, Seung Woo Park 2, Si Young Song 2, Jae Bock Chung 2, Jeong Youp Park 2
Background/aim: Distinguishing pancreatic adenocarcinomas from other pancreatic masses remains challenging in clinical practice. Contrastenhanced harmonic endoscopic ultrasound (CEH-EUS) is a promising method for characterizing pancreatic lesions due to its noninvasiveness. The clinical significance according to the change of enhancement pattern from arterial to venous phases was not established. The purpose of this study is to investigate the accuracy of CEH-EUS in the differentiation of pancreatic solid lesions by visualizing enhancement pattern during contrast infusion time. Methods: Between July, 2011 and March, 2013, 116 patients who referred for EUS examination of pancreatic lesions were consecutively enrolled. CEH-EUS was performed with a conventional radial echoendoscope after intravenous bolus injection of contrast agent (SonoVue). Enhancement pattern of target lesion was classified into three groups (hypo-, iso- or hyper-enhancement) and also described as contrast injection time; early (10 w 30 seconds), late (30 w 60 seconds) and delay phase (60 w 90 seconds). The enhancement pattern of pancreatic adenocarcinoma was compared with that of other pancreatic lesions. Results: A total of 83 patients (51 male, median age 68, range 25–91) were evaluated for pancreatic solid lesions. The final diagnoses were pancreatic adenocarcinoma in 63 (75.9%), neuroendocrine tumor in 8 (9.6%), chronic pancreatitis in 3 (3.6%), autoimmune pancreatitis in 3 (3.6%), pancreatic metastasis in 2 (2.4%), malignant lymphoma in 2 (2.4%) and each cases of pancreatic abscess and solid pseudopapillary neoplasm (2.4%). In 63 pancreatic lesions with adenocarcinoma, hypoenhancement during arterial, late and delay phase was observed in 52 (82.5%), 59 (93.7%), and 62 (98.4%), respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for adenocarcinoma as hypoenhancement at CEH-EUS showed at table 1. Conclusions: CEH-EUS could characterize pancreatic mass lesions with relatively high accuracy during late phase and may be useful for distinguishing adenocarcinomas from other pancreatic masses.
Keywords: EUS, Contrast enhanced, Harmonic, Pancreas, Solid lesion
[P-078]. Histological and immunohistochemical evaluation using endoscopic ultrasound-guided fine-needle aspiration in solid masses Jae Gu Jung 1, Ki Joo Kang 2, Cho Rong Oh 1, Jong Kyun Lee 1, Kyu Taek Lee 1, Kee Taek Jang 3, Jong Hak Choi 1, Sang Mo Park 4, Kwang Hyuck Lee 1 1
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 2 Department of Medicine, Hallym University College of Medical School, Hallym University Sacred Heart Hospital, Anyang, South Korea 3 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea 4 Department of Pathology, Soon Chun Hyang University Bucheon Hospital, Bucheon, South Korea
Background/aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been demonstrated to be useful in the diagnosis of lesions adjacent to the gastrointestinal tract. The aim was to evaluate the clinical utility of histological and immunohistochemical (IHC) analyses of specimens obtained by EUS-FNA. Methods: This study consisted of retrospective and prospective analyses. The retrospective study was performed on 116 patients who
S45
underwent EUS-FNA of solid masses for cytological smear, histological analysis, and combined analysis including IHC staining. In the prospective study, 79 patients were enrolled to evaluate the quality and accuracy of EUS-FNA histological analysis and feasibility of IHC staining. Results: The final diagnoses of all patients included pancreatic cancer (n¼126), non-pancreatic cancer (n¼21), other neoplasm (n¼27), and benign lesions (n¼21). In our retrospective study, the combined analysis was more sensitive than cytological analysis alone (P < 0.01). The overall sensitivity of cytology, histology, and combined analysis was 69.8%, 67.2%, and 81.8% respectively. In the prospective analysis, 64.2% of all punctures were helpful for determining a diagnosis and 40.7% provided sufficient tissue for IHC staining. Histological analysis was helpful for diagnosis in 74.7% of patients. IHC staining was necessary for a definite diagnosis in 11.4% of patients, especially in the cases of non-malignant pancreatic mass. Conclusions: Histological analysis and IHC study of EUS-FNA specimens was useful for the accurate diagnosis of pancreatic and peripancreatic lesions. Combined analysis showed significantly higher sensitivity than cytology alone because IHC staining was helpful for a diagnosis in some patients. Keywords: EUS-FNA, Histology, Pancreatic mass, Peripancreatic mass
[P-079]. Phase II clinical trial to evaluate the efficacy and safety of activated Tlymphocyte cell therapy in gemcitabine refractory advanced pancreatic cancer Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Jae Bock Chung, Si Young Song Division of Gastroenterology, Yonsei Institute of Gastroenterology, Seoul, South Korea Background/aim: Standard second-line chemotherapy in gemcitabine refractory patients with advanced pancreatic cancer is not established due to rapid disease progression and performance deterioration. In a previous randomized phase III trial, patients treated with 5-FU/FA plus oxaliplatin as second-line chemotherapy showed a median progression-free survival (PFS) of 13 weeks and a median overall survival (OS) of 26 weeks. The aim of this phase II trial was to evaluate the efficacy and safety of the activated T-lymphocyte cell therapy (ATLCT) (Immuncell-LC, INNOCELL Corporation) in gemcitabine refractory advanced pancreatic cancer. Methods: Patients with advanced pancreatic cancer who showed disease progression during gemcitabine-based chemotherapy were enrolled in this study. For generation of activated T-lymphocyte cells, peripheral bloods were collected from each patient and were cultured with anti-CD3 monoclonal antibody and IL-2. Patients received autologous T-lymphocytes intravenously every week for 5 weeks and then every other week for 10 weeks. Results: Twenty cases were enrolled between November 2009 and September 2010. A total of 127 cycles of ATLCT were delivered and a mean number of cells transferred per infusion was 7.3 x 109 ( 2.4 x 109). The disease control rate were 15 % (3/20 patients). The median PFS was 11 weeks (95% CI, 8.7–13.3) and median OS was 26.1 weeks (95% CI, 18.3– 33.9). Grade 3 toxicities included general weakness in 2 patients and thrombocytopenia in 1 patient. Grade 4 hematologic or non-hematologic toxicity was not observed. Conclusions: ATLCT showed comparable PFS and OS to survival data of previous trials assessing conventional chemotherapies while maintaining tolerability in gemcitabine refractory advanced pancreatic cancer. (Funded by Innocell Corporation; ClinicalTrials.gov numbers, NCT00965718.). Keywords: Pancreatic cancer, Gemcitabine refractory, Activated Tlymphocyte cell therapy
[P-080]. Risk factors for second primary pancreatic cancer in colorectal cancer patients Joo Won Chung 1, Moon Jae Chung 2, Seungmin Bang 2, Seung Woo Park 2, Si Young Song 2, Jae Bock Chung 2, Jeong Youp Park 2