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Saudi presentation with audio
 

Saudi presentation with audio

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    Saudi presentation with audio Saudi presentation with audio Presentation Transcript

    • Agreement between Rapid Onsite (ROSE) and Final Cytology in Pancreatic Cancer Ali Lankarani, MD [email_address]
    • Ali Lankarani, MD 3rd year GI fellow Allegheny General Hospital / Drexel University Pittsburgh Manish K. Dhawan, MD Disclaimer: Not an Endosonographer Ali Lankarani, MD [email_address]
    • Pancreatic Cancer
      • Fourth-leading cause of cancer death in USA
      • 36,800 death in 2010 (>4 life/Hr)
      • 5-year survival rate = 5.5%
      • $1.5 billion is spent each year on treatment of pancreatic cancer
      Ali Lankarani, MD [email_address]
    • Pancreatic Cancer
      • 43,140 Americans diagnosed with Pancreatic cancer in 2010
      • 1.38% of men and women born today will be diagnosed with cancer of the pancreas at some time during their lifetime
      Ali Lankarani, MD [email_address]
    • Pancreatic Cancer Dx
        • Cross sectional imaging with spiral CT or MRI
        • Abdominal US
        • EUS/FNA
        • ERCP
        • Serum markers
      Ali Lankarani, MD [email_address]
    • EUS in Pancreatic Cancer
      • EUS is sensitive but not specific
      • EUS-FNA is the modality of choice for obtaining tissue
      • Tissue diagnosis is mandatory before chemotherapy (not surgery!)
      Ali Lankarani, MD [email_address]
    • Rapid OnSite cytologic Evaluation (ROSE)
      • More than one needle pass is usually needed
      • Onsite cytopathologist, if available, can confirm the adequacy of sample
      • ROSE can helps with:
        • Adequacy of sample
        • Presence of neoplastic changes
      Ali Lankarani, MD [email_address]
    • Clinical Questions
      • Evaluate the accuracy of pancreatic Rapid Onsite Cytologic Evaluation (ROSE) during EUS-FNA
      • Identify the factors that may influence the number of FNA passes needed
      • Recognize other important EUS findings that can change the management of patients with pancreatic cancer during the EUS exam
      Ali Lankarani, MD [email_address]
    • Accuracy of pancreatic Rapid Onsite Cytologic Evaluation (ROSE)
      • Agreement of Rapid Onsite Cytologic Evaluation (ROSE) with final interpretation is unknown
      • ROSE over-read of neoplastic changes can result in premature termination of the exam
      • ? Need for additional investigation in case of discrepancy
      Ali Lankarani, MD [email_address]
    • ROSE Accuracy
      • Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer
      • Collection and analysis of:
        • ROSE result
        • Final cytopathologic result
        • Name of the cytopathologist attending involve in each case
      • Exams with onsite interpretation of” malignant”, “suspicious” or “atypical” were included in the study (n=200)
      Ali Lankarani, MD [email_address]
    • ROSE Accuracy
      • N=200
      • In 149 exams, ROSE and the final read were compatible (74.5%)
      • ROSE under read the neoplastic changes in 43 exams (21.5%)
      • ROSE over reads in 8 exams (4%)
      Ali Lankarani, MD [email_address] Definition of “over reading” and “under reading”. Malignant Suspicious Atypical Malignant Suspicious Final ROSE Under-reading: Atypical Benign Suspicious Suspicious Atypical Benign Malignant Final ROSE Over-reading:
    • ROSE Accuracy
      • All the patients with over-read on ROSE where recommended to have repeat EUS-FNA exam
      • 62% of patients with over-read on ROSE required additional endoscopic or surgical procedures
      • Incidence of ROSE over-read is cytopathologist dependent (0-7%)
      Ali Lankarani, MD [email_address]
    • Identifying the factors that may influence the number of FNA passes:
      • Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer (n=188)
      • Analyze the effect of the following variations:
        • FNA needle size
        • Location of the mass
        • Size of the tumor
        • Endosonographer’s experience
      Ali Lankarani, MD [email_address]
    • Endosonographer’s experience Location of the tumor Ali Lankarani, MD [email_address] Poster # 21
    • Detection of Metastasis during Staging EUS in Pancreatic Cancer
      • Resective surgery is curative only if the pancreatic cancer is localized
      • Frequency of detecting metastatic disease that was not picked on cross sectional imaging is unknown
      Ali Lankarani, MD [email_address]
    • Detection of Metastasis during Staging EUS in Pancreatic Cancer
      • Review of the past 6 yrs data of the patients that were diagnosed with pancreatic cancer
      • Collection and analysis of:
        • location of the extra pancreatic suspicious appearing organs
        • Final cytopathologic result
      Ali Lankarani, MD [email_address]
    • Detection of Metastasis during Staging EUS in Pancreatic Cancer
      • Out of 217 patients with pancreatic cancer, in 38 (17%) patients at least one new suspicious-appearing lesion separate from the pancreatic mass was detected
      • 10.1% patients were upstaged because of EUS
      Ali Lankarani, MD [email_address] Poster # 20
    • Multimedia Resources in Endoscopic Training TGIE, April 2011 Ali Lankarani, MD [email_address]