Management of Asymptomatic Sporadic Nonfunctioning Pancreatic Neuroendocrine Neoplasms (ASPEN) <= 2 cm: Study Protocol for a Prospective Observational Study

Introduction: The optimal treatment for small, asymptomatic, nonfunctioning pancreatic neuroendocrine neoplasms (NF-PanNEN) is still controversial. European Neuroendocrine Tumor Society (ENETS) guidelines recommend a watchful strategy for asymptomatic NF-PanNEN <2 cm of diameter. Several retrospective series demonstrated that a non-operative management is safe and feasible, but no prospective studies are available. Aim of the ASPEN study is to evaluate the optimal management of asymptomatic NF-PanNEN ≤2 cm comparing active surveillance and surgery. Methods: ASPEN is a prospective international observational multicentric cohort study supported by ENETS. The study is registered in ClinicalTrials.gov with the identification code NCT03084770. Based on the incidence of NF-PanNEN the number of expected patients to be enrolled in the ASPEN study is 1,000 during the study period (2017–2022). Primary endpoint is disease/progression-free survival, defined as the time from study enrolment to the first evidence of progression (active surveillance group) or recurrence of disease (surgery group) or death from disease. Inclusion criteria are: age >18 years, the presence of asymptomatic sporadic NF-PanNEN ≤2 cm proven by a positive fine-needle aspiration (FNA) or by the presence of a measurable nodule on high-quality imaging techniques that is positive at 68Gallium DOTATOC-PET scan. Conclusion: The ASPEN study is designed to investigate if an active surveillance of asymptomatic NF-PanNEN ≤2 cm is safe as compared to surgical approach

On the validation of K index values at Italian geomagnetic observatories

Local K index and the consequent global Kp index are well established three-hour range indices used to characterize the geomagnetic activity. K index is one of the parameters which INTERMAGNET observatories can provide and it’s widely used since several decades, although many other activity indices have been proposed in the meanwhile. The method for determining the K values has to be the same for all observatories. INTERMAGNET consortium recommends the use of one of the 4 methods endorsed by the International Service of Geomagnetic Indices ( ISGI) in close cooperation and agreement with the ad-hoc working group of International Association of Geomagnetism and Aeronomy (IAGA). INTERMAGNET provides the software code KASM, designed for an automatic calculation of K index according to the Adaptive Smoothed method. K values should be independent on the local dynamic response, therefore for their determination each observatory has its own specific scale regulated by the L9 lower limit, which represents the main input parameter for KASM. The determination of an appropriate L9 value for any geomagnetic observatory is then fundamental. In this work we statistically analyze the K values estimated by means of KASM code for the Italian geomagnetic observatories of Duronia (corrected geomagnetic latitude λ~36° N) and Lampedusa (λ~28° N) comparing them with the German observatories of Wingst and Niemegk. Our comparative analysis is finalized to establish the best estimation of the L9 lower limit for these two stations. A comparison of L9 lower limits found for the Italian observatories with results from a previous empirical method was also applied and used to verify the consistency and reliability of our outcomes.Published105–1151A. Geomagnetismo e PaleomagnetismoJCR Journa

Digital Subtraction of Magnetic Resonance Images Improves Detection and Characterization of Pancreatic Neuroendocrine Neoplasms

The aim of this study was to evaluate the usefulness of digital image subtraction of contrast-enhanced magnetic resonance (MR) images for detection and characterization of pancreatic neuroendocrine neoplasms (PanNENs)

Triple approach strategy for patients with locally advanced pancreatic carcinoma

AbstractBackgroundRadiofrequency ablation (RFA) is a relatively new technique, applied to metastatic solid tumours which, in recent studies, has been shown to be feasible and safe on locally advanced pancreatic carcinoma (LAPC). RFA can be combined with radio‐chemotherapy (RCT) and intra‐arterial plus systemic chemotherapy (IASC). The aim of this study was to investigate the impact on the prognosis of a multimodal approach to LAPC and define the best timing of RFA.MethodsThis is a retrospective observational study of patients who have consecutively undergone RFA associated with multiple adjuvant approaches.ResultsBetween February 2007 and December 2011, 168 consecutive patients were treated by RFA, of which 107 were eligible for at least 18 months of follow‐up. Forty‐seven patients (group 1) underwent RFA as an up‐front treatment and 60 patients as second treatment (group 2) depending on clinician choice. The median overall survival (OS) of the whole series was 25.6 months: 14.7 months in the group 1 and 25.6 months in the group 2 (P = 0.004). Those patients who received the multimodal treatment (RFA, RCT and IASC‐triple approach strategy) had an OS of 34.0 months.ConclusionsThe multimodal approach seems to be feasible and associated with an improved longer survival rate

TRUS and endocoil MRI in prostatic cancer

Objective: Accurate staging of prostatic cancer is important for planning an optimal treatment, such as radical prostatectomy in clinical stage T2. About 40-50% of patients operated for cT2 disease show a pathological stage T3 disease. In a prospective study we analysed accuracy of TRUS and endocoil MRI in a group of patients before radical prostatectomy. Materials and methods: 33 consecutive patients suspicious of prostate neoplasms were studied and staged with TRUS and endocoil MRI before prostatic biopsy and before radical prostatectomy. One urologist trained in TRUS conducted the exam, while one radiologist interpreted the MRI studies in a blind mode. The criteria evaluated were accuracy of global staging, extracapsular extension (ECE) and seminal vesicle invasion (SVI). These results were correlated with the histopathological findings after radical prostatectomy. Results: The histopatological results showed 14 patients (42%) with pT2 disease, 18 patients (54%) with pT3 disease and 1 case (4%) of pT4 disease. TRUS showed a low sensitivity (38%) and a good specificity (78%), with an overall accuracy of 50%; the best result was 96% specificity for SVI. Endocoil MRI showed a good sensivitity (70%) and specificity (76%), with an overall accuracy of 73%. Endocoil was also useful to stage Tlc disease when TRUS is negative. TRUS tends to understage, whereas endocoil MRI over-stages prostate cancer. Conclusions: TRUS and endocoil MRI may help in decision making about the appropriate treatment of prostatic cancer, even if they have limited current value, due to understaging or overstaging

Geomagnetic Activity at Lampedusa Island: Characterization and Comparison with the Other Italian Observatories, Also in Response to Space Weather Events

Regular automatic recordings of the time series of the magnetic field, together with routine manual absolute measurements for establishing dynamic baselines at Lampedusa Island—south of Sicily—Italy (geographic coordinates 35°31′N; 12°32′E, altitude 33 m a.s.l.), show a signature of very low electromagnetic noise. The observatory (provisional IAGA code: LMP) lays inside a restricted and remote wildlife reserve, far away from the built-up and active areas of the island, which at present is the southernmost location of the European territory for such observations. The availability of high-quality data from such site, whose survey started in 2005, is valuable for filling the spatial gap due to the lack of observatories in the whole south Mediterranean and North African sectors. We compare observations at Lampedusa, in both time and frequency domains, with those at the other Italian observatories (Castello Tesino and Duronia-L’Aquila), operating since the 1960s of last century, allowing us to report even the secular variation. Using data recorded in the last few years, we investigate higher frequency variations (from diurnal to Pc3-4 pulsations) in order to magnetically characterize the Italian territory and the local response to external forcing. In particular, we present a characterization in terms of diurnal variation and its seasonal dependence for the three observatories. This latter feature is in good agreement with a geomagnetic Sq-model, leading us to speculate about the position of the north Sq-current system vortex and its seasonal displacement with respect to the geographic positions of the observatories. We also study the geomagnetic individual response to intense space weather events by performing Superposed Epoch Analysis (SEA), with an ad-hoc significance test. Magnetic responses in the Ultra Low Frequency range (ULF) from spectral, local Signal-to-Noise Ratio (SNR) analyses under different local time, and polarization rates are computed. These latter studies lead us to search for possible signatures of magnetic field line resonances during intense space weather events, using cross-phase multi-observatory analysis, revealing the promising detection capability of such technique even at low latitudes. The geomagnetic observatories prove to be important points of observation for space weather events occurring at different spatial and time scales, originating in both upstream and ionospheric regions, here analyzed by several well-established methodologies and techniques. The quiet environmental site of LMP, providing high-quality geomagnetic data, allows us such investigations even at inner Earth’s magnetospheric shell

Pancreatic neuroendocrine neoplasms: Magnetic resonance imaging features according to grade and stage

To describe magnetic resonance (MR) imaging features of pancreatic neuroendocrine neoplasms (PanNENs) according to their grade and tumor-nodes-metastases stage by comparing them to histopathology and to determine the accuracy of MR imaging features in predicting their biological behavior

Downstaging in Stage IV Pancreatic Cancer: A New Population Eligible for Surgery?

Background. Recent papers consider surgery as an option for synchronous liver oligometastatic patients [metastatic pancreatic ductal adenocarcinoma (mPDAC)]. In this study, we present our series of resected mPDACs after neoadjuvant chemotherapy (nCT).Patients and methods. All patients resected after downstaging of mPDAC were included in this study. Downstaging criteria were disappearance of liver metastasis and a decrease in cancer antigen (CA) 19-9. The type and duration of nCT, last nCT surgery interval, histology, morbidity, and mortality were recorded, and overall survival (OS) and disease-free survival (DFS) were analyzed.Results. Overall, 24 of 535 patients (4.5%) observed with mPDAC were included. These patients received gemcitabine alone (5/24), gemcitabine + nanoparticle albuminbound (nab)-paclitaxel (3/24), and FOLFIRINOX (16/24). Primary tumor size decreased from 31 to 19 mm (p < 0.001), and serum CA19-9 decreased from 596 to 18 U/mL (p < 0.001). In 14/24 patients, the tumor was located in the head. Median interval nCT surgery was 2 months, there were no mortalities, and the postoperative course was uneventful in 34% of cases. Grade B/C pancreatic fistula, postoperative bleeding, and sepsis occurred in 17/4, 4, and 12% of cases, respectively, and reoperation rate was 4%. R0 resection was achieved in 88% of cases, with 17% complete pathological response. Positive nodes were found in 9/24 patients with a median node ratio of 0.37, and OS and DFS was 56 and 27 months, respectively.Conclusions. Patients with mPDAC who were fully responsive to nCT may be cautiously considered for surgery, with potential benefit in survival compared with palliative chemotherapy alone. This is supported by results of our retrospective study, which is the largest ever reported

Pancreatic neuroendocrine neoplasms: MRI features and correlation with their histological grade

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