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Publications (12)20.84 Total impact

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    ABSTRACT: BACKGROUND: Metastases to the pancreas are rare, and usually mistaken for primary pancreatic cancers. This study aimed to describe the histology results of solid pancreatic tumours obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosis of metastases to the pancreas. METHODS: In a retrospective review, patients with pancreatic solid tumours and history of previous extrapancreatic cancer underwent EUS-FNA from January/1997 to December /2010. Most patients were followed-up until death and some of them were still alive at the end of the study. The performance of EUS-FNA for diagnosis of pancreatic metastases was analyzed. Symptoms, time frame between primary tumour diagnosis and the finding of metastases, and survival after diagnosis were also analyzed. RESULTS: 37 patients underwent EUS-FNA for probable pancreas metastases. Most cases (65%) presented with symptoms, especially upper abdominal pain (46%). Median time between detection of the first tumour and the finding of pancreatic metastases was 36 months. Metastases were confirmed in 32 (1.6%) cases, 30 of them by EUS-FNA, and 2 by surgery. Other 5 cases were non-metastatic. Most metastases were from lymphoma, colon, lung, and kidney. Twelve (32%) patients were submitted to surgery. Median survival after diagnosis of pancreatic metastases was 9 months, with no difference of survival between surgical and non-surgical cases. Sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA with histology analysis of the specimens for diagnosis of pancreatic metastases were, respectively, 93.8%, 60%, 93.8%, 60% and 89%. CONCLUSION: EUS-FNA with histology of the specimens is a sensitive and accurate method for definitive diagnosis of metastatic disease in patients with a previous history of extrapancreatic malignancies.
    BMC Gastroenterology 04/2013; 13(1):63. DOI:10.1186/1471-230X-13-63 · 2.11 Impact Factor
  • Gastrointestinal Endoscopy 04/2012; 75(4):AB200. DOI:10.1016/j.gie.2012.04.344 · 4.90 Impact Factor
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    ABSTRACT: To disseminate transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) as an alternative to investigate mediastinal tumoral lesions because it is an underused modality that has been available in Brazil for more than 15 years. Descriptive analysis of a single endoscopy service's experience since 1997 in the accomplishment of EUSFNA for mediastinal staging of previously known malignancies (Group 1) or diagnostic definition of suspect lymph nodes and masses (Group 2). EUS-FNA was performed in 51 patients between 26 and 87 years of age. The diameter of the lesions ranged between 1.1 and 9.8 cm (mean 3.9 cm). Their location corresponded to the following stations: higher paratracheal (4 cases), lower paratracheal (7), aortic window (12), para-aortic (6), subcarinal (9), paraesophageal (8), and hilar (5). In Group 1, 17 patients had previously diagnosed primary lung (9), breast (4), kidney (2), colon (1), and bladder (1) cancer. Fifteen of these punctures were positive for malignity. Two others were later submitted to mediastinoscopy, which identified metastases not detected by EUS-FNA. Group 2 comprised 34 patients. Among these patients, EUS-FNA diagnosed 22 neoplasms, five cases of tuberculosis and two duplication cysts. Cytology was inconclusive or without a specific diagnosis in five other cases. Mediastinoscopy identified two undiagnosed cases of oat-cell carcinoma, one lymphoma and one cryptococcosis, and confirmed one reactive lymphadenitis. There were no complications related to the method. EUS-FNA obviated the need for surgical procedures in 86.3% of cases. Therefore, oncologists, pulmonologists, and thoracic surgeons should always remember the technique's potential and availability.
    Clinics (São Paulo, Brazil) 09/2011; 66(9):1579-83. DOI:10.1590/S1807-59322011000900013 · 1.59 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures. Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results. 46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic--11 biliary) and benign in 9 (8 chronic pancreatitis--1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2% and 52.2% for GP and 51.4% and 58.7% for GIP. Sensitivity and accuracy for EUS-FNA were 52.8% and 58.5%, respectively for GP and 69.4% e 73.2% for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9% and 69.6%, respectively) and GIP (83.8% and 84.8%, respectively) and improved agreement with final diagnosis for both (mostly for GIP). Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.
    Revista do Colégio Brasileiro de Cirurgiões 06/2010; 37(3):190-8.
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    Gastrointestinal Endoscopy 04/2010; 71(5). DOI:10.1016/j.gie.2010.03.644 · 4.90 Impact Factor
  • Revista do Colégio Brasileiro de Cirurgiões 01/2010; 37(3). DOI:10.1590/S0100-69912010000300006
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    ABSTRACT: Cytological smear is widely employed to analyse specimens obtained from endosonography-guided fine-needle aspiration (EUS-FNA), but false-negative or inconclusive results may occur. A better diagnostic yield can be obtained from processing cell blocks. We compared the effectiveness of the cell block technique and cytological smear in the diagnosis of pancreatic neoplasms. From January 1997 to December 2006, 611 patients with pancreatic tumors were evaluated by EUS-FNA. Surgery was performed in 356 cases, and the other 255 patients were followed clinically for an average of 12.8 months. In total, 282 (46.2%) patients were evaluated with cytological smears, and 329 (53.8%) were evaluated using only cell blocks. Malignant disease was detected in 352 (57.6%) cases, in which adenocarcinoma accounted for 236 (67%) cases. A benign disease was found in the other 259 cases, including 35.1% focal chronic pancreatitis and 32.4% pseudocysts. Aspiration samples were satisfactory in 595 (97.4%) patients after an average of 2.2 (1-4) passes of the needle. Regardless of the cytopathological examination technique, EUS-FNA confirmed malignancy in 269 of 352 (76.4%) cases, and a benign disease in 257 of 259 (99.2%) cases. For patients who received surgery with histologically confirmed lesions, the sensitivity specificity, positive and negative predictive values, and accuracy of the smears versus cell blocks in diagnosing pancreatic tumors were 61% versus 85.2% (P<0.001), 100% versus 93.1%, 100% versus 98.4%, 36% versus 55.1% (P=0.046) and 68% versus 86.5% (P<0.001), respectively The cell block technique demonstrated a hig her sensitivity, negative predictive value and accuracy than cytological smears.
    Acta gastroenterologica Latinoamericana 12/2008; 38(4):246-51.
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    ABSTRACT: endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) allows cytologic and/or histologic diagnosis of lesions within or adjacent to the gastrointestinal tract. However, the amount of tissue obtained with a regular 22 gauge needle is not always satisfactory. With the development of a needle XNA-10J-KB (Shot-Gun) that resembles the automatic liver biopsy needle, it is expected that significant samples be obtained more frequently (core biopsy), optimizing histological analysis. to compare samples obtained with EUS-FNA using 3 different needle systems: GIP, NA-10J-1 and Shot-Gun. 19 patients underwent EUS-FNA for diagnosis (5) or tumor staging (14). Mean age was 58.9 years (range 27-82), being 50% men. All patients were submitted to EUS-FNA with the 3 needle models. The Shot-Gun model was "shot" when its tip was near the target inside the lesion, followed by aspiration. Samples were submitted for cytologic and histologic examination. mean lesion size was 3.0 cm (range 0.8-5.5 cm). Final diagnoses were made after surgery or intra-operative biopsy: 13 pancreatic tumors (12 adenocarcinomas and 1 neuroendocrine tumor), 4 chronic pancreatitis, 1 acute pancreatitis, and 1 cholangiocarcinoma. Specimens adequate for cytologic diagnosis were obtained in 13/19 (68. 4%) patients using GIP model, in 14/19 (73.7%) with NA10J-1 model, and in 17/19 (89.5%) with ShotGun, model (p=0.039). Histologic analysis was possible in 10/19 (52.6%) patients using the GIP model, in 14/19 (73.7%) with NA10J-1, and in 17/19 (89.5%) with Shot-Gun, model (p=0.005). Adequate samples for cytologic or histologic assessment in 16/19 (84.2%) patients using the GIP model, in 17/19 (89.5%) with NA10J-1, and in 18/19 (94.7%) with Shot-Gun, model (p=0.223). In two cases biopsies were negative due to very hard tumors. the Shot-Gun needle obtained better samples for histological diagnosis than NA10J-1 needle and GIP.
    Acta gastroenterologica Latinoamericana 07/2008; 38(2):105-15.
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    ABSTRACT: To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUS-FNA. The final diagnosis was obtained either by surgery (356 cases) or after a mean clinical follow-up of 11.8 mo in the remaining patients. There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 (97.4%) cases. There were 352 (57.6%) malignancies and 259 (42.4%) benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67% of the lesions. Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4%, 99.2%, 99.3%, 77.2% and 87.2%. Specifically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8% vs 82.4%, 100% vs 98.4%, 100% vs 99%, 54.8% vs 74.1% and 83.1% vs 87.8%. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%. EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.
    World Journal of Gastroenterology 07/2007; 13(22):3112-6. · 2.43 Impact Factor
  • Gastrointestinal Endoscopy 04/2007; 65(5). DOI:10.1016/j.gie.2007.03.695 · 4.90 Impact Factor
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    ABSTRACT: Pseudotumoral chronic pancreatitis can be difficult to differentiate from pancreatic carcinoma. To evaluate the role of endoscopic ultrasound and fine needle aspiration in differentiating between inflammatory masses and malignancies in chronic pancreatitis. Retrospective study. Tertiary care endoscopy unit. Between February 1997 and December 2006, 69 pancreatic head masses from patients with alcoholic chronic pancreatitis underwent EUS-FNA using a linear echoendoscope and 22-gauge needles. Final diagnoses were obtained from surgery or clinical follow-up. The patients were subdivided into two groups: pseudotumoral chronic pancreatitis and pancreatic cancer. Pseudotumoral masses and adenocarcinoma were found in 58 and 11 patients, respectively. The size of the lesions and the clinical presentation were similar in both groups, but the cancer patients were older than the patients with pseudotumoral masses (P=0.020). Fourteen of the 58 (24.1%) pseudotumoral masses were misdiagnosed as cancers, and 4 of the 11 (36.4%) cancers were erroneously diagnosed as pseudotumoral masses when evaluated by EUS alone. EUS-FNA confirmed the final diagnosis in 66 of the 69 (95.7%) cases. Cytopathology correctly classified 8 of the 11 (72.7%) malignancies and all benign cases. Three of the 11 (27.3%) cancers were misdiagnosed as pseudotumoral masses, and no pseudotumoral mass was diagnosed as a cancer. In two cases, the specimens were inadequate for cytopathological assessment. The sensitivity, specificity, positive and negative predictive values, and the diagnostic accuracy of EUS-FNA were 72.7%, 100%, 100%, 95.1% and 95.7%, respectively. The diagnostic accuracy of endoscopic ultrasound alone for differentiating between pseudotumoral masses and pancreatic cancer arising from chronic pancreatitis is unsatisfactory. Fine needle aspiration of these tumors significantly improves diagnostic capability.
    JOP: Journal of the pancreas 02/2007; 8(4):413-21.
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    ABSTRACT: The dramatic increase in the number of patients diagnosed with incidental pancreatic cysts through imaging methods provides a unique opportunity to detect and treat these precursor lesions of ductal adenocarcinoma before their manifestation. However, without any reliable biomarkers, the cost-effectiveness and the limited accuracy of high-resolution imaging techniques for diagnose and staging seems troublesome. Small pancreatic cysts can be easily detected, but many are clinically irrelevant and are not harmful to the patient. Furthermore, patients with clinically benign lesions are at high risk of overtreatment and morbidity and mortality from unnecessary surgical intervention. It is believed that cyst fluid analysis may provide important information for a possible diagnosis, allowing stratification and treatment of these patients. Anyway, only the logical reasoning based on all available information (medical history, imaging, and laboratory analysis of the aspirated cyst fluid) can adequately stratify patients. It has been considered that there are three precursor lesions of the pancreatic cancer (PC): mucinous cystadenoma (MCA), intraductal papillary mucinous tumor (IPMT) and pancreatic intraepithelial neoplasia (PanIN). MCA and IPMT can be diagnosed by imaging methods, but PanIN are difficult to be identified. They must be detected and treated as soon as possible, as this is the only way to increase survival and reduce mortality of pancreatic ductal adenocarcinoma. The aim of this work is to establish diagnosis, staging, and the pathological findings and to compare the effectiveness and accuracy of the other imaging methods versus endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) for diagnosis of malignancy in the precursor lesions of pancreatic cancer.