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Thomas J Savides

Publications and source records attributed to Thomas J Savides.

18 recordsLinked to original sources
PubMed2006

Influence of the number of malignant regional lymph nodes detected by endoscopic ultrasonography on survival stratification in esophageal adenocarcinoma.

BACKGROUND & AIMS: The nodal staging of esophageal cancer accounts for the absence or presence of metastatic lymph nodes (N0 or N1, respectively). Surgical data suggest that patients have worse survival when esophagectomy specimens contain higher numbers of regional malignant lymph nodes. It has been proposed that the staging system for esophageal cancer be modified to include the number of malignant lymph nodes. The aim of this study was to determine the influence of the number of malignant-appearing regional lymph nodes detected on endoscopic ultrasonography (EUS) on survival in patients with esophageal adenocarcinoma. METHODS: Historical case series involved patients with esophageal adenocarcinoma who underwent EUS staging at a single center between 1994 and 2004. Endoscopy reports were reviewed to determine the number of malignant-appearing periesophageal lymph nodes seen on EUS examination. Subjects were categorized as having 0, 1-2, or >2 periesophageal lymph nodes. A regional cancer registry prospectively obtained survival data. RESULTS: Among 85 patients with esophageal adenocarcinoma, the Kaplan-Meier curves showed distinct survival advantages in those with fewer malignant-appearing regional lymph nodes (P=.0008). The median survivals were 66 months, 14.5 months, and 6.5 months for 0, 1-2, and >2 malignant-appearing lymph nodes, respectively. Survival was also influenced by celiac lymph nodes and tumor length, both of which were associated with increased number of malignant nodes. CONCLUSIONS: The number of malignant-appearing periesophageal lymph nodes detected by EUS is associated with improved survival stratification in patients with esophageal adenocarcinoma and should be considered in the presurgical staging of esophageal cancer.

Adenocarcinoma↗
PubMed2005

An evidence-based approach to the diagnosis and staging of pancreatic cancer.

Technology has revolutionized the diagnosis and staging of pancreatic malignancy. Previously, staging of disease was accomplished by exploratory laparotomy. Now, however, tumor size, lymph node and vascular involvement and the presence of metastases can be reliably assessed prior to operation using a widely available series of diagnostic tests, facilitating a preoperative assessment of tumor resectability. Appropriate use of these tests often spares patients with unresectable disease the need for operative intervention. As part of our staging algorithm we routinely employ a combination of clinical suspicion, a high-resolution helical CT scan and a serum CA 19-9 level. Endoscopic ultrasonography is useful in the patient in whom CT findings are equivocal, or in whom a tissue diagnosis is desired. Laparoscopy is reserved for patients with suspected advanced disease despite imaging findings to the contrary. Using this strategy, pancreatic malignancy may be diagnosed as expeditiously and as cost-effectively as is possible given current technology.

Adult↗
PubMed2004

Possible features of current electronic endoscopic information systems: what to look for.

The endoscopic electronic medical record (EEMR) has the potential to increase greatly the efficiency of both the endoscopist and the entire endoscopy unit. Potential efficiencies depend on the specific situation of the endoscopist and the type of endoscopy unit. This article describes a number of features available in current EEMRs as well as some emerging features that are important for future databases. Additionally, some aspects of equipment and staff needed to implement a successful EEMR are discussed.

Endoscopy, Digestive System↗
PubMed2004

Impact of EUS-guided FNA of enlarged mediastinal lymph nodes on subsequent thoracic surgery rates.

BACKGROUND: A histopathologic diagnosis of metastasis in enlarged mediastinal lymph nodes usually results in non-surgical management. Cytologic specimens obtained by EUS-guided FNA can be used to detect malignancy in posterior mediastinal lymph nodes. The purpose of this study was to determine the rate of thoracic surgery after EUS-guided FNA of enlarged mediastinal lymph nodes. METHODS: A prospective observational study of patients with enlarged posterior mediastinal lymphadenopathy who were referred for EUS-guided FNA. All patients were candidates for mediastinoscopy. Patients were followed for 12 months to determine the subsequent rate of mediastinoscopy or thoracotomy and the diagnostic accuracy of EUS-guided FNA. RESULTS: Evaluation of cytologic specimens obtained by EUS-guided FNA revealed malignancy in 23 of 59 (39%) patients. The overall rate of surgery was 22% (13/59): 95% CI[0.12, 0.35]. The surgery rate for patients with a positive cytologic result was 4% (1/23) compared with 33% (12/36) for those with a negative result (p=0.009). Of patients with CT findings of a peripheral lung mass plus mediastinal lymphadenopathy, 22 of 26 (42%) underwent surgery after EUS-guided FNA, compared with two of 33 (6%) of those with mediastinal lymphadenopathy alone (p=0.0009). For cytologic evaluation of specimens obtained by EUS-guided FNA, the overall sensitivity, specificity, and accuracy for the diagnosis of malignant lymphadenopathy were 96%, 100%, and 98%, respectively. CONCLUSIONS: Few patients who undergo EUS-guided FNA of enlarged posterior mediastinal lymph nodes require subsequent thoracic surgery.

Adult↗
PubMed2004

Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States.

BACKGROUND: The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted. METHODS: A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion. RESULTS: Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p=0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions. CONCLUSIONS: EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.

Acute Disease↗
PubMed2004

Simultaneous serous cystadenoma of the pancreas and mucinous cystadenoma of the appendix.

CONTEXT: Serous cystadenoma of the pancreas and mucinous tumors of the vermiform appendix are rare. To our knowledge, the simultaneous occurrence of these two tumors has not been reported. CASE REPORT: Here, we report an adult female who presented with signs and symptoms of appendicitis. A preoperative CT scan confirmed the findings of appendicitis and also showed an incidental large mass in the head of the pancreas. The patient underwent uneventful appendectomy. Her pathology revealed an acutely inflamed appendix with a benign mucinous cystadenoma at the tip. Several months after her recovery, a Whipple procedure was performed. Pathologic examination showed a 5x5 cm serous cystadenoma of the head of the pancreas without evidence of malignancy. Two years later, the patient is alive and well without evidence of tumor recurrence. CONCLUSIONS: Cystadenomas of the pancreas and appendix are unusual and their simultaneous occurrence is a rare event.

Appendiceal Neoplasms↗
PubMed2003

Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions.

BACKGROUND: The aim of this study was to evaluate the degree of agreement among endosonographers for EUS diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions and the specific type of cystic lesion. METHODS: Videotapes of EUS procedures from 31 consecutive cases of a range of histopathologically proven lesions, including mucinous cystic neoplasm, serous cystadenoma, neuroendocrine tumor, intraductal papillary mucinous tumor, and pseudocyst, were used to make a study videotape, which was reviewed by 8 experienced endosonographers. The reviewers, blinded to clinical and surgical histopathology results, reviewed each case for the presence or absence of the following features: abnormality of pancreatic duct and parenchyma, margins, solid component, debris, and septations. They were asked to identify each lesion as neoplastic or non-neoplastic and to give a specific diagnosis for each lesion. RESULTS: There was fair agreement between endosonographers for diagnosis of neoplastic versus non-neoplastic lesions (kappa = 0.24). Agreement for individual types of lesions was moderately good for serous cystadenomas (kappa = 0.46) but fair for the remainder. Agreement was moderately good for presence or absence of solid component (kappa = 0.43); fair for presence or absence of abnormal pancreatic duct (kappa = 0.29), debris (kappa = 0.21), and septations (kappa = 0.30); and slight for presence or absence of margins (kappa = 0.01) and abnormal pancreatic parenchyma (kappa = 0.01). Accuracy rates of EUS for the diagnosis of neoplastic versus non-neoplastic lesions ranged from 40% to 93%. CONCLUSIONS: There is little more than chance interobserver agreement among experienced endosonographers for diagnosis of neoplastic versus non-neoplastic, specific type, and EUS features of pancreatic cystic lesions.

Aged↗
PubMed2002

Randomized trial of medical or endoscopic therapy to prevent recurrent ulcer hemorrhage in patients with adherent clots.

BACKGROUND & AIMS: Treatment of high-risk patients with nonbleeding adherent clots on ulcers is controversial. In a previous randomized trial, there was no benefit to endoscopic therapies compared with medical therapy for prevention of ulcer rebleeding. Our purpose was to test the hypothesis that patients treated with combination endoscopic therapy would have significantly lower rebleeding rates than those treated with medical therapy. METHODS: In this randomized, controlled trial, 32 high-risk patients with severe ulcer hemorrhage and nonbleeding adherent clots resistant to target irrigation were randomized to medical therapy or to combination endoscopic therapy (with epinephrine injection, shaving down the clot with cold guillotining, and bipolar coagulation on the underlying stigmata). Physicians blinded to the endoscopic therapy managed all patients. RESULTS: Patients were similar at study entry, except for older age in the medical group and lower platelet count in the endoscopic group. By hospital discharge, significantly more medically treated patients (6/17; 35.3%) than endoscopically treated patients (0/15; 0%) rebled (P = 0.011). There were no complications of endoscopic treatment. CONCLUSIONS: Combination endoscopic therapy of nonbleeding adherent clots significantly reduced early ulcer rebleeding rates in high-risk patients compared with medical therapy alone. This endoscopic treatment was safe.

Aged↗
PubMed2002

Endoscopic ultrasound/fine-needle aspiration diagnosis of a malignant subcarinal lymph node in a patient with lung cancer and a negative positron emission tomography scan.

Transesophageal, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) and positron emission tomography (PET) scanning are new modalities for staging non-small cell lung cancer (NSCLC), the roles of which are still being defined. A 78-year-old man with a right lower lobe (RLL) mass and mediastinal adenopathy seen on CT scan had a PET scan that revealed only a RLL hypermetabolic area. EUS/FNA cytology of a subcarinal lymph node (LN) revealed the presence of NSCLC. This is a case of a false-negative PET scan for nodal involvement in NSCLC that was diagnosed with EUS/FNA. Patients with NSCLC and suspicious lymphadenopathy may benefit from EUS/FNA of enlarged posterior mediastinal LNs, even with negative findings of PET scanning.

Aged↗
PubMedDate not supplied

Utility of immediate evaluation of endoscopic ultrasound-guided transesophageal fine needle aspiration of mediastinal lymph nodes.

OBJECTIVE: To assess the value of immediate cytologic evaluation (ICE) in mediastinal endoscopic ultrasound-guided transesophageal fine needle aspiration (EUS-FNA). STUDY DESIGN: Fifty eight patients with mediastinal lymphadenopathy underwent transesophageal EUS-FNA. Cellularity, number of needle passes and number of slides prepared were reviewed retrospectively. RESULTS: Of moderate to highly cellular passes, 75% were diagnostic. ICE had a 100% positive predictive value and 97% negative predictive value. ICE allowed a diagnosis in all cases. Calculated diagnostic accuracy was 70% if the procedure ended after a single specimen of at least moderate cellularity or after completion of 4 needle passes. CONCLUSION: Immediate cytologic evaluation of EUS-FNA specimens allowed a diagnosis in all cases and contributed to the utility of EUS-FNA as a diagnostic procedure for mediastinal adenopathy.

Aged↗