- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03210948
Conventional Versus Elastography Targeted Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Lesions
Conventional Versus Elastography Targeted Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Lesions: a Randomized Controlled Trial
Diagnostic assessment of solid pancreatic lesions may represent a real challenge in the clinical practice, even with the aid of tissue sampling by means of endoscopic ultrasound (EUS) fine needle aspiration (FNA).
Aim of this randomized controlled trial (RCT) is to establish the diagnostic accuracy, sensitivity, and specificity of real time elastography (RTE)-guided EUS-FNA as compared to conventional EUS-FNA in a series of patients with solid pancreatic masses.
Eligible will be patients with solid pancreatic masses detected at abdominal imaging (ultrasound, CT-scan or MRI).
In the treatment arm, RTE assessment of pancreatic masses will be performed using a last generation ultrasound machine, and all suspicious areas at elastography (i.e. those appearing in dark blue color as a consequence of higher cellularity of tumoral tissue) will be recorded and stored in our database. A 25 G needle will be then inserted into the most suspicious part ("dark blue") of the lesion and immediately after the procedure the stylet will be removed. At the end of the procedure, the needle will be retracted and the samples will be prepared for cytological examination.
Primary endpoint will be diagnostic yield of the procedure. Secondary endpoints the diagnostic sensitivity, specificity, number of passes needed to achieve an adequate sample and safety It will be planned to enroll 142 patients (71 per arms) within 1 year. A minimum follow up of 6 months from the last patient unsuitable to surgery will be required.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
To establish the diagnostic accuracy, sensitivity, and specificity of RTE-guided EUS-FNA as compared to conventional EUS-FNA in a series of patients with solid pancreatic masses.
Protocol design Phase II, two-arms, open-label, randomized controlled trial.
Trial population Patients with solid pancreatic masses detected at abdominal imaging (ultrasound, CT-scan or MRI).
Protocol Treatments
- The Treatment arm will undergo RTE-guided EUS-FNA with 25 G needle.
- The Control arm will undergo conventional EUS-FNA with 25 G needle.
Technical procedure
Under sedation with propofol, EUS will be performed using a curved-array transducer. A 25 G needle with a central stylet to protect the aspiration channel of the needle will be introduced though the endoscope's working channel. RTE assessment of pancreatic masses will be performed using a last generation ultrasound machine, and all suspicious areas at elastography (i.e. those appearing in dark blue color as a consequence of higher cellularity of tumoral tissue) will be recorded and stored in our database. Beside qualitative assessment based on red-green-blue color map, a semi-quantitative approach providing a numeric value expressed as strain ratio5 will be undertaken.
The needle will be then inserted into the most suspicious part ("dark blue") of the lesion and immediately after the procedure the stylet will be removed. More than 10 to- and fro- movements will be made within the lesion and aspiration will be obtained with a 10 cm3 suction syringe applied to the hub of FNA device. Up to four passes will be performed. At the end of the procedure, the needle will be retracted and the samples fixed in 95% ethanol solution. After being grossly checked for adequacy samples will be prepared for cytological examination with Papanicolaou staining.
The reference standard for classification will be surgery or death from PC in those subjects unsuitable to surgery. In particular, if after a follow-up of 6 months there will be no sign of disease progression or if disease regression will be registered, the lesion will be classified as inflammatory.
Lesions diagnosed as malignant by cytopathology on EUS-FNA sample and finally confirmed by surgery or clinical course will be considered to be true positives (TPs); similarly, benign aspirates finally diagnosed as benign will be considered to be true negatives (TNs). On the other hand, those aspirates apparently benign at cytopathological examination which will be finally diagnosed as malignant will be considered to be false negatives (FNs). Non-diagnostic/inconclusive samples will be registered as such in the database and for analytical purposes when computing diagnostic accuracy will be classified as FNs.
Primary Endpoint Diagnostic yield of the procedure.
Secondary Endpoints
- Diagnostic sensitivity
- Diagnostic specificity
- Number of passes needed to achieve an adequate sample
- Safety
Sample size and study duration It will be planned to enroll 142 patients (71 per arms) within 1 year. A minimum follow up of 6 months from the last patient unsuitable to surgery will be required.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Antonio Facciorusso, MD
- Phone Number: +39 0881732015
- Email: antonio.facciorusso@virgilio.it
Study Contact Backup
- Name: Nicola Muscatiello, MD
- Phone Number: +39 0881733848
- Email: nicomuscatiello@gmail.com
Study Locations
-
-
-
Foggia, Italy, 71122
- Ospedali Riuniti Foggia
-
Contact:
- Antonio Facciorusso, MD
- Email: antonio.facciorusso@virgilio.it
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with solid pancreatic masses detected at abdominal imaging (ultrasound, CT-scan or MRI).
Exclusion Criteria:
- Age under 18 years
- Cystic pancreatic lesions
- Lesions < 1 cm
- History of previous gastrectomy
- Patients with severe coagulopathy or under anticoagulant/antiaggregant therapy which could not be suspended
- Refusal to provide informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: RTE-guided EUS-FNA
The needle will be then inserted into the most suspicious part ("dark blue") of the lesion as assessed at real time elastography.
|
Fine needle aspiration with 25 gauge needle under RTE-guidance
|
ACTIVE_COMPARATOR: Conventional EUS-FNA
A 25 G needle with a central stylet to protect the aspiration channel of the needle will be introduced though the endoscope's working channel.
|
Fine needle aspiration with no RTE guidance
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Diagnostic accuracy
Time Frame: 12 months
|
Proportion of correctly classified subjects (true positives+true negatives) among all subjects (true positives+true negatives+false positives+false negatives)
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Diagnostic sensitivity
Time Frame: 12 months
|
Proportion of subjects with the disease with positive test result in a total group of subjects with the disease
|
12 months
|
Diagnostic specificity
Time Frame: 12 months
|
Proportion of subjects without the disease with negative test result in total of subjects without disease
|
12 months
|
Number of passes needed to achieve an adequate sample
Time Frame: 1 day
|
Number of needle injections into the lesion needed to obtain an adequate and diagnostic sample
|
1 day
|
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Time Frame: 1 week
|
Side effects
|
1 week
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Antonio Facciorusso, MD, Ospedali Riuniti di Foggia
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- EUS01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Pancreas Cancer
-
Washington University School of MedicineCompletedPancreatic Cancer | Pancreas Cancer | Pancreas Neoplasms | Cancer of Pancreas | Cancer of the PancreasUnited States
-
Joseph J. CullenNational Cancer Institute (NCI); National Institutes of Health (NIH); Holden... and other collaboratorsActive, not recruitingAdenocarcinoma | Pancreatic Neoplasms | Pancreas Cancer | Pancreas Neoplasms | Cancer of Pancreas | Cancer of the Pancreas | Neoplasms, PancreaticUnited States
-
Emory UniversityCompletedPancreas Cancer | Pancreas Neoplasms | Cancer of Pancreas | Cancer of the Pancreas | Neoplasms, PancreaticUnited States
-
BioXcel Therapeutics IncIQVIA BiotechWithdrawnPancreatic Cancer | Pancreas Cancer | Cancer of Pancreas | Cancer of the Pancreas | Neoplasms, PancreaticUnited States
-
Washington University School of MedicineNational Cancer Institute (NCI); BioMed Valley Discoveries, IncTerminatedPancreatic Cancer | Pancreas Cancer | Cancer of Pancreas | Cancer of the PancreasUnited States
-
National Cancer Institute (NCI)CompletedPancreatic Neoplasms | Pancreatic Cancer | Pancreas Cancer | Cancer of Pancreas | Cancer of the PancreasUnited States
-
Baylor Research InstituteUnknownPancreas Cancer | Localized Pancreas Cancer | Non-metastatic Pancreas CancerUnited States
-
AmgenTerminatedPancreatic Cancer | Pancreas Cancer | Cancer of Pancreas | Cancer of the Pancreas
-
Washington University School of MedicineTerminatedPancreatic Cancer | Pancreas Cancer | Cancer of Pancreas | Cancer of the PancreasUnited States
-
Newcastle-upon-Tyne Hospitals NHS TrustMedtronicCompletedPancreas Adenocarcinoma | Chronic Pancreatitis | Pancreas Cancer | Pancreas Neoplasm, BenignUnited Kingdom
Clinical Trials on RTE-guided EUS-FNA
-
Mauna Kea TechnologiesUnknownPancreatic Neoplasms | Pancreatic Cancer | Lymphadenopathy | Pancreatic Cyst | Pancreatic Islet Cell Tumors | Pancreatic Adenoma | Lymph NodeFrance
-
American Society for Gastrointestinal EndoscopyMidwest Biomedical Research FoundationUnknownMediastinal or Intra-abdominal Lymphadenopathy, | Pancreatic Masses, | Left Adrenal Masses, | Gastrointestinal Submucosal Lesions, and | Liver MassesUnited States
-
University of Colorado, DenverKansas City Veteran Affairs Medical CenterCompleted
-
H. Lee Moffitt Cancer Center and Research InstituteAmerican Cancer Society, Inc.TerminatedEvaluation of Image-guided Brushing of Pancreatic Cyst Wall in Diagnosis of Cystic Pancreatic TumorsPancreatic TumorsUnited States
-
Universitätsklinikum Hamburg-EppendorfCompletedPancreatic NeoplasmGermany
-
University of Sao Paulo General HospitalBoston Scientific Corporation; Medi - GlobeCompletedPancreatic NeoplasmBrazil
-
Changhai HospitalUnknown
-
The Third Xiangya Hospital of Central South UniversityUnknownSolid Pancreatic MassesChina
-
Asan Medical CenterCompletedPancreatic MassesKorea, Republic of
-
Chinese University of Hong KongCompleted