IU Indianapolis ScholarWorks :: Browsing by Author "Roch, Alexandra M."

Browsing by Author "Roch, Alexandra M."

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Automated pancreatic cyst screening using natural language processing: a new tool in the early detection of pancreatic cancer
(Elsevier, 2015-05) Roch, Alexandra M.; Mehrabi, Saeed; Krishnan, Anand; Schmidt, Heidi E.; Kesterson, Joseph; Beesley, Chris; Dexter, Paul R.; Palakal, Matthew; Schmidt, C. Max; Department of Surgery, IU School of Medicine
INTRODUCTION: As many as 3% of computed tomography (CT) scans detect pancreatic cysts. Because pancreatic cysts are incidental, ubiquitous and poorly understood, follow-up is often not performed. Pancreatic cysts may have a significant malignant potential and their identification represents a 'window of opportunity' for the early detection of pancreatic cancer. The purpose of this study was to implement an automated Natural Language Processing (NLP)-based pancreatic cyst identification system. METHOD: A multidisciplinary team was assembled. NLP-based identification algorithms were developed based on key words commonly used by physicians to describe pancreatic cysts and programmed for automated search of electronic medical records. A pilot study was conducted prospectively in a single institution. RESULTS: From March to September 2013, 566,233 reports belonging to 50,669 patients were analysed. The mean number of patients reported with a pancreatic cyst was 88/month (range 78-98). The mean sensitivity and specificity were 99.9% and 98.8%, respectively. CONCLUSION: NLP is an effective tool to automatically identify patients with pancreatic cysts based on electronic medical records (EMR). This highly accurate system can help capture patients 'at-risk' of pancreatic cancer in a registry.
Cancer History: A Predictor of IPMN Subtype and Dysplastic Status?
(Elsevier, 2017) Carr, Rosalie A.; Kiel, Brandon A.; Roch, Alexandra M.; Ceppa, Eugene P.; House, Michael G.; Zyromski, Nicholas J.; Nakeeb, Attila; Schmidt, C. Max; Surgery, School of Medicine
Introduction The aim of this study was to determine the association of PMH and FH of pancreatic (PDAC) and non-pancreatic cancers with IPMN malignant risk. Methods A retrospective review of a prospective database of IPMN patients undergoing resection was performed to assess FH and PMH. Results FH of PDAC was present in 13% of 362 included patients. Of these, 8% had at least one first degree relative (FDR) with PDAC. The rate of PDAC positive FH in non-invasive versus invasive IPMN patients was 14% and 8%, respectively (p = 0.3). In main duct IPMN patients, FH (44%) and PMH of non-pancreatic cancer (16%) was higher than that seen in branch duct IPMN (FH 29%; PMH 6%; p = 0.004 and 0.008). Conclusions FH of PDAC is not associated with IPMN malignant progression. FH and PMH of non-pancreatic cancer is associated with main duct IPMN, the subtype with the highest rate of invasive transformation.
The continuum of complications in survivors of necrotizing pancreatitis
(Elsevier, 2020-12) Maatman, Thomas K.; Roch, Alexandra M.; Ceppa, Eugene P.; Easler, Jeffrey J.; Gromski, Mark A.; House, Michael G.; Nakeeb, Attila; Schmidt, C. Max; Sherman, Stuart; Zyromski, Nicholas J.; Surgery, School of Medicine
Background: Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data have cataloged these late complications after acute necrotizing pancreatitis resolution. We sought to identify the types and incidence of complications after necrotizing pancreatitis. Design: An observational study was performed evaluating 647 patients with necrotizing pancreatitis captured in a single-institution database between 2005 and 2017 at a tertiary care hospital. Retrospective review and analysis of newly diagnosed conditions attributable to necrotizing pancreatitis was performed. Exclusion criteria included the following: death before disease resolution (n = 57, 9%) and patients lost to follow-up (n = 12, 2%). Results: A total of 578 patients were followed for a median of 46 months (range, 8 months to 15 y) after necrotizing pancreatitis. In 489 (85%) patients 1 or more complications developed and included symptomatic disconnected pancreatic duct syndrome (285 of 578, 49%), splanchnic vein thrombosis (257 of 572, 45%), new endocrine insufficiency (195 of 549, 35%), new exocrine insufficiency (108 of 571, 19%), symptomatic chronic pancreatitis (93 of 571, 16%), incisional hernia (89 of 420, 21%), biliary stricture (90 of 576, 16%), chronic pain (44 of 575, 8%), gastrointestinal fistula (44 of 578, 8%), pancreatic duct stricture (30 of 578, 5%), and duodenal stricture (28 of 578, 5%). During the follow-up period, a total of 340 (59%) patients required an invasive intervention after necrotizing pancreatitis resolution. Invasive pancreatobiliary intervention was required in 230 (40%) patients. Conclusion: Late complications are common in necrotizing pancreatitis survivors. A broad variety of problems manifest themselves after resolution of the acute disease process and often require invasive intervention. Necrotizing pancreatitis patients should be followed lifelong by experienced clinicians.
Evolving treatment of necrotizing pancreatitis
(Elsevier, 2017) Roch, Alexandra M.; Maatman, Thomas; Carr, Rose A.; Easler, Jeffrey J.; Schmidt, C. Max; House, Michael G.; Nakeeb, Attila; Ceppa, Eugene P.; Zyromski, Nicholas J.; Surgery, School of Medicine
Background Over the past decade, the treatment of necrotizing pancreatitis (NP) has incorporated greater use of minimally invasive techniques, including percutaneous drainage and endoscopic debridement. No study has yet compared outcomes of patients treated with all available techniques. We sought to evaluate the evolution of NP treatment at our high volume pancreas center. We hypothesized that minimally invasive techniques (medical only, percutaneous, and endoscopic) were used more frequently in later years. Methods Treatment strategy of NP patients at a single academic medical center between 2005 and 2014 was reviewed. Definitive management of pancreatic necrosis was categorized as: 1) medical treatment only; 2) surgical only; 3) percutaneous (interventional radiology – IR) only; 4) endoscopic only; and 5) combination (Surgery ± IR ± Endoscopy). Results 526 NP patients included biliary (45%), alcoholic (17%), and idiopathic (20%) etiology. Select patients were managed exclusively by medical, IR, or endoscopic treatment; use of these therapies remained relatively consistent over time. A combination of therapies was used in about 30% of patients. Over time, the percentage of NP patients managed without operation increased from 28% to 41%. 247 (47%) of patients had operation as the only NP treatment; an additional 143 (27%) required surgery as part of a multidisciplinary management. Conclusion Select NP patients may be managed exclusively by medical, IR, or endoscopic treatment. Combination treatment is necessary in many NP patients, and surgical treatment continues to play an important role in the definitive therapy of necrotizing pancreatitis patients.
High Rates of Readmission in Necrotizing Pancreatitis: Natural History or Opportunity for Improvement?
(Springer, 2019-09) Maatman, Thomas K.; Mahajan, Sarakshi; Roch, Alexandra M.; Lewellen, Kyle A.; Heimberger, Mark A.; Colgate, Cameron L.; Ceppa, Eugene P.; House, Michael G.; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.; Surgery, School of Medicine
Background Necrotizing pancreatitis (NP) is a complex and heterogeneous disease with a protracted disease course. Hospital readmission is extremely common; however, few data exist regarding the cause of readmission in NP. Methods A retrospective review of NP patients treated between 2005 and 2017 identified patients readmitted both locally and to our hospital. All patients with unplanned hospital readmissions were evaluated to determine the cause for readmission. Clinical and demographic factors of all patients were recorded. As appropriate, two independent group t tests and Pearson’s correlation or Fisher’s exact tests were performed to analyze the relationship between index admission clinical factors and readmission. p values of < 0.05 were accepted as statistically significant. Results Six hundred one NP patients were reviewed. Median age was 52 years (13–96). Median index admission length of stay was 19 days (2–176). The most common etiology was biliary (49.9%) followed by alcohol (20.0%). Unplanned readmission occurred in 432 patients (72%) accounting for a total of 971 unique readmissions (mean readmissions/patient, 2.3). The most common readmission indications were symptomatic necrosis requiring supportive care and/or intervention (31.2%), infected necrosis requiring antibiotics and/or intervention (26.6%), failure to thrive (9.7%), and non-necrosis infection (6.6%). Patients requiring readmission had increased incidence of index admission renal failure (21.3% vs. 14.2%, p = 0.05) and cardiovascular failure (12.5% vs. 4.7%, p = 0.01). Discussion Readmission in NP is extremely common. Significant portions of readmissions are a result of the disease natural history; however, a percentage of readmissions appear to be preventable. Patients with organ failure are at increased risk for unplanned readmission and will benefit from close follow-up.
Hypercalcemic Crisis Caused by a Parathyroid Mass Requiring Thoracoscopic Resection
(Elsevier, 2021-02-04) Kim, Rachel C.; Roch, Alexandra M.; Birdas, Thomas J.; Ritter, Hadley E.; McDow, Alexandria D.; Surgery, School of Medicine
Objective: To describe the presentation, work up, and treatment of a giant parathyroid adenoma presenting as hypercalcemic crisis that ultimately weighed 57 g and extended into the mediastinum, requiring hand-assisted thoracoscopic resection. Methods: The patient is a 68-year-old man with a prior history of parathyroidectomy, who initially presented with a severe hypercalcemia of 16.3 mg/dL and a parathyroid hormone (PTH) level of 2692 pg/mL on routine labs. Results: Diagnostic and staging work up revealed a 7.2-cm mass extending from just superior to the sternal notch into the right posterior mediastinum to the carina, causing esophageal displacement. No evidence of local invasion or distant metastasis was observed on further imaging, and cytology demonstrated hypercellular parathyroid tissue. The PTH level of the aspirate was >5000 pg/mL. The patient subsequently underwent a right hand-assisted video-assisted thoracoscopic resection of the intrathoracic mass. Final pathology identified a 7.0-cm, 57-g parathyroid adenoma, without any pathologic findings suspicious for malignancy. However, the endocrine surgery team plans for annual laboratory assessment to ensure no recurrence. Conclusion: Primary hyperparathyroidism is most commonly caused by a single adenoma. However, in the setting of severe hypercalcemia and elevated PTH, one must have a high suspicion for malignancy, and care should be taken to remove the mass en bloc. For extremely large adenomas extending into the mediastinum, a minimally invasive, hand-assisted, thoracoscopic approach is a safe and effective method of resection.
Identification of Patients with Family History of Pancreatic Cancer - Investigation of an NLP System Portability
(IOS, 2015) Mehrabi, Saeed; Krishnan, Anand; Roch, Alexandra M.; Schmidt, Heidi; Li, DingCheng; Kesterson, Joe; Beesley, Chris; Dexter, Paul; Schmidt, Max; Palakal, Mathew; Liu, Hongfang; Department of BioHealth Informatics, School of Informatics and Computing
In this study we have developed a rule-based natural language processing (NLP) system to identify patients with family history of pancreatic cancer. The algorithm was developed in a Unstructured Information Management Architecture (UIMA) framework and consisted of section segmentation, relation discovery, and negation detection. The system was evaluated on data from two institutions. The family history identification precision was consistent across the institutions shifting from 88.9% on Indiana University (IU) dataset to 87.8% on Mayo Clinic dataset. Customizing the algorithm on the the Mayo Clinic data, increased its precision to 88.1%. The family member relation discovery achieved precision, recall, and F-measure of 75.3%, 91.6% and 82.6% respectively. Negation detection resulted in precision of 99.1%. The results show that rule-based NLP approaches for specific information extraction tasks are portable across institutions; however customization of the algorithm on the new dataset improves its performance.
Multifocal High-Grade Pancreatic Precursor Lesions: A Case Series and Management Recommendations
(Mary Ann Liebert, 2019-04-29) Soufi, Mazhar; Yip-Schneider, Michele T.; Carr, Rosalie A.; Roch, Alexandra M.; Wu, Howard H.; Schmidt, Christian Max; Surgery, IU School of Medicine
Background: The risk of developing invasive cancer in the remnant pancreas after resection of multifocal high-grade pancreatic precursor lesions is not well known. We report three patients who were followed up after resection of multifocal high-grade pancreatic intraepithelial neoplasia (PanIN)-3 or intraductal papillary mucinous neoplasia (IPMN), two of whom eventually developed invasive carcinoma. Presentation: 1) 68-year-old woman who had a laparoscopic distal pancreatectomy for multifocal mixed-type IPMN, identified as high-grade on final pathology, with negative surgical margins. During semiannual monitoring, eight years from the first surgery, the patient developed suspicious features prompting surgical resection of the body with final pathology revealing invasive ductal adenocarcinoma in the setting of IPMN. 2) 48-year-old woman who had a distal pancreatectomy for severe acute/chronic symptomatic pancreatitis, with final pathology revealing multifocal high-grade PanIN-3, with negative surgical margins. Despite semiannual monitoring, two years from the first surgery, the patient developed pancreatic adenocarcinoma with liver metastasis. 3) 55-year-old woman who had a Whipple procedure for symptomatic chronic pancreatitis, with multifocal PanIN-3 on final pathology. The patient underwent completion pancreatectomy due to symptomatology and her high-risk profile, with final pathology confirming multifocal PanIN-3. Conclusion: Multifocal high-grade dysplastic lesions of the pancreas might benefit from surgical resection.
Pancreatic Cancer Risk Stratification based on Patient Family History
(Office of the Vice Chancellor for Research, 2013-04-05) Krishnan, Anand; Schmidt, C. Max; Roch, Alexandra M.; Beesley, Chris; Mehrabi, Saeed; Kesterson, Joe; Dexter, Paul; Al-Haddad, Mohammed A.; Palakal, Mathew
Background: Pancreatic cancer is the fourth leading cause of cancer-related deaths in the US with an annual death rate approximating the incidence (38,460 and 45,220 respectively according to 2013 American Cancer Society). Due to delayed diagnosis, only 8% of patients are amenable to surgical resection, resulting in a 5-year survival rate of less than 6%. Screening the general population for pancreatic cancer is not feasible because of its low incidence (12.1 per 100,000 per year) and the lack of accurate screening tools. However, patients with an inherited predisposition to pancreatic cancer would benefit from selective screening. Methods: Clinical notes of patients from Indiana University (IU) Hospitals were used in this study. A Natural Language Processing (NLP) system based on the Unstructured Information Management Architecture framework was developed to process the family history data and extract pancreatic cancer information. This was performed through a series of NLP processes including report separation, section separation, sentence detection and keyword extraction. The family members and their corresponding diseases were extracted using regular expressions. The Stanford dependency parser was used to accurately link the family member and their diseases. Negation analysis was done using the NegEx algorithm. PancPro risk-prediction software was used to assess the lifetime risk scores of pancreatic cancer for each patient according to his/her family history. A decision tree was constructed based on these scores. Results: A corpus of 2000 reports of patients at IU Hospitals from 1990 to 2012 was collected. The family history section was present in 249 of these reports containing 463 sentences. The system was able to identify 222 reports (accuracy 87.5%) and 458 sentences (accuracy 91.36%). Conclusion: The family history risk score will be used for patients’ pancreatic cancer risk stratification, thus contributing to selective screening.
Potential Health Disparities in the Early Detection and Prevention of Pancreatic Cancer
(Springer Nature, 2024-05-13) Yip-Schneider, Michele T.; Muraru, Rodica; Rao, Nikita; Kim, Rachel C.; Rempala-Kurucz, Jennifer; Baril, Jackson A.; Roch, Alexandra M.; Schmidt, C. Max; Surgery, School of Medicine
Introduction: Pancreatic cancer remains one of the deadliest cancers in the United States. Some types of pancreatic cysts, which are being detected more frequently and often incidentally on imaging, have the potential to develop into pancreatic cancer and thus provide a valuable window of opportunity for cancer interception. Although racial disparity in pancreatic cancer has been described, little is known regarding health disparities in pancreatic cancer prevention. In the present study, we investigate potential health disparities along the continuum of care for pancreatic cancer. Methods: The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708). Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race. Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point. Conclusion: Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.

Browsing by Author "Roch, Alexandra M."

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