Background: One critical step in the therapy of patients with localized pancreatic cancer is the determination of local resectability. The decision between primary surgery versus upfront local or systemic cancer therapy seems especially to differ between pancreatic cancer centers. In our cohort study, we analyzed the independent judgement of resectability of five experienced high volume pancreatic surgeons in 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer. Methods: Pretherapeutic CT or MRI scans of 200 consecutive patients with borderline resectable or locally advanced pancreatic cancer were evaluated by 5 independent pancreatic surgeons. Resectability and the degree of abutment of the tumor to the venous and arterial structures adjacent to the pancreas were reported. Interrater reliability and dispersion indices were compared. Results: One hundred ninety-four CT scans and 6 MRI scans were evaluated and all parameters were evaluated by all surgeons in 133 (66.5%) cases. Low agreement was observed for tumor infiltration of venous structures (κ = 0.265 and κ = 0.285) while good agreement was achieved for the abutment of the tumor to arterial structures (interrater reliability celiac trunk κ = 0.708 P < 0.001). In patients with vascular tumor contact indicating locally advanced disease, surgeons highly agreed on unresectability, but in patients with vascular tumor abutment consistent with borderline resectable disease, the judgement of resectability was less uniform (dispersion index locally advanced vs. borderline resectable p < 0.05). Conclusion: Excellent agreement between surgeons exists in determining the presence of arterial abutment and locally advanced pancreatic cancer. The determination of resectability in borderline resectable patients is influenced by additional subjective factors. Trial registration: EudraCT:2009-014476-21 (2013-02-22) and NCT01827553 (2013-04-09).

Percutaneous renal biopsy (PRB) of kidney transplants might be prevented by an elevated risk of bleeding or limited access to the allograft. In the following, we describe our initial experience with 71 transvenous renal transplant biopsies in 53 consecutive patients with unexplained reduced graft function who were considered unsuitable candidates for PRB (4.2% of all renal transplant biopsies at our institution). Biopsies were performed via the ipsilateral femoral vein with a renal biopsy set designed for transjugular renal biopsy (TJRB) of native kidneys. Positioning of the biopsy system within the transplant vein was achievable in 58 of 71 (81.7%) procedures. The specimen contained a median of 10 glomeruli (range 0–38). Tissue was considered as adequate for diagnosis in 56 of 57 (98.2%) biopsies. With respect to BANFF 50.9% of the specimen were adequate (>10 glomeruli), 47.4% marginally adequate (1–9 glomeruli) and 1.8% inadequate (no glomeruli). After implementation of real‐time assessment all specimen contained glomeruli. One of the fifty‐eight (1.8%) procedure‐related major complications occurred (hydronephrosis requiring nephrostomy due to gross hematuria). Transfemoral renal transplant biopsy (TFRTB) is feasible and appears to be safe compared to PRB. It offers a useful new alternative for histological evaluation of graft dysfunction in selected patients with contraindications to PRB.

Ziel: Experimentelle Phantomstudie zur Detektion simulierter Läsionen an fünf verschiedenen digitalen und einem konventionellen Mammographiesystem. Material und Methoden: Es wurden je 3 Phantomaufnahmen bei unterschiedlicher Phantomkonfiguration mit einem konventionellen Film-Folien-System (Mammomat 3000 N, Fa. Siemens) und 5 digitalen Mammographie-Systemen (hochauflösendes Speicherfoliensystem, Fa. Fuji/Siemens; a-Si Detektor, Fa. GE Medical Systems; a-Se Detektoren, Fa. Siemens, Fa. Hologic/Lorad; und CCD-Detektor, Fa. Fischer Imaging) bei gleichen Aufnahmeparametern angefertigt. Testobjekt war das Wisconsin-Mammographic-Random-Phantom, Modell 152 A. Fünf Untersuchern mit unterschiedlicher Mammographieerfahrung (3 Monate bis mehr als 4 Jahre) wurden die 18 Aufnahmen in willkürlicher Reihenfolge (Zufallsgenerator) zur Auswertung vorgelegt. Ergebnisse: Es ergaben sich für die konventionelle Film-Folien-Mammographie (84,9 %), die hochauflösende Speicherfolientechnik (86,7 %) und die digitale Mammographie mit a-Si-Detektor (89,8 %) keine signifikanten Unterschiede bezüglich der Detektion der simulierten Mammaläsionen. Die digitalen a-Se-Systeme (97,3 %) und das CCD-System (100 %) erreichten hochsignifikant bessere Detektionsraten (p < 0,001). Schlussfolgerung: Die konventionelle Film-Folien-Mammographie kann durch die digitale Mammographie mit hochauflösenden Speicherfolien und durch die digitale Mammographie mit a-Si-, a-Se- und CCD-Detektoren ersetzt werden - dies müssen jedoch weitere klinische Studien zeigen. Purpose: Experimental phantom study for the detection of simulated lesions with five different digital and one conventional screen-film mammography system. Materials and Methods: Three radiographs were obtained at various configurations of the phantom with one conventional screen-film system (Mammomat 3000 N) (Siemens), five digital systems (high resolution computed radiography system [Fuji/Siemens], one a-Si detector [GE Medical Systems], two a-Se detectors [Siemens; Hologic / Lorad] and one CCD detector [Fischer Imaging]), applying the same exposure parameters. The Wisconsin Mammographic Random Phantom, Model 152 A, was used. Five investigators with different experience in mammography (3 months to more than 4 years) evaluated the 18 randomly selected radiographs. Results: No significant differences were found in the detection rate of simulated breast lesions for conventional screen-film mammography (84.9 %), high resolution computed radiography (86.7 %) and digital mammography with an a-Si detector (89.8 %). Highly significantly better results (p < 0.001) were found with the two a-Se systems (97.3 %) and the CCD system (100 %). Conclusion: Conventional screen-film mammography can be replaced by high resolution computed radiography and digital mammography with a-Si-, a-Se- and CCD-detectors. This has to be confirmed in further clinical studies.