Identifying Contraindication to Resection in Patients with Pancreatic Carcinoma: The Role of Endoscopic Ultrasound

OBJECTIVE: To present recently published material comparing the performance of endosonography relative to other imaging modalities when evaluating the patient with a suspected or known pancreas carcinoma.METHODS: Medline was searched using the terms ‘endosonography’ and ‘pancreas neoplasms’. References from retrieved papers were reviewed to identify other reports. Emphasis was placed on peer-reviewed material published within the past three years that included comparison with other imaging modalities.RESULTS: Despite advances in cross-sectional imaging modalities, endosonography remains the most sensitive and specific method for identifying pancreatic mass lesions. The resectability of pancreatic carcinoma is best determined with dual-phase helical computed tomography, although endosonography may be slightly more accurate for lymph node assessment. Endoscopic ultrasound-guided fine needle aspiration biopsy has a high sensitivity (93%) and specificity (100%) when used in patients with masses in whom pancreatic cancer is suspected but prior biopsies have been negative.CONCLUSIONS: Endosonography helps in the diagnosis of pancreatic neoplasms through definitive inclusion or exclusion of a mass lesion as well as biopsy confirmation of malignancy. The role of endosonography in the determination of resectability has been eclipsed by dual-phase helical computed tomography. However, endoscopic ultrasound with fine needle aspiration of nonperitumoral lymph nodes may identify advanced disease with sufficient frequency to justify its routine use in patients with lesions that are thought to be resectable based on helical computed tomography.

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Role of Endoscopic Ultrasound-guided Fine-needle Aspiration in Lung and Mediastinal Lesions

Journal of the Chinese Medical Association ◽

10.1016/s1726-4901(10)70114-3 ◽

2010 ◽

Vol 73 (10) ◽

pp. 523-529 ◽

Cited By ~ 4

Author(s):

Lien-Fu Lin ◽

Pi-Teh Huang ◽

Ming-Hung Tsai ◽

Tsung-Ming Chen ◽

Ka-Sic Ho

Keyword(s):

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle

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Diagnostic accuracy of endoscopic-ultrasound-guided fine-needle aspiration in the study of pancreatic masses with and without rapid-on-site-evaluation. The role of the experience

Pancreatology ◽

10.1016/j.pan.2015.05.319 ◽

2015 ◽

Vol 15 (3) ◽

pp. S87

Author(s):

Noé Quesada Vázquez ◽

José Ramón Aparicio Tormo

Keyword(s):

Diagnostic Accuracy ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Fine Needle ◽

Pancreatic Masses ◽

Site Evaluation

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Diagnosis of atypical mass-forming chronic pancreatitis mimicking pancreatic carcinoma: A case report

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1350 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Han-Yue Wang ◽

◽

Hao-Su Huang ◽

Meng Wang ◽

Jie Peng ◽

...

Keyword(s):

Computed Tomography ◽

Chronic Pancreatitis ◽

Pancreatic Carcinoma ◽

Endoscopic Ultrasonography ◽

Fine Needle Aspiration ◽

Multimodal Imaging ◽

Needle Aspiration ◽

Imaging Features ◽

Pathological Findings ◽

Fine Needle

Background: Mass-Forming Chronic Pancreatitis (MFCP) is rare. Moreover, atypical MFCP is difficult to differentiate from Pancreatic Carcinoma (PC) in clinical manifestations, laboratory, and imaging examinations. Diagnosis could be supported by the pathological findings of focal inflammatory fibrosis without evidence of tumor in the pancreas. Case summary: A 52-year-old man had acute pancreatitis twice over 7 months. Amylase and lipase levels were three times higher than the normal range without any clinical symptoms. At the 6th month, the patient lost 15 kg of weight, and abdominal ultrasonography revealed pancreatic head space occupied. All the findings in multimodal imaging including computed tomography image, Magnetic Resonance (MR) imaging with MR cholangiopancreatography, and 18F-FDG positron emission tomography/computed tomography showed an irregular nodule with low density, low signal, and low echo in the head of the pancreas, which were lower than those in the normal pancreatic tissue. The proximal main pancreatic duct was truncated and stenosed, and the distal duct was dilated. Subsequently, he developed progressive painless jaundice, and the specific tumor marker levels were increased. Most of these manifestations were suggestive of the pancreatic malignant tumor; however, multiple specimen pathological findings obtained from laparotomy and endoscopic ultrasonography-guided fine-needle aspiration revealed focal chronic inflammation, fibrosis, and necrosis. Conclusion: This report describes a case of atypical MFCP mimicking PC at clinical presentation and laboratory findings, especially in multimodal imaging. However, the combination of atypical multimodal imaging features, which support MFCP rather than PC, and endoscopic ultrasonography-guided fine-needle aspiration are useful for improving the diagnostic rate of atypical MFCP and avoiding unnecessary surgery.

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The Role of Endoscopic Ultrasound in the Diagnosis of Gallbladder Lesions

Diagnostics ◽

10.3390/diagnostics11101789 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1789

Author(s):

Senju Hashimoto ◽

Kazunori Nakaoka ◽

Naoto Kawabe ◽

Teiji Kuzuya ◽

Kohei Funasaka ◽

...

Keyword(s):

Differential Diagnosis ◽

High Resolution ◽

Endoscopic Ultrasound ◽

Wall Thickness ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Histological Diagnosis ◽

Fine Needle ◽

High Resolution Images

Gallbladder (GB) diseases represent various lesions including gallstones, cholesterol polyps, adenomyomatosis, and GB carcinoma. This review aims to summarize the role of endoscopic ultrasound (EUS) in the diagnosis of GB lesions. EUS provides high-resolution images that can improve the diagnosis of GB polypoid lesions, GB wall thickness, and GB carcinoma staging. Contrast-enhancing agents may be useful for the differential diagnosis of GB lesions, but the evidence of their effectiveness is still limited. Thus, further studies are required in this area to establish its usefulness. EUS combined with fine-needle aspiration has played an increasing role in providing a histological diagnosis of GB tumors in addition to GB wall thickness.

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