MR Imaging of Pancreatic Lesions

Aim: The aim of this work was to evaluate the role of MRI in differentiating between benign and malignant pancreatic lesions and its correlation with histopathological results as the reference standard. Patients and Methods: This MRI study included 30 patients, 17 females and 13 males with a mean age 50 years. Sixteen patients had malignant masses (14 patients were adenocarcinoma, one patient was lymphoma and one patient was metastasis) and 14 patients had benign masses (7 patients were pancreatic pseudocysts, two patients were pancreatic abscesses, three patients were simple cysts and two patients were focal pancreatitis). The main clinical symptom was abdominal pain and most of masses were located in the head of the pancreas. Results: In our study, 25 cases of the 30 patients showed increased intensity at T2-weighted images. Most of malignant cases showed low or equal intensity on T1- and high intensity on T2-weighted images compared to normal pancreatic parenchyma. In our study, DW-MRI was performed on all subjects at b-values of 500 and 1000 s/mm2. Benign pancreatic masses as pancreatic pseudocyst, simple cyst and abscess show low signal intensities on DWI, however malignant pancreatic masses as adenocarcinoma, lymphoma and metastasis show high signal intensities on DWI with a cut-off value of 1.5 x10-3 s/mm2 for the differentiation of benign from malignant pancreatic masses by b-value 1000 s/mm2 with the sensitivity, specificity, PPV, NPV& p value were 100%, 83.33%, 100%, 88.88% and <0.001 respectively. Conclusion: MRI plays an important role in the diagnosis of different pancreatic lesions and can assess the neoplastic pancreatic lesions with accurate detection of extension, nodal involvement and hepatic metastatic lesions. It also has a major role in differentiation between benign and malignant pancreatic lesions by the aids of DWI.

Role of fine needle aspiration cytology (FNAC) in diagnosing Pancreatic lesions in a tertiary care institution

OBJECTIVE- FNAC is an accurate and rapid technique for diagnosing pancreatic masses. Pancreatic carcinoma represents the seventh leading cause of cancer death in the world, responsible for more than 300,000 deaths per year.[1] Worldwide, both the incidence and death rates of pancreatic cancer are increasing. The aim of this study was early diagnosis of these lesions and to evaluate its burden and study the global, regional, and national patterns. These would further aid in policy making , better resource allocation for controlling pancreatic cancer risk factors and formulating more effective treatments.[2] METHODS- This was a retrospective observational study performed at a tertiary care hospital over a period of one and a half year. A total of 86 patients with pancreatic lesions were subjected to image guided FNA . 35 of these patients underwent diagnostic histopathology in addition to FNA. RESULTS- The 86 cases analyzed were in the age group of 61-70 years with mean age distribution of 57.34 years. Male predominance was seen with M:F ratio of 2.18:1. Head was the most common area to be aspirated followed by tail and least number of lesions were in body of pancreas. Maximum cases were found to be malignant (55) in etiology. Only 2 were non diagnostic because one of them had insufficient cellularity and other had necrosis mainly on histopathology. Adenocarcinoma was the most common malignancy found followed by one case each of lymphoma and solid pseudo papillary neoplasm of pancreas. Histo pathological correlation was obtained in 91.42% cases proving that FNA is a very useful tool in early diagnosing pancreatic lesions.

Two Needle Passes Achieve Similar Diagnostic Yield Compared to Three Passes Regarding Diagnosis of Solid Pancreatic Lesions in Endoscopic Ultrasound-Guided Fine Needle Aspiration

Current guidelines advocate 3–4 passes with a fine-needle aspiration (FNA) to achieve high rates of diagnostic samples for malignancy when performing endoscopic ultrasound (EUS)-guided sampling of solid pancreatic lesions, in the absence of on-site cytologic evaluation. The aim of this study is to compare 2 vs. 3 needle passes in EUS-FNA for solid pancreatic lesions in terms of incremental diagnostic yield and to identify factors associated with the procedure’s outcome. In this retrospective study, 2 passes of EUS-FNA were found to have similar diagnostic yield compared to 3 passes for the diagnosis of solid pancreatic masses, suggesting that there might be no significant incremental tissue yield when 3 passes are performed.