Contrast-enhanced harmonic endoscopic ultrasonography in gallbladder cancer and pancreatic cancer

Abstract

Endoscopic ultrasonography (EUS) plays a major role in diagnosing gallbladder (GB) cancer and pancreatic cancer (PC). In cases of GB cancer, EUS allows for precise observations of morphology and wall layers. However, proficiency is required for the morphologic diagnosis of GB tumors. Therefore, contrast -enhanced harmonic EUS (CH -EUS) began to be performed to diagnose GB lesions. CH -EUS enables real -time observation of the hemodynamics of GB tumors. The enhanced patterns generated by CH -EUS improve precision in the diagnosis of such tumors. PC appears as a hypoechoic mass on EUS. However, distinguishing between PC and mass -forming pancreatitis or focal autoimmune pancreatitis (AIP) is difficult via conventional EUS. CH -EUS allows for differentiating among these diseases (PC is hypoenhanced and heterogeneously enhanced, pancreatitis is isoenhanced, and a pancreatic neuroendocrine tumor is hyperenhanced). EUS -guided fine needle aspiration (EUS -FNA) also contributes to pathological diagnoses of pancreatic lesions. However, certain PC patients cannot be diagnosed via EUS -FNA. PC is heterogeneously enhanced on CH -EUS, and unenhanced regions have been reported to be areas of fibrosis or necrosis. CH -EUS -guided fine needle aspiration (CH -EUS -FNA) permits puncturing of the enhanced area while avoiding necrotic and fibrotic regions. Moreover, as CH -EUS findings have been quantitatively analyzed, a time -intensity curve (TIC) has become usable for diagnosing solid pancreatic lesions. CH -EUS -related techniques have been developed and increasingly utilized in the pancreaticobiliary area.

Neuroendocrine tumors of the gallbladder (Review)

“…Apart from the pathological immunohistochemical examinations, contrast-enhanced ultrasonography has differential clinical significance (38). Case reports using contrast-enhanced ultrasonography have revealed that biliary sludge is not enhanced (39) .In these case reports, the gallbladder polyp was enhanced with grape-like fine pedicles and the three-layer structure of gallbladder wall was clear (40) .For adenomyosis of the gallbladder, unenhanced vesiculoid echocardiography was observed and the inner and serous membranes of the gallbladder were intact (41). Gallbladder adenoma resulted in delayed enhancement that was identifiable by 'fast in and slow out' through the complete three-layer structure of the gallbladder wall (38).…”

Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling

“…53,54 EUS-FNAB under CEH-EUS may improve the diagnostic accuracy and adequacy with fewer needle passes. [55][56][57][58]…”

Advances in Gallbladder-Preserving Surgery for Gallbladder Diseases

“…It should be clear that asymptomatic patients who can be observed for a long time should not be blindly operated on to remove gallbladder; similarly, it should not be free to preserve gallbladder and stone [18]. Cholecystectomy or cholecystolithotomy should be carefully selected, and excessive treatment should be vigilant [19,20]. As for whether long-term observation of asymptomatic gallstones will lead to delayed treatment of gallbladder carcinogenic, this is another aspect of the problem [21].…”