Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

Abstract

Pancreatic cancer is the 5 th leading cause of cancer-related death in Western countries. The 5-year survival rate is approximately 4%, without significant changes over the last 50 years. This poor survival rate and bad prognosis are associated with the diagnosis of advanced-stage disease, which precludes the only potential curative treatment-surgical resection. In this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and a correct staging of the disease. Endoscopic ultrasonography (EUS) appears to be an essential tool for the diagnosis and staging of pancreatic cancer. EUS diagnostic accuracy for detecting pancreatic tumors ranges from 85 to 100%, clearly superior to other imaging techniques. EUS accuracy for the local staging of pancreatic cancer ranges from 70 to 90%, superior or equivalent to other imaging modalities. EUSguided fine-needle aspiration allows a cyto-histological diagnosis in nearly 90% of cases, with a very low complication rate. At present, the formal indications for EUS-guided fine-needle aspiration are the necessity of palliative treatment or whenever the possibility of neoadjuvant treatment is present. It could be also indicated to differentiate pancreatic adenocarcinoma from other pancreatic conditions, like lymphoma, metastasis, autoimmune pancreatitis or chronic pancreatitis. We can conclude that EUS is an essential tool in the management of patients with pancreatic tumors.

Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature

“…Studies reporting the diagnostic ability of EUS in the past were fraught with the bias that even benign lesions were included. Hence care should be exerted when interpreting earlier results of EUS 80 …”

Role of Eus in the Early Detection of Small Pancreatic Cancer

“…Pancreatic cancer is the 5th leading cause of cancer‐related death in Japan, as well as in western countries 1,2 . In Japan, more than 26,000 patients die from pancreatic cancer each year, and the recent 5 year survival rate is approximately 5% 1 .…”

Introductory Chapter: Current Challenges in the Management of Patients with Acute and Chronic Pancreatitis

“…Historically, diagnostic methods included ultrasound imaging of the abdominal organs, endoscopic ultrasound (EUS), ultrasound with contrast enhancement (CEUS), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance imaging (MRI), and computed tomography (CT). While ultrasound is considered the least accurate, and EUS is one of the most sensitive methods [12], ERCP is no longer a diagnostic test for chronic pancreatitis [13]. EUS is highly accurate in assessing the parenchyma and ductal system of the pancreas and is also very useful in identifying Introductory Chapter: Current Challenges in the Management of Patients with Acute… DOI: http://dx.doi.org/10.5772/intechopen.86528 complication characteristic of chronic pancreatitis [14].…”

“…Due to the cumbersomeness and unpleasantness of the method for both patient and laboratory personnel, it is very rarely used in everyday clinical practice. Other methods for diagnosing exocrine pancreatic insufficiency include measuring the concentration of fecal elastase 1, the 13 C-mixed triglycerides ( 13 C-MTG) breath test, a test based on analysis of pancreatic juice after secretin/cerulein stimulation, and others [18].…”