Role of contrast harmonic endoscopic ultrasonography in other pancreatic solid lesions: Neuroendocrine tumors, autoimmune pancreatitis and metastases

Abstract

Contrast harmonic endoscopic ultrasonography (CH-EUS) is a new technique which allows the dynamic study of the microvascularization of a target tissue. Its application is validated for the diagnosis of pancreatic adenocarcinoma but remains unclear for other solid pancreatic tumors (neuroendocrine tumors [NETs], autoimmune pancreatitis [AIP], metastases). The purpose of this review is to outline the potential role of the CH-EUS in these indications. NETs are typically iso/hyperenhanced at CH-EUS, and a heterogeneous enhancement seems a good predictor of malignancy in neuroendocrine pancreatic tumor. AIP is often iso/hyperenhanced at CH-EUS. Quantitative analysis of time-intensity parameters is promising for the distinction between pancreatic adenocarcinoma and AIP. The appearance of pancreatic metastases at CH-EUS is various depending on the origin of the primary tumor. Data from the literature remain to this day weak to determine the role of the CH-EUS in the management of rare solid tumor of the pancreas (NETs, AIP, and metastases). Specific studies are expected to further clarify the impact of this procedure in this field.

Clinical profile and treatment outcomes in autoimmune pancreatitis: a report from North India

“…The classic features reported in previous studies, such as elevated serum IgG4, sausage-shaped diffuse enlargement of the pancreas and variably enhancing focal masses, were also seen in our patients with AIP. No specific features of AIP were noted on EUS, with patients having diffuse enlargement of the pancreas with echogenic foci/strands, lobularity and a hyperechoic pancreatic duct wall or hypoechoic mass lesion, while contrast-enhanced EUS revealed a hyperenhancing mass, in accordance with previously published studies [ 17 - 19 ].…”

Present status and perspectives of endosonography 2017 in gastroenterology

“…This can usually already be seen in an unenhanced Doppler EUS [ 91 ]. To date, CHI mode can improve the display of the hypervascularization of the tumor but this is not absolutely necessary [ 66 , 90 , 92 ]. In cases of hormone-active tumors, the clinical picture leads the way to the differential diagnosis of an unclear pancreatic lesion.…”

Pancreatic cystic neoplasms in 2018: The final cut

“…However, when preoperative assessment and postoperative histology of PCLs have been compared, a surprising high rate of misdiagnosis was observed. [ 10 11 12 13 14 15 16 ] Most patients with PCLs receive MRI as first-line investigation, with EUS with fine-needle aspiration, and evaluation of intracystic fluid being employed as second-line tests when diagnosis is uncertain or malignant behavior is suspected. As the accuracy of these tests remains suboptimal, novel EUS-based technologies are under evaluation.…”