Role of Endoscopic Ultrasonography in Evaluation of Metastatic Lesions to the Pancreas

Atiq, Muslim; Bhutani, Manoop S.; Ross, William A.; Raju, Gottumukkala S.; Gong, Yun; Tamm, Eric P.; Javle, Milind; Wang, Xuemei; Lee, Jeffrey H.

doi:10.1097/mpa.0b013e31826c276d

Cited by 39 publications

(65 citation statements)

References 34 publications

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“…However, the above reports only apply to metastatic RCC. More recently, several institutions have reported a high level of accuracy when using endoscopic ultrasound with fine-needle aspiration to diagnose pancreatic metastases from a wide range of different primary tumours [43,44].…”

Section: Discussionmentioning

confidence: 99%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Aim: Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.Methods: A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality.Results: 18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a oneyear survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16. Conclusions:Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire. Key words:pancreatic metastasis, metastasectomy, pancreatectomy, metastatic renal cell cancer, 3 Introduction:

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Section: Discussionmentioning

confidence: 99%

Pancreatectomy for metastatic disease: A systematic review

Adler

Redmond

Heneghan

et al. 2014

European Journal of Surgical Oncology (EJSO)

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“…18,19 Endoscopic ultrasonography with fine-needle aspiration is well established in clinical practice for the differential diagnosis of pancreatic lesions because of its safety 20 and accurateness. 21 However, EUS-FNA is not completely risk-free; it is expensive and requires a dedicated team of expert endosonographers and cytopathologists.…”

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confidence: 99%

Contrast Harmonic Endoscopic Ultrasonography in the Characterization of Pancreatic Metastases (With Video)

Fusaroli¹,

D'Ercole²,

Giorgio³

et al. 2014

Pancreas

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In our population, standard EUS features of PM were unremarkable. At CH-EUS, most of the PM appeared hypoenhancing suggesting a possible malignant origin. However, a subset of PM showed hyperenhancing pattern. In the appropriate context, particularly when cancer history is present, CH-EUS may add to the differential diagnosis and potentially spare endoscopic ultrasonography with fine-needle aspiration.

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“…In our patient cohort we noted that the head and body were the most common sites of involvement, with other studies also describing the head and body as frequent sites of involvement. 6,13,22,28,30 It is not clear as to why the size of individual metastatic lesions appear smaller in our series, though the interval of clinical follow-up may be a factor. 6,13,22,28,30 It is not clear as to why the size of individual metastatic lesions appear smaller in our series, though the interval of clinical follow-up may be a factor.…”

Section: Discussionmentioning

confidence: 64%

“…13,22,28 The seemingly lower percentage of symptomatic presentations may related to close clinical monitoring employed at our institution of cancer patients, and detection of less clinically evident and smaller lesions by radiologic screening (see next paragraph). Others have reported 82-90% of patients being symptomatic, with abdominal pain as the most commonly reported symptom.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, understanding survival after a diagnosis of metastasis to the pancreas is equally important in providing prognostic data to the patient and for appropriate clinical management. 5,9,14,[21][22][23]25,28 This is likely reflective of the large population of cancer patients treated at our institution and followed for years, somewhat diluting the number of initial diagnoses with diagnoses rendered during long-term surveillance/follow-up. Others have observed the mean and median interval periods for all neoplasms to range from 63.6-99.0 months to 42.5-108 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

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