Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Abstract

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography (CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T staging with less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy. Key words: Endosonography; Pancreatic neoplasms; Endoscopy; Diagnosis; Neoplasm Staging; Therapeutics Core tip: In this article, the role of endoscopic ultrasonography as a diagnostic, staging and therapeutic procedure in patients with pancreatic cancer is discussed and all the current knowledge on this subject is summarized, providing the reader with a quick update.Gonzalo-Marin J, Vila JJ, Perez-Miranda M. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer. World J Gastrointest Oncol 2014; 6(9): 360-368 Available from: URL:

Diagnostic value of a pancreatic mass on computed tomography in patients undergoing pancreatoduodenectomy for presumed pancreatic cancer

“…27 In the current cohort, a pancreatic mass was identified on EUS in 115 of 162 (71%) patients, of whom 30 (26%) had unexpected benign disease, indicating that also pancreatic masses identified on EUS have limited specificity for malignancy, as reported previously. 18,28,29 Endoscopic retrograde cholangiopancreatography (ERCP; with brush cytology) can provide additional information about the nature of a biliary stricture and was performed in 245 patients of our study cohort. Further details on the EUS, ERCP, and preoperative pathologic findings are reported in the previously published multicenter cohort study.…”

State-Of-The-Art Endoscopic Procedures for Pancreatic Cancer

“…It has a reported sensitivity of 87-100% [28] and it is specially useful in pancreatic tumors that are 3 cm or less [29,30]. Interestingly, it provides a high negative predictive value, providing confidence in ruling out pancreatic masses in the case that these are not detected by EUS [29,31].…”

“…Patients with lesions that are T4 (tumor that involves the most of the celiac axis or superior mesenteric artery) or M1 at any T-stage are considered to be unresectable [5]. Endoscopic Ultrasound has proven to be superior to crosssectional imaging for T-staging and has a lower risk of overstaging patients, potentially increasing the number of patients who could be resected [31]. EUS can also be used for N-staging but its accuracy is variable [28].…”

Molecular Analysis of Vascular Endothelial Growth Factor (VEGF) Receptors in EUS-guided Samples Obtained from Patients with Pancreatic Adenocarcinoma*

“…Endoscopic ultrasound (EUS) is the most effective method used in the management of pancreatic cancer, having a diagnostic yield higher than US, CT, MRI and PET for recognising early pancreatic tumors [1,2]. Moreover, EUS-guided fine needle aspiration (EUS-FNA) allows the collection of cytological/ histological samples from pancreatic masses.…”