Role of Eus in the Early Detection of Small Pancreatic Cancer

Yasuda, Ichiro; Iwashita, Takuji; Doi, Shinpei; Nakashima, Masanori; Moriwaki, Hisataka

doi:10.1111/j.1443-1661.2011.01113.x

Cited by 45 publications

(27 citation statements)

References 17 publications

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“…[15] Yasuda et al . detected pancreatic masses of <10 mm diameter in 3 out of 132 patients by EUS; however, these masses could not be detected by CE-CT.[16] In the present study, fundamental EUS could detect all mural nodule-like lesions that were detected by CE-CT or MRI. The detection rate of these mural nodule-like lesions in BD-IPMN patients was higher on fundamental EUS than on CE-CT or MRI.…”

Section: Discussioncontrasting

confidence: 44%

Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

et al. 2016

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Background and Objectives:There have been few studies to date evaluating the effectiveness of contrast-enhanced endoscopic ultrasound (CE-EUS) for detecting mural nodules in patients with branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. We aim to evaluate the effectiveness of CE-EUS for detecting mural nodules in BD-IPMN.Patients and Methods:Of the 427 BD-IPMN patients, 21 patients (4.9%) in whom the presence of mural nodules was suggested by CE computed tomography (CT) or magnetic resonance imaging (MRI), or in whom the presence of nodule-like lesions as shown by fundamental EUS, were examined by CE-EUS.Results:The mean diameter of cystic lesions was 29.8 ± 12.8 mm. The mean diameter of mural nodules was 9.5 ± 5.7 mm. BD-IPMN was detected in the pancreatic head in 16 cases, pancreatic body in 2 cases, and pancreatic tail in 3 cases. The mean follow-up period was 17.2 ± 11.9 months. The detection rates of mural nodule-like lesions in BD-IPMN patients on CT, MRI, and fundamental EUS were 36.8%, 63.2%, and 100%, respectively. The detection rates of true mural nodules in BD-IPMN patients on CT, MRI, and fundamental EUS were 85.7%, 71.4%, and 100%, respectively. The echo levels of mural nodule-like lesions on fundamental EUS were hyperechoic in 6 patients, isoechoic in 9 patients, and hypoechoic in 6 patients. The final diagnosis was mucus lumps in 14 patients and mural nodules in 7 patients. The contrast patterns observed were avascular, isovascular, and hypervascular in 14, 3, and 4 patients, respectively. No patients showed a hypovascular pattern. Fourteen patients showing an avascular pattern were diagnosed as having mucus lumps, and they were able to avoid surgical resection. Of the 7 patients who were diagnosed as having mural nodules, 5 underwent surgical resection. The pathological findings were adenocarcinoma in 2 patients and adenoma in 3 patients. Of the 3 adenoma patients, fundamental EUS demonstrated a hypoechoic area in 1 patient and an isoechoic area in 2 patients. Of the 2 adenocarcinoma patients, 1 each showed a hypoechoic area and a hyperechoic area. It was difficult to distinguish between patients with adenoma and patients with adenocarcinoma using the echo levels obtained from fundamental EUS.Conclusions:CE-EUS may be useful for avoiding the overdiagnosis of BD-IPMN with mural nodule-like lesions. However, it has difficulty in distinguishing between clearly benign and malignant lesions in BD-IPMN.

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Section: Discussioncontrasting

confidence: 44%

Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

et al. 2016

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“…Ogawa et al[2] reported that they could diagnose IPM (2 mm) preoperatively by EUS. EUS has higher sensitivity than other imaging modalities for the detection of pancreatic small lesions, in particular solid lesions[9,10]. IOUS in which the transducer is in direct contact with the pancreas can provide higher resolution images than extracorporeal ultrasound because the pancreas is located deep in the body cavity.…”

Section: Discussionmentioning

confidence: 99%

Two cases of pancreatic ductal adenocarcinoma with intrapancreatic metastasis

Fujita

Kitago

Masugi

et al. 2016

WJG

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There are no standardized diagnostic criteria for intrapancreatic metastasis of pancreatic ductal adenocarcinoma (PDAC). Here, we report two cases of patients with PDAC who were pathologically diagnosed as harboring intrapancreatic metastasis. In both cases, the main lesions were located in the pancreatic body, and no other lesion was detected preoperatively. The patients were diagnosed with pancreatic body cancers and distal pancreatectomy was performed. Pathological findings revealed microscopic cancer nests, which had connections to neither the main lesion nor the premalignant lesion in the pancreatic tail parenchyma. In both cases, the histological type of the daughter lesion was quite similar to that of the main lesion. Hence, we diagnosed the daughter lesions as metastatic foci in the pancreas. Although intrapancreatic metastasis of PDAC has been regarded as a poor prognostic factor, few reports of intrapancreatic metastasis are available. This article reports two such cases and provides a review of the literature.

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“…As for image diagnosis using EUS, Yasuda et al 55. retrospectively examined 132 cases with high‐risk factors for PC without a detectable mass on CT. EUS could detect a small PC <10 mm in three cases.…”

Section: Algorithms Of Image Diagnosis For Early Pcmentioning

confidence: 99%

Early diagnosis of pancreatic cancer: Current trends and concerns

Hanada

Amano

Abe

2017

Annals of Gastroent Surgery

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Early detection of pancreatic cancer (PC) is essential for a better prognosis. Some recent studies have demonstrated that a slight dilatation of the main pancreatic duct (MPD) and small cystic lesions were detected initially in most cases diagnosed at an early stage. Detecting these abnormal findings in cases with high risk factors through an effective screening system including image diagnosis, some biological markers, or familial cancer registrations should contribute to early diagnosis of PC. It has been reported that endoscopic ultrasonography (EUS) is essential for detecting tumors <10 mm with a favorable prognosis. Additionally, EUS‐guided fine‐needle aspiration biopsy is useful for confirming final histological diagnosis. For the diagnosis of stage 0 PC, local irregular stenosis of MPD should be an important initial abnormal sign detected by EUS or magnetic resonance cholangiopancreatography. Cytodiagnosis multiple times using pancreatic juice obtained by endoscopic nasopancreatic drainage should be essential for the final diagnosis. Recently, activities of regional networks between specialist doctors in medical centers and general practitioners for early diagnosis of PC have been reported in Japan. In the future, these activities may play an important role in the early diagnosis of PC.

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Role of Eus in the Early Detection of Small Pancreatic Cancer

Abstract: EUS is strongly recommended for early detection of small pancreatic cancer in patients in whom the dilation of the main pancreatic duct was detected in previous imaging tests, with or without increase of pancreatic enzymes or tumor markers.

Cited by 45 publications

References 17 publications

Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

Two cases of pancreatic ductal adenocarcinoma with intrapancreatic metastasis

Early diagnosis of pancreatic cancer: Current trends and concerns

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