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      About Digestion: 3.0 Impact Factor I 7.9 CiteScore I 0.891 Scimago Journal & Country Rank (SJR)

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      Role of Endoscopic Ultrasound in the Diagnosis of Patients with Solid Pancreatic Masses

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          Abstract

          Endoscopic ultrasound (EUS) is the most sensitive imaging procedure for the detection of small solid pancreatic masses and is accurate in determining vascular invasion of the portal venous system. Even compared to the new CT techniques, EUS provides excellent results in preoperative staging of solid pancreatic tumors. Compared to helical CT techniques, EUS is less accurate in detecting tumor involvement of the superior mesenteric artery. EUS staging and EUS-guided FNA can be performed in a single-step procedure, to establish the diagnosis of cancer. There is no known negative impact of tumor cell seeding due to EUS-guided fine needle aspiration (FNA). Without FNA, EUS and additional methods are not able to reliably distinguish between inflammatory and malignant masses.

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          Assessment of complications of EUS-guided fine-needle aspiration.

          A Aubert, R Arotçarena, Armando Amaris … (2001)
          EUS-guided fine-needle aspiration (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Despite increasing use of this technique, the safety and overall complication rates remain poorly defined. During a period of 20 months, 322 consecutive patients underwent EUS-FNA in 2 centers. All procedures were performed with the patients under general anesthesia. All complications (including local complications resulting from endoscopy/aspiration or clinical complications after the procedure) were evaluated. Potential risk factors for the development of complications were also analyzed including site and nature of the lesion, presence of portal hypertension, and number of needle passes. A total of 345 lesions were aspirated in 322 patients. EUS-FNA involved the pancreas in 248 cases. Pancreatic lesions included solid (134) and cystic (114) types, which required a mean of 2.5 and 1.4 needle passes, respectively. Complications were observed in 4 (1.2%) patients after aspiration of pancreatic cystic lesions (acute pancreatitis, n = 3; aspiration pneumonia, n = 1) and all cases of pancreatitis resulted from FNA of lesions in the head/uncinate process. No complications resulted from FNA of solid pancreatic lesions. Complications were not observed after FNA of lymph nodes (n = 62) and one case of aspiration pneumonia was observed after FNA of a stromal tumor. EUS-FNA was performed without complication in 16 patients (5%) with portal hypertension. The number of needle passes was not predictive of complications. Because the overall risk of complications from EUS-FNA was relatively low (1.6%) with no severe or fatal incidents and although the risk appears slightly higher than that for standard EUS alone, the safety of EUS-FNA appears acceptable based on this analysis from an experienced center.
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            Assessment of EUS for diagnosing, staging, and determining resectability of pancreatic cancer: a review.

            Douglas O. Faigel, Arthur Hunt (2002)
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              EUS in preoperative staging of pancreatic cancer.

              G Ginsberg, Helen J Lewis, Adriana E. Rosato … (2000)
              Endoscopic ultrasound (EUS) is believed to be highly accurate in the local (T) and nodal (N) staging of pancreatic cancer. However, there are scant data concerning the predictive value of EUS for resectability of pancreatic adenocarcinoma. This study was performed to determine the accuracy of TNM staging by EUS in patients with pancreatic adenocarcinoma and to evaluate the role of preoperative TNM staging by EUS for determining resectability in patients with pancreatic adenocarcinoma. This is a retrospective review of a cohort of 89 patients evaluated preoperatively with EUS for pancreatic adenocarcinoma between January 1995 and December 1997. Preoperative TNM classification by EUS was compared with surgical and histopathologic TNM staging. Resectability rates were determined and compared with the preoperative TNM staging by EUS. The overall accuracy of EUS for T and N staging was found to be 69% and 54%, respectively. The overall proportion of tumors that were deemed resectable by EUS and were actually found to be resectable during surgical exploration was 46%. The proportion of tumors staged as T4 N1, T4 N0, T3 N1 and T3 N0 by EUS that were found to be resectable during surgical exploration was 45%, 37%, 44% and 62%, respectively. In a tertiary referral patient population, EUS is not as accurate as previously reported in the T and N staging of pancreatic cancer. EUS is also not predictive of resectability in stage T3 or T4 pancreatic cancer.
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                Author and article information

                Journal
                Journal ID (publisher-id): DDI
                Journal ID (nlm-ta): Dig Dis
                Journal ID (doi): 10.1159/issn.0257-2753
                Title: Digestive Diseases
                Publisher: S. Karger AG
                ISBN: 978-3-8055-7777-9
                ISBN: 978-3-318-01108-1
                ISSN (Print): 0257-2753
                ISSN (Electronic): 1421-9875
                Publication date Subscription-year: 2004
                Publication date (Print): July 2004
                Publication date (Electronic): 02 August 2004
                Volume: 22
                Issue: 1
                Pages: 26-31
                Affiliations
                Department of Gastroenterology, Otto von Guericke University, Magdeburg, Germany
                Article
                Publisher ID: 78732 Other ID: Dig Dis 2004;22:26–31
                DOI: 10.1159/000078732
                PubMed ID: 15292692
                SO-VID: 041d3d1c-39bb-4ae2-ac38-1fdccac7a9bf
                Copyright © © 2004 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Tables: 2, References: 35, Pages: 6
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Oncology & Radiotherapy,Gastroenterology & Hepatology,Surgery,Nutrition & Dietetics,Internal medicine
                Keywords: Endosonography,Pancreatic neoplasms,Solid pancreatic tumors, surgery,EUS, review of the literature,Neoplasm staging,Ultrasonography, interventional,Adenoma,Digestive system neoplasms,Islet cell tumors, diagnosis,Pancreatitis,Adenocarcinoma
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Gastroenterology & Hepatology, Surgery, Nutrition & Dietetics, Internal medicine
                Keywords: Endosonography, Pancreatic neoplasms, Solid pancreatic tumors, surgery, EUS, review of the literature, Neoplasm staging, Ultrasonography, interventional, Adenoma, Digestive system neoplasms, Islet cell tumors, diagnosis, Pancreatitis, Adenocarcinoma

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