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      Impact of endoscopic ultrasonography on diagnosis of pancreatic cancer

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          Abstract

          Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic cancers. EUS can provide high-resolution images of the pancreas with a quality regarded as far surpassing that achieved on transabdominal ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). EUS is particularly useful for the detection of small pancreatic lesions, while EUS and its related techniques such as contrast-enhanced EUS (CE-EUS), EUS elastography, and EUS-guided fine needle aspiration (EUS-FNA) are also useful in the differential diagnosis of solid or cystic pancreatic lesions and the staging (T-staging, N-staging, and M-staging) of pancreatic cancers. In the diagnosis of pancreatic lesions, CE-EUS and EUS elastography play a complementary role to conventional EUS. When sampling is performed using EUS-FNA, CE-EUS and EUS elastography provide information on the target lesions. Thus, conventional EUS, CE-EUS, EUS elastography, and EUS-FNA are essential in the clinical investigation of pancreatic cancer.

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          Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review.

          Kai-Xuan Wang, Qi-Wen Ben, Zhen-Dong Jin … (2011)
          EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience. To systematically review the morbidity and mortality associated with EUS-FNA. MEDLINE and EMBASE were searched to identify relevant English-language articles. EUS-FNA-specific morbidity and mortality rates. We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions (P=.000), whereas it was 2.33% versus 5.07% for pancreatic cysts (P=.036). Few articles reported well-designed, prospective studies and few focused on overall complications after EUS-FNA. EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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            European experts consensus statement on cystic tumours of the pancreas.

            Ralf Segersvärd, Helmut Friess, Colin McKay … (2013)
            Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer. Copyright © 2013 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
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              Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society.

              Takuji Okusaka, Hiroyuki Maguchi, Akimasa Nakao … (2012)
              Since 1981, the Japan Pancreas Society has been hosting a nationwide pancreatic cancer registry. To commemorate its 30th anniversary, we review its history and latest achievement. During 3 decades, more than 350 leading institutions in Japan contributed voluntarily to register and periodic follow-up. The registry was modified to protect privacy by encrypting and hash algorithm. From 1981 to 2007, 32,619 cumulative records were analyzed. The overall survival of invasive cancer was improved significantly. More patients with earlier stage or with intraductal and cystic neoplasms underwent resection. The strongest prognostic factor of Union for International Cancer Control (UICC) stage IIA and IIB tubular adenocarcinoma in the pancreatic head was histological grade, followed by tumor size, extent of lymph node dissection, and postoperative chemotherapy. The 5-year survival rate of Union for International Cancer Control stage 0 reached 85%. The improvement of survival of patients with invasive cancer in Japan can be attributed to the introduction of effective chemotherapies, regionalization, and the earlier diagnosis and treatment. Simple definition of "early pancreatic cancer" is needed. At the 30th year anniversary, the Japan Pancreas Society nationwide pancreatic cancer registry is more shining than ever for current perspectives and for future diagnostic and treatment tactics.
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                Author and article information

                Contributors
                Masayuki Kitano: +81 73 441 0627 , kitano@wakayama-med.ac.jp
                Journal
                Journal ID (nlm-ta): J Gastroenterol
                Journal ID (iso-abbrev): J. Gastroenterol
                Title: Journal of Gastroenterology
                Publisher: Springer Japan (Tokyo )
                ISSN (Print): 0944-1174
                ISSN (Electronic): 1435-5922
                Publication date (Electronic): 7 November 2018
                Publication date PMC-release: 7 November 2018
                Publication date (Print): 2019
                Volume: 54
                Issue: 1
                Pages: 19-32
                Affiliations
                [1 ]ISNI 0000 0004 1763 1087, GRID grid.412857.d, Department of Gastroenterology, , Wakayama Medical University School of Medicine, ; 811-1 Kimiidera, Wakayama-City, Wakayama 641-0012 Japan
                [2 ]ISNI 0000 0004 1763 1087, GRID grid.412857.d, Second Department of Internal Medicine, , Wakayama Medical University School of Medicine, ; 811-1 Kimiidera, Wakayama-City, Wakayama 641-0012 Japan
                Article
                Publisher ID: 1519
                DOI: 10.1007/s00535-018-1519-2
                PMC ID: 6314985
                PubMed ID: 30406288
                SO-VID: 562500e5-c567-4b21-a195-a89df49c57d9
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 8 August 2018
                Date accepted : 3 October 2018
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Japanese Society of Gastroenterology 2019

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: endoscopic ultrasonography,contrast-enhanced endoscopic ultrasonography,pancreatic cancer
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: endoscopic ultrasonography, contrast-enhanced endoscopic ultrasonography, pancreatic cancer

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