scholarly journals Proposal for Endoscopic Ultrasonography Classification for Small Pancreatic Cancer

Diagnostics ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 15 ◽  
Author(s):  
Shuzo Terada ◽  
Masataka Kikuyama ◽  
Shinya Kawaguchi ◽  
Hideyuki Kanemoto ◽  
Yoshihiro Yokoi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasonography ◽  
Invasive Carcinoma ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Tumor Type ◽  
Cytologic Examination ◽  
Small Pancreatic Cancer ◽  
Invasive Carcinomas

Backgrounds: Endoscopic ultrasonography (EUS) is used to observe the stricture of the main pancreatic duct (MPD) and in diagnosing pancreatic cancer (PC). We investigate the findings on EUS by referring to the histopathological findings of resected specimens. Materials and Methods: Six patients with carcinoma in situ (CIS) and 30 patients with invasive carcinoma of 20 mm or less were included. The preoperative EUS findings were classified as follows. A1: Simple stricture type—no findings around the stricture; A2: Hypoecho stricture type—localized hypoechoic area without demarcation around the stricture; A3: Tumor stricture type—tumor on the stricture; B: Dilation type—the dilation of the pancreatic duct without a downstream stricture; C: Parenchymal tumor type—tumor located apart from the MPD. Results: Classes A1 and A2 consisted of 2 CISs, and 4 invasive carcinomas included two cases smaller than 5 mm in diameter. Most of the cancers classified as A3 or C were of invasive carcinoma larger than 5 mm in diameter. All cancers classified as B involved CIS. Serial pancreatic-juice aspiration cytologic examination (SPACE) was selected for all types of cases, with a sensitivity of 92.0%, while EUS-guided fine needle aspiration cytology (EUS-FNA) was only useful for invasive carcinoma, and its sensitivity was 66.7%. Conclusions: Stricture without a tumor could be a finding for invasive PC and pancreatic duct dilation without a downstream stricture could be a finding indicative of CIS. Carcinoma smaller than 5 mm in diameter could not be recognized by EUS. SPACE had a high sensitivity for diagnosing small PC.

scholarly journals Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 238
Author(s):  
Yasutaka Ishii ◽  
Masahiro Serikawa ◽  
Tomofumi Tsuboi ◽  
Ryota Kawamura ◽  
Ken Tsushima ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasonography ◽  
Treatment Decision ◽  
Needle Aspiration ◽  
Pancreatic Tumors ◽  
Decision Strategy ◽  
Endoscopic Retrograde ◽  
Small Pancreatic Cancer ◽  
Eus Elastography

Pancreatic cancer has the poorest prognosis among all cancers, and early diagnosis is essential for improving the prognosis. Along with radiologic modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), endoscopic modalities play an important role in the diagnosis of pancreatic cancer. This review evaluates the roles of two of those modalities, endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), in the diagnosis of pancreatic cancer. EUS can detect pancreatic cancer with higher sensitivity and has excellent sensitivity for the diagnosis of small pancreatic cancer that cannot be detected by other imaging modalities. EUS may be useful for the surveillance of pancreatic cancer in high-risk individuals. Contrast-enhanced EUS and EUS elastography are also useful for differentiating solid pancreatic tumors. In addition, EUS-guided fine needle aspiration shows excellent sensitivity and specificity, even for small pancreatic cancer, and is an essential examination method for the definitive pathological diagnosis and treatment decision strategy. On the other hand, ERCP is invasive and performed less frequently for the purpose of diagnosing pancreatic cancer. However, ERCP is essential in cases that require evaluation of pancreatic duct stricture that may be early pancreatic cancer or those that require differentiation from focal autoimmune pancreatitis.

scholarly journals Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 945
Author(s):  
Ryota Sagami ◽  
Kentaro Yamao ◽  
Jun Nakahodo ◽  
Ryuki Minami ◽  
Masakatsu Tsurusaki ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Invasive Carcinoma ◽  
Current Knowledge ◽  
Precancerous Lesions ◽  
Ductal Adenocarcinoma ◽  
Pancreatic Ducts ◽  
High Grade ◽  
Cytologic Examination ◽  
Imaging Characteristics ◽  
Retention Cysts

Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN.

scholarly journals Improvement of the Diagnosis of Isoattenuating Pancreatic Carcinomas by Defining their Characteristics on Contrast Enhanced Computed Tomography and Endosonography with Fine-Needle Aspiration (EUS-FNA)

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 776
Author(s):  
Robert Psar ◽  
Ondrej Urban ◽  
Marie Cerna ◽  
Tomas Rohan ◽  
Martin Hill
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Fine Needle Aspiration ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Characteristic Analysis ◽  
Fine Needle ◽  
Contrast Enhanced ◽  
Secondary Signs

(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA.

scholarly journals Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

2016 ◽  
Vol 18 (1) ◽  
pp. 18 ◽  
Author(s):  
Sevastiţa Iordache ◽  
Mădălin Ionuţ Costache ◽  
Carmen Florina Popescu ◽  
Costin Teodor Streba ◽  
Sergiu Cazacu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Algorithm ◽  
High Sensitivity ◽  
Clinical Decision ◽  
Needle Aspiration ◽  
Clinical Tool ◽  
Decision Algorithm ◽  
Contrast Enhanced ◽  
Pancreatic Masses ◽  
Sensitivity Specificity

Aims: It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS. Material and methods: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established. Results: For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer. Conclusions: The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses. 

EARLY DIAGNOSIS OF SMALL PANCREATIC CANCER: ROLE OF ENDOSCOPIC ULTRASONOGRAPHY

2009 ◽  
Vol 21 ◽  
pp. S92-S96 ◽  
Author(s):  
Atsushi Irisawa ◽  
Ai Sato ◽  
Masaki Sato ◽  
Tsunehiko Ikeda ◽  
Rei Suzuki ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Early Diagnosis ◽  
Endoscopic Ultrasonography ◽  
Small Pancreatic Cancer

scholarly journals Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Early Diagnosis of Small Pancreatic Cancer

Diagnostics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 23 ◽  
Author(s):  
Yasunobu Yamashita ◽  
Kensuke Tanioka ◽  
Yuki Kawaji ◽  
Takashi Tamura ◽  
Junya Nuta ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Early Diagnosis ◽  
Endoscopic Ultrasonography ◽  
Multidetector Row Computed Tomography ◽  
Diagnostic Ability ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri ◽  
Pancreatic Solid Lesion ◽  
Small Pancreatic Cancer ◽  
Sensitivity Specificity

This study aimed to assess whether contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), compared to multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), is useful for early diagnosis of small pancreatic cancer (PC). Between March 2010 and June 2018, all three imaging modalities and surgery were performed for patients with a pancreatic solid lesion measuring ≤20 mm; diagnostic ability was compared among modalities. Fifty-one of 60 patients were diagnosed with PC (PC size in 41 patients: 11–20 mm; 10 patients: ≤10 mm). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (11–20 mm) detection were 95%/83%/94%, 78%/83%/79%, and 73%/33%/68%, respectively. The diagnostic ability of CH-EUS was significantly superior compared with MDCT and MRI (p = 0.002 and p = 0.007, respectively). The sensitivity, specificity, and accuracy of CH-EUS, MDCT, and MRI for PC (≤10 mm) detection were 70%/100%/77%, 20%/100%/38%, and 50%/100%/62%, respectively. The diagnostic ability of CH-EUS tended to be superior to that of MDCT (p = 0.025). The sensitivity of MDCT for PC (≤10 mm) detection was significantly lower than that for PC (11–20 mm) detection (20% vs. 78%; p = 0.001). CH-EUS, compared to MDCT and MRI, is useful for diagnosing small PCs.

scholarly journals Novel Cytological Diagnostic Scoring System for Pancreatic Specimens Obtained by Endoscopic Ultrasound-Guided Fine Needle Aspiration

2020 ◽  
Author(s):  
Yuri Kiso ◽  
Yoko Matsuda ◽  
Shikine Esaka ◽  
Yuri Hamashima ◽  
Hiroto Shirahata ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Sensitivity And Specificity ◽  
Fine Needle Aspiration ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Youden Index ◽  
Cytological Diagnosis ◽  
Benign Lesions ◽  
Ultrasound Guided ◽  
Fine Needle

Abstract Background: Cytological diagnosis of pancreatic specimens obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is often challenging because of the small amount of sample or well-differentiated adenocarcinoma with weak cytological atypia. Therefore, the sensitivity and specificity of cytological diagnosis for pancreatic cancer should be improved. Hence, we aimed to evaluate the indices, which are used to distinguish malignant from benign lesions for the cytological diagnosis of pancreatic EUS-FNA specimens. Methods: Seven reviewers, including 3 cytotechnologists and 4 medical doctors, evaluated 20 morphological indices in pancreatic specimens obtained by EUS-FNA (malignant, n=111; benign, n=31). Statistical analyses were performed using Fisher’s exact test, logistic regression analysis, area under the receiver operating characteristic curve, and Youden Index.Results: Among the 20 indices, there was a high incidence rate (>40%) of the following 13 indices in malignant cases: structural atypia, hyperchromatic nucleus, irregular cell polarity, unclear cell boundary, nuclear membrane thickening, anisonucleosis, overlapping, irregular nuclei, high nuclear/cytoplasmic ratio, binding decline, simultaneous appearance of malignant and benign cells, enlarged nucleoli, and background necrosis. When we diagnosed pancreatic specimens using these 13 cytological indices, the cutoff value of 8/9 showed the highest Youden index (0.950) as well as high sensitivity and specificity in distinguishing malignant from benign specimens (98% and 97%, respectively). Conclusion: Thirteen cytological indices showed high sensitivity and specificity in differentiating malignant and benign lesions using pancreatic EUS-FNA samples. Further validation or prospective studies are necessary to establish criteria for the cytological diagnosis of pancreatic cancer.

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