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Diagnosis of pancreatic tumors by endoscopic ultrasonography  [cached]
Hiroki Sakamoto, Masayuki Kitano, Ken Kamata, Muhammad El-Masry, Masatoshi Kudo
World Journal of Radiology , 2010,
Abstract: Pancreatic tumors are highly diverse, as they can be solid or cystic, and benign or malignant. Since their imaging features overlap considerably, it is often difficult to characterize these tumors. In addition, small pancreatic tumors, especially those less than 2 cm in diameter, are difficult to detect and diagnose. For characterizing pancreatic tumors and detecting small pancreatic tumors, endoscopic ultrasonography (EUS) is the most sensitive of the imaging procedures currently available. This technique also provides good results in terms of the preoperative staging of pancreatic tumors. EUS-guided fine needle aspiration (EUS-FNA) has also proved to be a safe and useful method for tissue sampling of pancreatic tumors. Despite these advantages, however, it is still difficult to differentiate between benign and malignant, solid or cystic pancreatic tumors, malignant neoplasms, and chronic pancreatitis using EUS, even when EUS-FNA is performed. Recently, contrast-enhanced EUS with Doppler mode (CE-EUS) employing ultrasound contrast agents, which indicate vascularization in pancreatic lesions, has been found to be useful in the differential diagnosis of pancreatic tumors, especially small pancreatic tumors. However, Doppler ultrasonography with contrast-enhancement has several limitations, including blooming artifacts, poor spatial resolution, and low sensitivity to slow flow. Consequently, an echoendoscope was developed recently that has a broad-band transducer and an imaging mode that was designed specifically for contrast-enhanced harmonic EUS (CEH-EUS) with a second-generation ultrasound contrast agent. The CEH-EUS technique is expected to improve the differential diagnosis of pancreatic disease in the future. This review describes the EUS appearances of common solid and cystic pancreatic masses, the diagnostic accuracy of EUS-FNA, and the relative efficacies and advantages of CE-EUS and CEH-EUS along with their relative advantages and their complementary roles in clinical practice.
The Impact on Clinical Practice of Endoscopic Ultrasonography Used for the Diagnosis and Staging of Pancreatic Adenocarcinoma
Queneau PE,Sauvé G,Koch S,Thibault P
JOP Journal of the Pancreas , 2001,
Abstract: CONTEXT: Endoscopic ultrasonography is considered a highly accurate procedure for diagnosing small pancreatic tumors and assessing their locoregional extension. OBJECTIVE: To evaluate the impact of endoscopic ultrasonography on the management of pancreatic adenocarcinoma in clinical practice. PATIENTS: Sixty-four consecutive patients (mean age 70.5 plus/minus 11.9 years) hospitalized for staging or diagnosis of pancreatic adenocarcinoma were retrospectively (from January 1995 to November 1997) or prospectively studied (from December 1997 to August 1999). SETTING: Group 1 consisted of 52 patients with pancreatic adenocarcinoma which was discovered using computerized tomography scanning and/or ultrasound. Endoscopic ultrasonography was utilized for staging purposes only in patients who were considered to be operable and the tumor to be resectable based on computerized tomography scanning criteria. Group 2 consisted of 12 patients who were diagnosed as having a pancreatic adenocarcinoma using endoscopic ultrasonography whereas computerized tomography scanning and ultrasound was negative. MAIN OUTCOME MEASURES: The impact of endoscopic ultrasonography was analyzed on the basis of the number of patients requiring endoscopic ultrasonography as a staging procedure (Group 1) and by evaluating the performance of endoscopic ultrasonography in determining resectability (Groups 1 and 2) based on the surgical and anatomopathological results. RESULTS: Endoscopic ultrasonography was performed in 20 out of 64 patients (31.3%): 8/52 in Group 1 (15.4%) and all 12 patients of Group 2. Endoscopic ultrasonography correctly assessed an absolute contraindication to resection in 11 cases. Resection was confirmed in 8 of the 9 cases selected by endoscopic ultrasonography. The positive predictive value, negative predictive value and overall accuracy of endoscopic ultrasonography for determining resection were 89%, 100%, and 95%, respectively. CONCLUSIONS: The impact of endoscopic ultrasonography seems especially relevant for the detection of pancreatic tumors after negative computerized tomography scanning, and for the prevention of unnecessary laparotomies as complementary staging after ultrasonography and computerized tomography scanning.
Role of pancreatic endoscopic ultrasonography in 2010  [cached]
Ioannis S Papanikolaou,Pantelis S Karatzas,Konstantinos Triantafyllou,Andreas Adler
World Journal of Gastrointestinal Endoscopy , 2010,
Abstract: Endoscopic ultrasonography (EUS) was introduced 25 years ago aiming at better visualization of the pancreas compared to transabdominal ultrasonography. This update discusses the current evidence in 2010 concerning the role of EUS in the clinical management of patients with pancreatic disease. Major indications of EUS are: (1) Detection of common bile duct stones (e.g. in acute pancreatitis); (2) Detection of small exo- and endocrine pancreatic tumours; and (3) Performance of fine needle aspiration in pancreatic masses depending on therapeutic consequences. EUS seems to be less useful in cases of chronic pancreatitis and cystic pancreatic lesions. Moreover the constant improvement of computed tomography has limited the role of EUS in pancreatic cancer staging. On the other hand, new therapeutic options are available due to EUS, such as pancreatic cyst drainage and celiac plexus neurolysis, offering a new field in which new techniques may arise. So the main goal of this review is to determine the exact role of EUS in a number of pancreatic and biliary diseases.
Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer
Iglesias García,J.; Lari?o Noia,J.; Domínguez Mu?oz,J. E.;
Revista Espa?ola de Enfermedades Digestivas , 2009, DOI: 10.4321/S1130-01082009000900006
Abstract: pancreatic cancer is the 5th leading cause of cancer-related death in western countries. the 5-year survival rate is approximately 4%, without significant changes over the last 50 years. this poor survival rate and bad prognosis are associated with the diagnosis of advanced-stage disease, which precludes the only potential curative treatment - surgical resection. in this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and a correct staging of the disease. endoscopic ultrasonography (eus) appears to be an essential tool for the diagnosis and staging of pancreatic cancer. eus diagnostic accuracy for detecting pancreatic tumors ranges from 85 to 100%, clearly superior to other imaging techniques. eus accuracy for the local staging of pancreatic cancer ranges from 70 to 90%, superior or equivalent to other imaging modalities. eus-guided fine-needle aspiration allows a cyto-histological diagnosis in nearly 90% of cases, with a very low complication rate. at present, the formal indications for eus-guided fine-needle aspiration are the necessity of palliative treatment or whenever the possibility of neoadjuvant treatment is present. it could be also indicated to differentiate pancreatic adenocarcinoma from other pancreatic conditions, like lymphoma, metastasis, autoimmune pancreatitis or chronic pancreatitis. we can conclude that eus is an essential tool in the management of patients with pancreatic tumors.
Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer  [cached]
J. Iglesias García,J. Lari?o Noia,J. E. Domínguez Mu?oz
Revista Espa?ola de Enfermedades Digestivas , 2009,
Abstract: Pancreatic cancer is the 5th leading cause of cancer-related death in Western countries. The 5-year survival rate is approximately 4%, without significant changes over the last 50 years. This poor survival rate and bad prognosis are associated with the diagnosis of advanced-stage disease, which precludes the only potential curative treatment - surgical resection. In this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and a correct staging of the disease. Endoscopic ultrasonography (EUS) appears to be an essential tool for the diagnosis and staging of pancreatic cancer. EUS diagnostic accuracy for detecting pancreatic tumors ranges from 85 to 100%, clearly superior to other imaging techniques. EUS accuracy for the local staging of pancreatic cancer ranges from 70 to 90%, superior or equivalent to other imaging modalities. EUS-guided fine-needle aspiration allows a cyto-histological diagnosis in nearly 90% of cases, with a very low complication rate. At present, the formal indications for EUS-guided fine-needle aspiration are the necessity of palliative treatment or whenever the possibility of neoadjuvant treatment is present. It could be also indicated to differentiate pancreatic adenocarcinoma from other pancreatic conditions, like lymphoma, metastasis, autoimmune pancreatitis or chronic pancreatitis. We can conclude that EUS is an essential tool in the management of patients with pancreatic tumors.
Endoscopic ultrasonography in pancreatic carcinoma
Tomi? D.,Pavlovi? A.R.,Krsti? M.,Je?i? R.
Acta Chirurgica Iugoslavica , 2005, DOI: 10.2298/aci0501065t
Abstract: Even though pancreatic cancer is not such a common diagnosis, its treatment is very expensive and it has a great economic impact to the health system. 5-year survival rates after excessive surgical treatment is only 5%, which imposes more careful selection of patients that have to be surgically treated. According to experience from some medical centers all over the world, EUS is considered as a high sensitive diagnostic method for establishing a diagnosis of pancreatic cancer and evaluation of TNM staging. The main purpose of this survey is to present our experience in using of EUS as a diagnostic method in establishing a diagnosis of pancreatic cancer, as well as to evaluate how reliable this method is in preoperative evaluation if tumor could be successfully resected. We examined the group of 63 patients with pancreatic cancer, which were surgically explored after EUS examination. We wanted to compare TNM status before and after the penetration ability of the probe working with the frequency of 7,5 MHz, EUS is not a suitable method for evaluation of M stage (figure 8,9). Patients were divided in different groups, specified by TNM status. For 10 patients resection was estimated as a probably successful solution, but only 8 of them was surgically treated. According to this, our estimation was 79,7% accurate, which is in accordance to results obtained from other medical centers all over the world.
Interventional endoscopic ultrasonography for pancreatic cancer  [cached]
Kazuo Hara,Kenji Yamao,Nobumasa Mizuno,Susumu Hijioka
World Journal of Clinical Oncology , 2011,
Abstract: Endoscopic ultrasonography (EUS) represents the combination of endoscopy and intraluminal ultrasonography. This allows use of a high-frequency transducer (5-20 MHz) that, due to the short distance to the target lesion, provides ultrasonographic images of higher resolution than those obtained from other imaging modalities, including multiple-detector-row-computed tomography, magnetic resonance imaging, and positron emission tomography. EUS is now a widely accepted modality for diagnosing pancreatic diseases. However, the most important limitation of EUS has been the lack of specificity in differentiating between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (FNA) of lesions in the pancreas head was introduced into clinical practice, using a curved linear-array echoendoscope. Since then, EUS has evolved from EUS imaging to EUS-FNA and wider applications. Interventional EUS for pancreatic cancer includes EUS-FNA, EUS-guided fine needle injection, EUS-guided biliary drainage and anastomosis, EUS-guided celiac neurolysis, radiofrequency ablation, brachytherapy, and delivery of a growing number of anti-tumor agents. This review focuses on interventional EUS, including EUS-FNA and therapeutic EUS for pancreatic cancer.
MRI and endoscopic ultrasonography in the staging of gastric cancer
Arocena,M. G.; Barturen,A.; Bujanda,L.; Casado,O.; Ramírez,M. M.; Oleagoitia,J. M.; Galdiz Iturri,M.; Múgica,P.; Cosme,A.; Gutiérrez-Stampa,M. A.; Zapata,E.; Echenique-Elizondo,M.;
Revista Espa?ola de Enfermedades Digestivas , 2006, DOI: 10.4321/S1130-01082006000800003
Abstract: objective: to determine the diagnostic precision of endoscopic ultrasounds (eus) and magnetic resonance imaging (mri) in the preoperative staging of gastric cancer. methods: a prospective, blind study was carried out in 17 patients diagnosed with gastric cancer (gc) using endoscopic biopsy from november 2002 to june 2003. patients underwent preoperative mri and eus. the reference test used was pathology, and laparotomy for non-resectable cases. results: mri (53%) was better than eus in the assessment of gastric wall infiltration (35%). mri (50%) was also superior to eus (42%) for n staging. after pooling stages t1-t2 and t3-t4 together, results improved for both mri (67 and 87.5%, respectively) and eus (67 and 62.5%, respectively) (p < 0.05). n staging -lymph node invasion- results were correct in 50% for mri as compared to eus (42%). in classifying positive and negative lymph nodes eus was superior to mri (73 versus 54%). conclusions: mri was the best method in the assessment of gastric wall infiltration. eus was superior to mri for t1 staging, and in the assessment of lymph node infiltration.
Low accuracy of endoscopic ultrasonography for detailed T staging in gastric cancer  [cached]
Lee Han,Lim Chul,Park Jae,Cho Yu
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-190
Abstract: Background The accuracy of endoscopic ultrasonography (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS tumor (T) and node (N) staging, and to identify the histopathological factors influencing accuracy based on the detailed tumor depth of gastric cancer. Methods In total, 309 patients with gastric cancer with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary’s Hospital, Korea, between January and December 2009. The T and N staging of EUS and the pathologic report were compared. Results The overall accuracies of EUS for T stage and the detailed T stages were 70.2% and 43.0%, respectively. In detailed stage, tumors greater than 50 mm in diameter were significantly associated with T overstaging (odds ratio (OR) = 2.094). The overall accuracy of EUS for N staging was 71.2%. Tumor size (20 mm ≤ size < 50 mm, OR = 4.389; and 50 mm ≤ size, OR = 8.170), cross-sectional tumor location (circumferential, OR = 4.381) and tumor depth (submucosa, OR = 3.324; muscular propria, OR = 6.923; sub-serosa, OR = 4.517; and serosa-exposed, OR = 6.495) were significant factors affecting incorrect nodal detection. Conclusions Careful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging.
Contrast-Enhanced Harmonic Endoscopic Ultrasonography in Pancreatic Diseases  [PDF]
Can Xu,Zhaoshen Li,Michael Wallace
Diagnostic and Therapeutic Endoscopy , 2012, DOI: 10.1155/2012/786239
Abstract: Endoscopic ultrasonography (EUS) is the most sensitive imaging method for diagnosis of pancreatic tumors. However, it still has limits in the differentiation between pancreatic cancers and inflammatory tumor-like masses. A novel technology, contrast-enhanced harmonic EUS (CH-EUS), has been developed recently. It can visualize both parenchymal perfusion and microvasculature in pancreas without Doppler-related artifacts. Therefore, it is superior to EUS and CT in detecting small pancreatic masses and differential diagnosis of pancreatic masses. CH-EUS could be used for adequate sampling of pancreatic tumors and may predict the pathological features of the pancreatic solid lesions but still cannot replace EUS-FNA now. 1. Introduction Pancreatic cancer is one of the most devastating diseases with long-term survival being still rare. Therefore, there is an urgent need to develop a method for diagnosing pancreatic cancer at an early curable stage. Endoscopic ultrasound (EUS) is considered to be the most sensitive technology in detecting small pancreatic tumors [1, 2]. However, the differentiation between pancreatic tumors and inflammatory tumor-like masses still remains difficult. The evaluation of vascularity using ultrasound contrast may assist the differentiation of cancers from benign tumors. Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is a novel technology which observes both parenchymal perfusion and microvasculature in the pancreas and has been reported to improve characterization of pancreatic cancers from other pancreatic diseases [3, 4]. In this paper, we will describe the development of a new technology CH-EUS and will review the advantages and its value in clinical practice in pancreatic diseases [5]. 2. Development of CH-EUS Power-Doppler and color-Doppler have been used for contrast enhanced transabdominal US (CE-US) until recently. Although the contrast agent selectively enhances the useful signal, the main disadvantage of these techniques is the presence the inevitable artifacts such as blooming and overpainting [3]. CE harmonic US (CH-US) is a technique that is able to detect signals from microbubbles in vessels with very slow flow without Doppler-related artifacts [5]. CH-US is used to characterize tumor vascularity in liver and pancreas. It helps to differential diagnose of benign and malignant liver tumors mainly because of the dual blood supply of the liver via the arterial supply and liver-specific portal vessels. In contrast to liver, pancreas does not contain a dual vascular system. But, several studies showed
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