Original contribution
Utility of Contrast-Enhanced Endoscopic Ultrasonography for Diagnosis of Small Pancreatic Carcinomas

https://doi.org/10.1016/j.ultrasmedbio.2007.09.018Get rights and content

Abstract

The aim of our study was to assess the utility of endoscopic ultrasonography (EUS) and contrast-enhanced EUS (CE-EUS) for the depiction and differential diagnosis of pancreatic tumors focusing in particularly those 2 cm or smaller. We compared different diagnostic procedures, contrast-enhanced multidetector computed tomography (CE-CT) and EUS with the use of power Doppler (PD-EUS) and CE-EUS for detection and differential diagnosis of pancreatic tumors. The study included 156 consecutive patients with suspected pancreatic tumors, who underwent CE-CT, and EUS followed by PD-EUS and CE-EUS. CE-EUS was performed by power Doppler mode using sonographic contrast agent Levovist®. Thirty-six of 156 patients examined had tumors of ≤2 cm. EUS had significantly higher sensitivity (94.4%) for detection of pancreatic carcinomas of 2 cm or less in comparison to CE-CT (50%). For small pancreatic tumor of 2 cm or less, sensitivities for differentiating ductal carcinomas from other tumors were 50.0%, 11.0% and 83.3% for CE-CT, PD-EUS and CE-EUS. CE-EUS was significantly more sensitive than PD-EUS and CE-CT. EUS and subsequent CE-EUS are more sensitive than CE-CT in the detection and the differentiation of small pancreatic tumors. (E-mail: [email protected])

Introduction

Small pancreatic lesions, especially those less than 2 cm are difficult to diagnose and differentiating them from other pancreatic lesions is a challenging-task. Contrast-enhanced computed tomography has been used for detection and for differentiation of various pancreatic nodules and has demonstrated hypovascular lesions in pancreatic carcinoma (Dewitt et al 2004, Kitano et al 2004, Ishikawa et al 1999). Endoscopic ultrasonography (EUS), now commonly used worldwide (DiMagno et al 1980, Levy and Wiersema 2002), is more sensitive in detection of small pancreatic lesions when compared with computed tomography (CT) and transabdominal ultrasonography (US) (Dewitt et al 2004, Fujita et al 2004, Wiersema 2001). Power Doppler or color Doppler mode EUS (PD-EUS) with or without sonographic contrast agent (CE-EUS) has been used for the differential diagnosis of pancreatic tumors. Hocke et al. (2006) compared the diagnostic sensitivity for detecting pancreatic lesion by conventional EUS, power Doppler EUS and CE-EUS, and found that evaluation of vascularity was useful in the differential diagnosis of pancreatic carcinomas from chronic pancreatitis. The primary endpoint of this study was to compare the sensitivity of contrast-enhanced multidetector computed tomography (CE-CT) and EUS for detection of small pancreatic carcinoma, especially those ≤2 cm. The secondary endpoint was to compare the sensitivity of CE-CT, PD-EUS and CE-EUS in differentiating pancreatic carcinomas from the other tumors by evaluation of vascularity.

Section snippets

Materials and Methods

This study was performed with the approval of the ethical committee of Kinki University. Between March 2002 and August 2006, 61,920 patients underwent screening transabdominal US and/or abdominal CT at our institution. Among them, 156 patients suspected of having a pancreatic solid tumor due to abnormal finding on screening US or CT (nodule, dilation of main pancreatic duct >3 mm, dilation of common bile duct >10 mm and pancreatic cyst), were enrolled in this study. The enrolled patients

Results

The final diagnosis of 156 lesions was made by EUS-FNA (n = 98), surgery (n = 25), biopsy of liver metastases (n = 12) and autopsy (n = 21). The final pathologic diagnosis of these pancreatic lesions included: 119 patients with pancreatic carcinomas, 16 patients with inflammatory pseudotumors related to chronic pancreatitis, 19 patients with endocrine tumors and two patients with metastatic pancreatic tumor from renal cell carcinoma. Thirty-six of the 156 patients underwent surgical resection

Discussion and Summary

The development of imaging technology has improved the detection and differentiation of small carcinoma but difficulties remain. Pancreatic cancer is commonly undetected at an early stage since the symptoms of small pancreatic carcinomas are frequently vague and nonspecific. EUS is a highly sensitive diagnostic method for detection of pancreatic carcinoma, especially small pancreatic carcinomas (Rösch et al 1991, Snady et al 1992, Yasuda et al 1984, Oshikawa et al 2002). In this study, we found

Acknowledgments

The present study was supported by grants from the Japan Society for Promotion of Science, Research and Development Committee Program of The Japan Society of Ultrasonics in Medicine, Japan Research Foundation for Clinical Pharmacology, and Japanese Foundation for Research and Promotion of Endoscopy.

References (25)

  • J. Dewitt et al.

    Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer

    Ann Intern Med

    (2004)
  • S.J. Diehl et al.

    Pancreatic cancerValue of dual-phase helical CT in assessing resectability

    Radiology

    (1998)
  • Cited by (155)

    View all citing articles on Scopus
    View full text