Pancreatic carcinoma

The most streamlined approach to patients with suspected pancreatic neoplasms is to perform a pancreatic protocol helical CT. In patients who have obviously unre-sectable disease, percutaneous techniques can be used to establish a tissue diagnosis. In patients whose lesions are considered surgically resectable based on the CT, the added benefit of EUS is unknown and […]

The evaluation of the patient with a pancreatic mass has been outlined and suggests that, once the suspicion of a neoplasm has been raised, the major challenge is to determine the resectability of the lesion. Patients who are otherwise considered medically suitable should be offered surgery because it is the only chance for cure. In […]

In addition to establishing a diagnosis when prior biopsy methods have failed, EUS FNA may be able to identify nonperitumoral lymph node (NPTLN) metastases. Limited information is available on the frequency of NPTLN and the sensitivity of EUS FNA in this setting. EUS with FNA of identified NPTLN, if performed in patients thought to be […]

The usual technique for confirming the presence of malignant disease is percutaneous biopsy under sonographic or CT guidance. The accuracy of this method is well established. It is safe and, in patients not being considered for surgical therapy, straightforward. Concerns have been raised with respect to the potential for seeding of tumour along the needle […]

Studies comparing helical CT with EUS yield conflicting results. EUS is clearly the most sensitive technique for the detection of pancreatic masses, particularly when they are smaller than 3 cm in diameter. The accuracy of EUS for local and regional tumour staging is similar among different series, ranging from 80% to 90%, whereas the accuracy […]

The introduction of rapid-scanning helical CT has permitted multiple scans to be obtained through the abdomen during different phases of contrast enhancement. The dualphase technique permits images to be obtained when arterial and pancreatic parenchymal features are optimally visible, and then later when hepatic metastases may be better detected. Employing this technique and EUS, Legmann […]

Accurate staging of pancreatic cancer is essential for determining which patients may benefit from surgery. Vascular and lymph node invasion are important prognostic factors that should be identified before surgery. Early reports showed that the accuracy of EUS for preoperative staging of pancreatic cancer (85% to 100%) was superior to that of dynamic CT (64% […]

The high resolution imaging afforded by EUS may permit the identification of features that assist in distinguishing benign from malignant pancreatic mass lesions. EUS findings that are suggestive of an inflammatory mass include diffuse inflammatory changes throughout the pancreas (inhomogeneous echo pattern, calcification with or without duct lithiasis, echopoor peripancreatic fat stranding and cysts), whereas […]

Neoplastic pancreatic mass lesions can usually be diagnosed easily by presenting symptoms, signs and imaging studies. More difficult challenges are posed by mass lesions that occur in the setting of chronic pancreatitis or when the initial presentation of the mass lesion is associated with an episode of pancreatitis. Ancillary testing may help determine the malignant […]

Patients presenting with refractory upper abdominal pain may undergo CT or ultrasound imaging that demonstrates a pancreatic ‘mass’ (or more commonly a ‘fullness’). The significance of this finding rests in the ominous prognosis of patients with pancreatic carcinoma. There is an obligation to investigate this radiological finding fully so that the therapy of a potentially […]