Identifying contraindications to resection in patients with pancreatic carcinoma: DISTINGUISHING INFLAMMATORY Part 2

Pancreatic carcinomaThe 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 malignancy is characterized by invasion of adjacent organs, an echopoor irregular mass, echopoor enlarged regional lymph nodes and evidence of distant metastases. Baron et al demonstrated a high sensitivity (95%) and specificity (88%) of EUS when used to distinguish malignant from benign pancreatic masses (Table 2). Unfortunately, these results have not been confirmed by other studies that have shown specificities of EUS ranging from 46% to 93%.
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TABLE 2
Sensitivity and specificity of endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in differentiating between benign and malignant pancreatic masses

EUS ERCP
Author (reference) n Sensitivity (%) Specificity (%) Sensitivity (%) Specificity (%)
Baron et al (12) 105 95 88
Glasbrenner et al (11) 95 78 93 81 88
Rosch et al (10) 102 76 46 86 62

Endoscopic retrograde cholangiopancreatography (ERCP) was not superior to EUS in either of two studies, and resulted in complications in up to 4% of patients. PET using F-18-fluoro-2-deoxy-D-glucose (FDG) has recently been investigated for this purpose. The increased uptake of FDG in inflammatory lesions has limited the applications of PET, but more recent investigations suggest that delayed imaging may enhance its specificity. Nakamoto et al reported a diagnostic accuracy of 91.5% when they evaluated 47 patients with suspected pancreatic carcinoma (27 malignant, 20 benign) using 2 h delayed imaging.


Category: Pancreatic carcinoma

Tags: Biopsy, Computed tomography, Endosonography, Pancreas adenocarcinoma, Pancreas neoplasm

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