Pancreatic cancer ultrasound: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pancreatic cancer}} | {{Pancreatic cancer}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{ | {{CMG}}; '''Associate Editor-In-Chief:''' {{Cherry}} | ||
==Overview== | ==Overview== | ||
[[Pancreatic cancer]] has a variable appearance on [[Ultrasound|USG]]. The appearance relative to normal [[Pancreas|pancreatic]] tissue may be ''hypoechoic'', ''isoechoic'' or ''hyperechoic''. In majority of the cases, an ill defined ''hypoechoic'' mass is seen infiltrating into a bright [[Pancreas|pancreatic]] [[parenchyma]]. [[Pancreas|Pancreatic]] and [[Bile duct|biliary duct]] [[Dilation|dilatation]] is seen in case of [[Pancreatic cancer|carcinoma of the head of pancreas]] (''Double duct sign''). The disadvantage of a [[Ultrasound|transabdominal USG]] is its inability to clearly demarcate [[lymphadenopathy]], [[tumor]] margins and the relation of the [[tumor]] to [[Blood vessel|vessels]] around the [[pancreas]]. ''[[Endoscopic ultrasound|Endoscopic Ultrasound]]'' (''[[Endoscopic ultrasound|EUS]]'') has a high efficacy in the detection of [[Tumor|tumors]] smaller than 2 cm, for local T and N staging, and prediction of [[vascular]] invasion. It has a higher resolution than [[Ultrasound|transabdominal ultrasound]], due to the small distance between the [[Endoscopy|endoscope]] and [[pancreas]] through the wall of the [[duodenum]]. [[Endoscopic ultrasound|EUS]] plays an important role in the preoperative [[Cancer staging|staging]] of [[pancreatic cancer]] particularly in cases where [[Computed tomography|CT]] evaluation suggests equivocal findings. Moreover, [[Endoscopic ultrasound|EUS]]-guided [[Needle aspiration biopsy|fine needle aspiration biopsy (FNA)]] is the best modality for obtaining a [[Diagnosis|tissue diagnosis]]. | |||
==Ultrasound== | ==Transabdominal Ultrasound== | ||
The | * [[Pancreatic cancer]] has a variable appearance on [[Ultrasound|USG]]. | ||
* | * The appearance relative to normal [[Pancreas|pancreatic tissue]] may be:<ref name="pmid19276960">{{cite journal |vauthors=Shin LK, Brant-Zawadzki G, Kamaya A, Jeffrey RB |title=Intraoperative ultrasound of the pancreas |journal=Ultrasound Q |volume=25 |issue=1 |pages=39–48; quiz 48 |year=2009 |pmid=19276960 |doi=10.1097/RUQ.0b013e3181901ce4 |url=}}</ref> | ||
** ''Hypoechoic'' | |||
** ''Isoechoic'' | |||
** ''Hyperechoic'' | |||
* In majority of the cases, an ill defined hypoechoic mass is seen infiltrating into a bright ''pancreatic parenchyma''. [[Ascites]] may also be visible. | |||
* [[Pancreas|Pancreatic]] and [[Bile duct|biliary]] duct [[Dilation|dilatation]] is seen in case of [[Pancreatic cancer|carcinoma of the head of pancreas]] (Double duct sign <ref name="radio">Pancreatic ductal carcinoma. Dr Ahmed Abd Rabou and Dr Frank Gaillard et al. Radiopedia.org 2015. http://radiopaedia.org/articles/pancreatic-ductal-carcinoma </ref>) | |||
* | * The drawbacks of transabdominal [[Ultrasound|USG]] are as follows:<ref name="pmid19117085">{{cite journal |vauthors=Tawada K, Yamaguchi T, Kobayashi A, Ishihara T, Sudo K, Nakamura K, Hara T, Denda T, Matsuyama M, Yokosuka O |title=Changes in tumor vascularity depicted by contrast-enhanced ultrasonography as a predictor of chemotherapeutic effect in patients with unresectable pancreatic cancer |journal=Pancreas |volume=38 |issue=1 |pages=30–5 |year=2009 |pmid=19117085 |doi= |url=}}</ref> | ||
* | ** [[Ultrasound|USG]] does not clearly demarcate | ||
*** [[Lymphadenopathy]] | |||
: | *** [[Tumor]] margins | ||
*** The relation of the [[tumor]] to vessels around the [[pancreas]] | |||
* [[Ultrasound|USG]] has lower [[Sensitivity (tests)|sensitivity]] as compared to other modalities in the detection of [[pancreatic cancer]] smaller than 2 cm. | |||
* For [[pancreatic cancer]] detection: | |||
** [[Sensitivity (tests)|Sensitivity]]= 70% | |||
** [[Specificity (tests)|Specificity]]= 95% | |||
== [[Endoscopic ultrasound|Endoscopic Ultrasound]] == | |||
Advantages of [[Endoscopic ultrasound|EUS]] are as follows:<ref name="pmid27631326">{{cite journal |vauthors=Tamburrino D, Riviere D, Yaghoobi M, Davidson BR, Gurusamy KS |title=Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer |journal=Cochrane Database Syst Rev |volume=9 |issue= |pages=CD011515 |year=2016 |pmid=27631326 |doi=10.1002/14651858.CD011515.pub2 |url=}}</ref><ref name="pmid24619804">{{cite journal |vauthors=Yoon WJ, Daglilar ES, Fernández-del Castillo C, Mino-Kenudson M, Pitman MB, Brugge WR |title=Peritoneal seeding in intraductal papillary mucinous neoplasm of the pancreas patients who underwent endoscopic ultrasound-guided fine-needle aspiration: the PIPE Study |journal=Endoscopy |volume=46 |issue=5 |pages=382–7 |year=2014 |pmid=24619804 |doi=10.1055/s-0034-1364937 |url=}}</ref> | |||
* [[Endoscopic ultrasound|EUS]] has a high efficacy in the detection of [[Tumor|tumors]] smaller than 2 cm, for local T and N staging, and prediction of [[vascular]] invasion. | |||
* [[Endoscopic ultrasound|EUS]] has a higher resolution than transabdominal [[ultrasound]], due to the small distance between the [[Endoscopy|endoscope]] and [[pancreas]] through the wall of the [[duodenum]]. | |||
* [[Endoscopic ultrasound|EUS]] has a role in the preoperative [[Cancer staging|staging]] of [[pancreatic cancer]] particularly in cases where [[Computed tomography|CT evaluation]] suggests equivocal findings. | |||
* [[Endoscopic ultrasound|EUS]]-guided [[Fine needle aspiration|fine needle aspiration biopsy (FNA)]] is the best modality for obtaining a tissue diagnosis. | |||
Drawbacks of EUS are as follows: <ref name="pmid11906856">{{cite journal |vauthors=Horton KM, Fishman EK |title=Multidetector CT angiography of pancreatic carcinoma: part I, evaluation of arterial involvement |journal=AJR Am J Roentgenol |volume=178 |issue=4 |pages=827–31 |year=2002 |pmid=11906856 |doi=10.2214/ajr.178.4.1780827 |url=}}</ref> | |||
* [[Endoscopic ultrasound|EUS]] is inferior to [[Computed tomography|CT]] for evaluation of distant [[metastasis]]. | |||
* [[Endoscopic ultrasound|EUS]] is also operator-dependent; hence its value varies with physician expertise. | |||
==References== | ==References== | ||
Revision as of 00:12, 16 November 2017
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Risk calculators and risk factors for Pancreatic cancer ultrasound |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sudarshana Datta, MD [2]
Overview
Pancreatic cancer has a variable appearance on USG. The appearance relative to normal pancreatic tissue may be hypoechoic, isoechoic or hyperechoic. In majority of the cases, an ill defined hypoechoic mass is seen infiltrating into a bright pancreatic parenchyma. Pancreatic and biliary duct dilatation is seen in case of carcinoma of the head of pancreas (Double duct sign). The disadvantage of a transabdominal USG is its inability to clearly demarcate lymphadenopathy, tumor margins and the relation of the tumor to vessels around the pancreas. Endoscopic Ultrasound (EUS) has a high efficacy in the detection of tumors smaller than 2 cm, for local T and N staging, and prediction of vascular invasion. It has a higher resolution than transabdominal ultrasound, due to the small distance between the endoscope and pancreas through the wall of the duodenum. EUS plays an important role in the preoperative staging of pancreatic cancer particularly in cases where CT evaluation suggests equivocal findings. Moreover, EUS-guided fine needle aspiration biopsy (FNA) is the best modality for obtaining a tissue diagnosis.
Transabdominal Ultrasound
- Pancreatic cancer has a variable appearance on USG.
- The appearance relative to normal pancreatic tissue may be:[1]
- Hypoechoic
- Isoechoic
- Hyperechoic
- In majority of the cases, an ill defined hypoechoic mass is seen infiltrating into a bright pancreatic parenchyma. Ascites may also be visible.
- Pancreatic and biliary duct dilatation is seen in case of carcinoma of the head of pancreas (Double duct sign [2])
- The drawbacks of transabdominal USG are as follows:[3]
- USG does not clearly demarcate
- Lymphadenopathy
- Tumor margins
- The relation of the tumor to vessels around the pancreas
- USG does not clearly demarcate
- USG has lower sensitivity as compared to other modalities in the detection of pancreatic cancer smaller than 2 cm.
- For pancreatic cancer detection:
- Sensitivity= 70%
- Specificity= 95%
Endoscopic Ultrasound
Advantages of EUS are as follows:[4][5]
- EUS has a high efficacy in the detection of tumors smaller than 2 cm, for local T and N staging, and prediction of vascular invasion.
- EUS has a higher resolution than transabdominal ultrasound, due to the small distance between the endoscope and pancreas through the wall of the duodenum.
- EUS has a role in the preoperative staging of pancreatic cancer particularly in cases where CT evaluation suggests equivocal findings.
- EUS-guided fine needle aspiration biopsy (FNA) is the best modality for obtaining a tissue diagnosis.
Drawbacks of EUS are as follows: [6]
- EUS is inferior to CT for evaluation of distant metastasis.
- EUS is also operator-dependent; hence its value varies with physician expertise.
References
- ↑ Shin LK, Brant-Zawadzki G, Kamaya A, Jeffrey RB (2009). "Intraoperative ultrasound of the pancreas". Ultrasound Q. 25 (1): 39–48, quiz 48. doi:10.1097/RUQ.0b013e3181901ce4. PMID 19276960.
- ↑ Pancreatic ductal carcinoma. Dr Ahmed Abd Rabou and Dr Frank Gaillard et al. Radiopedia.org 2015. http://radiopaedia.org/articles/pancreatic-ductal-carcinoma
- ↑ Tawada K, Yamaguchi T, Kobayashi A, Ishihara T, Sudo K, Nakamura K, Hara T, Denda T, Matsuyama M, Yokosuka O (2009). "Changes in tumor vascularity depicted by contrast-enhanced ultrasonography as a predictor of chemotherapeutic effect in patients with unresectable pancreatic cancer". Pancreas. 38 (1): 30–5. PMID 19117085.
- ↑ Tamburrino D, Riviere D, Yaghoobi M, Davidson BR, Gurusamy KS (2016). "Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer". Cochrane Database Syst Rev. 9: CD011515. doi:10.1002/14651858.CD011515.pub2. PMID 27631326.
- ↑ Yoon WJ, Daglilar ES, Fernández-del Castillo C, Mino-Kenudson M, Pitman MB, Brugge WR (2014). "Peritoneal seeding in intraductal papillary mucinous neoplasm of the pancreas patients who underwent endoscopic ultrasound-guided fine-needle aspiration: the PIPE Study". Endoscopy. 46 (5): 382–7. doi:10.1055/s-0034-1364937. PMID 24619804.
- ↑ Horton KM, Fishman EK (2002). "Multidetector CT angiography of pancreatic carcinoma: part I, evaluation of arterial involvement". AJR Am J Roentgenol. 178 (4): 827–31. doi:10.2214/ajr.178.4.1780827. PMID 11906856.