Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jan-Feb;6(1):25-30.
doi: 10.4103/2303-9027.190931.

Role of contrast harmonic-endoscopic ultrasound in pancreatic cystic lesions

Marta Serrani  1 , Andrea Lisotti  1 , Giancarlo Caletti  1 , Pietro Fusaroli  1
Affiliations
Review

Role of contrast harmonic-endoscopic ultrasound in pancreatic cystic lesions

Marta Serrani et al. Endosc Ultrasound. 2017 Jan-Feb.

Abstract

Incidental pancreatic cysts (PCs) are frequently encountered in the general population often in asymptomatic patients who undergo imaging tests to investigate unrelated conditions. The detection of a PC poses a significant clinical dilemma, as the differential diagnosis is quite broad ranging from benign to malignant conditions. Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) has been reported to be an accurate tool in the differential diagnosis; however, its sensitivity is suboptimal and false negative results do occur. Contrast harmonic EUS (CH-EUS) was demonstrated to be a useful tool to investigate pancreatic solid lesions to differentiate between benign and malignant ones. In the setting of PCs, CH-EUS could help identify areas of malignant growth inside the cystic cavities. Several studies have reported promising results showing malignant areas in PCs as hyperenhanced lesions. Confirmation of malignancy can then be obtained by FNA, which should be precisely targeted according to the findings of the contrast harmonic study.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A cystic lesion is seen in the pancreatic head containing solid components with mixed echogenicity (left panel, thin arrows). At contrast harmonic-endoscopic ultrasound, a small area of hyperenhancement is clearly visible (right panel, arrow). This finding is highly suggestive of malignancy
Figure 2
Figure 2
A small cyst is detected in the pancreatic body. At B-mode endoscopic ultrasound, the lesion appears full of echogenic material (left panel, arrow). At contrast harmonic-endoscopic ultrasound, the cyst is clearly unenhanced thus ruling out malignancy (right panel, arrow)
Figure 3
Figure 3
(a) A complex multiloculated cystic lesion is visible in the pancreatic head, containing a hypoechoic solid component (left panel, arrow). At contrast harmonic-endoscopic ultrasound, the solid component appears hyperenhanced (right panel, arrow), as well as septae and cystic wall. (b) As the contrast harmonic-endoscopic ultrasound finding is highly suggestive of malignancy, selective endoscopic ultrasound-fine-needle aspiration is performed
See this image and copyright information in PMC

References

    1. Freeny PC, Saunders MD. Moving beyond morphology: New insights into the characterization and management of cystic pancreatic lesions. Radiology. 2014;272:345–63. - PubMed
    1. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: Observe or operate. Ann Surg. 2004;239:651–7. - PMC - PubMed
    1. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191:802–7. - PMC - PubMed
    1. Zhang XM, Mitchell DG, Dohke M, et al. Pancreatic cysts: Depiction on single-shot fast spin-echo MR images. Radiology. 2002;223:547–53. - PubMed
    1. Lee KS, Sekhar A, Rofsky NM, et al. Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol. 2010;105:2079–84. - PubMed