Endoscopic Ultrasound for Early Diagnosis of Pancreatic Cancer

Abstract

Detection of small pancreatic cancers, which have a better prognosis than large cancers, is needed to reduce high mortality rates. Endoscopic ultrasound (EUS) is the most sensitive imaging modality for detecting pancreatic lesions. The high resolution of EUS makes it particularly useful for detecting small pancreatic lesions that may be missed by other imaging modalities. Therefore, EUS should be performed in patients with obstructive jaundice in whom computed tomography (CT) or magnetic resonance imaging (MRI) does not identify a definite pancreatic lesion. Interest in the use of EUS for screening individuals at high risk of pancreatic cancer, including those with intraductal papillary mucinous neoplasms (IPMNs) and familial pancreatic cancer is growing. Contrast-enhanced EUS can facilitate differential diagnosis of small solid pancreatic lesions as well as malignant cystic lesions. In addition, EUS-guided fine needle aspiration can provide samples of small pancreatic lesions. Thus, EUS and EUS-related techniques are essential for early diagnosis of pancreatic cancer.

Keywords: contrast-enhanced endoscopic ultrasound; endoscopic ultrasound; pancreatic cancer.

Figure 1

A case of small pancreatic cancer. (A) Endoscopic ultrasound (EUS) detection of a hypoechoic lesion (9 mm, pancreatic body, arrowhead) with distal dilation of the pancreatic duct (arrow); (B) Conventional EUS showing a hypoechoic lesion (arrowhead) at the pancreas body (left) and contrast-enhanced EUS (CE-EUS) showing the lesion has a lower intensity than that of the surrounding tissue (right); (C) EUS-guided fine-needle aspiration (EUS-FNA). The needle targeted the lesion through the stomach (arrowhead); (D) Cytological examination of the aspirated material suggested the presence of an adenocarcinoma (Papanicolaou ×1000); (E) The surgically removed lesion (left) and histological findings revealed a final diagnosis of pancreatic cancer (right).