The Role of Endoscopic Ultrasonography in the Diagnosis and Staging of Pancreatic Cancer

Abstract

Pancreatic cancer is the fourth leading cause of cancer-related death and the second gastrointestinal cancer-related death in the United States. Early detection and accurate diagnosis and staging of pancreatic cancer are paramount in guiding treatment plans, as surgical resection can provide the only potential cure for this disease. The overall prognosis of pancreatic cancer is poor even in patients with resectable disease. The 5-year survival after surgical resection is ~10% in node-positive disease compared to ~30% in node-negative disease. The advancement of imaging studies and the multidisciplinary approach involving radiologists, gastroenterologists, advanced endoscopists, medical, radiation, and surgical oncologists have a major impact on the management of pancreatic cancer. Endoscopic ultrasonography is essential in the diagnosis by obtaining tissue (FNA or FNB) and in the loco-regional staging of the disease. The advancement in EUS techniques has made this modality a critical adjunct in the management process of pancreatic cancer. In this review article, we provide an overall description of the role of endoscopic ultrasonography in the diagnosis and staging of pancreatic cancer.

Keywords: endoscopic ultrasonography; loco-regional staging; pancreatic cancer.

Figure 1

Endoscopic Ultrasonographic images using linear echoendoscope reveal a heterogeneous hypoechoic solid mass with irregular borders in the head of the pancreas.

Figure 2

Cell blocks from FNA (A,B) vs FNB (B,C) needles. (A) FNA cell block with single fragment with desmoplastic stroma and cluster of adenocarcinoma cells surrounded by blood (hematoxylin and eosin, 10×). (B) The sample contains a limited number of malignant cells, sufficient for a diagnosis of malignancy, but insufficient for ancillary testing (hematoxylin and eosin, 20×) (C) Sample collected using FNB needle, intact core fragments fill the field, in comparison to the FNA sample (hematoxylin and eosin, 10×) (D) The increased number of representative cells renders this adequate for ancillary testing (hematoxylin and eosin, 20×) (Images courtesy of Dr. Barbara A. Centeno, Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA).

Figure 2

Cell blocks from FNA (A,B) vs FNB (B,C) needles. (A) FNA cell block with single fragment with desmoplastic stroma and cluster of adenocarcinoma cells surrounded by blood (hematoxylin and eosin, 10×). (B) The sample contains a limited number of malignant cells, sufficient for a diagnosis of malignancy, but insufficient for ancillary testing (hematoxylin and eosin, 20×) (C) Sample collected using FNB needle, intact core fragments fill the field, in comparison to the FNA sample (hematoxylin and eosin, 10×) (D) The increased number of representative cells renders this adequate for ancillary testing (hematoxylin and eosin, 20×) (Images courtesy of Dr. Barbara A. Centeno, Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA).

Figure 3

Endoscopic Ultrasonographic images using linear echoendoscope reveal pancreatic mass with the invasion of the portosplenic confluence to different degrees in all three illustrations.

Figure 3

Endoscopic Ultrasonographic images using linear echoendoscope reveal pancreatic mass with the invasion of the portosplenic confluence to different degrees in all three illustrations.

Figure 4

Endoscopic Ultrasonographic images using linear echoendoscope reveal peripancreatic lymph nodes.

Figure 4

Endoscopic Ultrasonographic images using linear echoendoscope reveal peripancreatic lymph nodes.

Figure 4

Endoscopic Ultrasonographic images using linear echoendoscope reveal peripancreatic lymph nodes.

Figure 5

Endoscopic Ultrasonographic images using linear echoendoscope reveal pancreatic mass with a fiducial marker placed using EUS guidance.