Abstract
The National Cancer Institute names pancreatic cancer the 11th most common type of cancer in the United States. However, even with a somewhat low prevalence, in 2017, the American Cancer Society reported pancreatic cancer as the fourth leading cause of cancer-related death. With a lack of symptomology and a broad range of risk factors, pancreatic cancer is frequently diagnosed in a later phase than many other types of cancers, thus resulting in higher metastasis along with a poorer prognosis. This highlights the need for early detection and diagnosis. Currently, abdominal ultrasound or contrast-enhanced CT imaging of the abdomen are standard of care. A new technology: contrast-enhanced ultrasound (CEUS), which employs contrast agents to act as acoustic enhancers for ultrasound, has FDA approval for use in hepatic and renal lesions, but not pancreatic. By examining seven individual studies from Europe and Asia, this review aims to examine the diagnostic value of CEUS to initially diagnose pancreatic adenocarcinomas, potentially followed by a biopsy to confirm, when compared against modalities currently used such as conventional ultrasound and CT imaging. CEUS would potentially be more accurate when compared to conventional ultrasound due to the addition of contrast, and when compared against CT and MRI, CEUS would be advantageous in its low cost, similar sensitivities, and specificities, limited renal toxicity, lack of ionizing radiation, short half-life, and its safe use in both adult and pediatric patients. Due to this, additional research is warranted for further FDA approval and future clinical implementation.
Highlights
BackgroundThe National Cancer Institute states that pancreatic cancer represents 3.2% of all new cancer cases in the United States
They found that diagnosing ductal adenocarcinoma with its hypo enhancing pattern on contrast-enhanced ultrasound (CEUS) had a sensitivity of 91.3%, specificity of 85.3%, and diagnostic accuracy of 91.3%
In the United States there exists a lack of controlled trials for the use of CEUS in diagnosing pancreatic cancer and other pancreatic lesions
Summary
Tanaka et al evaluated and compared the sensitivity of CEUS and CECT imaging for the characterization of small and early-stage pancreatic ductal adenocarcinoma by performing a prospective cohort study in Osaka, Japan They looked at 6297 patients and used IV Sonazoid as their contrast agent. Wang et al performed a prospective cohort study in China by enrolling 210 patients with solid pancreatic lesions to investigate the value of CEUS against conventional US and CT imaging They used SonoVue as their CEUS contrast agent. FDA approval becomes plausible after and only after large-scale trials in the United States display comparable or greater diagnostic accuracy, sensitivity, and specificity than CT imaging in diagnosing pancreatic adenocarcinomas in each location of the pancreas at all sizes. It is our recommendation for CEUS use to be further investigated for it can potentially become the standard of care in the diagnosis of pancreatic adenocarcinoma
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