Abstract
Early diagnosis of pancreatic cancer (PC) can improve patients’ prognosis. We aimed to investigate the utility of endoscopic ultrasonography (EUS) for the early diagnosis of PC. This study included 64 patients with PC at an early stage treated at Onomichi General Hospital between January 2007 and January 2020. Diagnostic procedures included contrast computed tomography (CT), magnetic resonance cholangiopancreatography, EUS fine-needle aspiration, and endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic juice cytology. The mean age was 71.3 years. In all, 32 patients were stage 0, and 32 were stage I. As for image findings, the main pancreatic duct (MPD) stenosis was detected in several cases, although CT and MRCP seldom detected tumors. EUS had a high detection rate for stage 0 tumor lesions. The median observation period was 3.9 years. In cases with stage 0, the 1 year and 5 year survival rates were 100% and 78.9%, respectively. In cases with stage I, the 1 year and 5 year survival rates were 96.4% and 66.7%, respectively. EUS has the highest sensitivity among all imaging modalities for detecting small pancreatic tumors. Cases with MPD dilation or stenosis, especially with tumors that cannot be identified on CT and MRI, should have EUS performed. In some cases, EUS was not able to detect any tumor lesions, and ERCP-based pancreatic juice cytology should be useful for pathological diagnosis.
Highlights
According to the Vital Statistics of Japan reported by the Ministry of Health, Labor, and Welfare [1]), 40,981 patients were diagnosed with pancreatic cancer (PC) in 2017, and the number is increasing yearly
32 patients were classified as UICC stage 0, including 23 pancreatic cancer in situ (PCIS), and nine high-grade dysplasia from intraductal papillary mucinous neoplasm, and 32 patients as stage I
For stage 0, endoscopic ultrasonography (EUS) detected tumor lesions in some cases, they were too small for EUS–fine needle aspiration (EUS–FNA), and pancreatic juice cytology was performed; the sensitivity was 87.5%. These results suggest that EUS–FNA is useful for diagnosing small PCs; it cannot be used for pancreatic cancers that do not have sufficient mass lesions, including PCIS
Summary
According to the Vital Statistics of Japan reported by the Ministry of Health, Labor, and Welfare [1]), 40,981 patients were diagnosed with pancreatic cancer (PC) in 2017, and the number is increasing yearly. PC has the fourth highest mortality rate of all cancers in Japan, and the 5 year survival rate is 8.7%. The poor prognosis is attributed to the difficulty in diagnosing PC at an early stage; it is usually diagnosed at an advanced stage [2,3]. When PC is diagnosed at an early stage, it has a good prognosis. According to an analysis from the Japan Pancreatic Cancer Registry, the 5 year survival rates of patients with Union for International Cancer Control (UICC) stage IA and stage 0 were 68.4% and 85.8%, respectively [4]
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