Abstract
Backgrounds: Endoscopic ultrasonography (EUS) is used to observe the stricture of the main pancreatic duct (MPD) and in diagnosing pancreatic cancer (PC). We investigate the findings on EUS by referring to the histopathological findings of resected specimens. Materials and Methods: Six patients with carcinoma in situ (CIS) and 30 patients with invasive carcinoma of 20 mm or less were included. The preoperative EUS findings were classified as follows. A1: Simple stricture type—no findings around the stricture; A2: Hypoecho stricture type—localized hypoechoic area without demarcation around the stricture; A3: Tumor stricture type—tumor on the stricture; B: Dilation type—the dilation of the pancreatic duct without a downstream stricture; C: Parenchymal tumor type—tumor located apart from the MPD. Results: Classes A1 and A2 consisted of 2 CISs, and 4 invasive carcinomas included two cases smaller than 5 mm in diameter. Most of the cancers classified as A3 or C were of invasive carcinoma larger than 5 mm in diameter. All cancers classified as B involved CIS. Serial pancreatic-juice aspiration cytologic examination (SPACE) was selected for all types of cases, with a sensitivity of 92.0%, while EUS-guided fine needle aspiration cytology (EUS-FNA) was only useful for invasive carcinoma, and its sensitivity was 66.7%. Conclusions: Stricture without a tumor could be a finding for invasive PC and pancreatic duct dilation without a downstream stricture could be a finding indicative of CIS. Carcinoma smaller than 5 mm in diameter could not be recognized by EUS. SPACE had a high sensitivity for diagnosing small PC.
Highlights
Pancreatic cancer (PC) has a poor prognosis, mainly due to delayed diagnosis [1]
Value is added to the diagnosis through the use of Endoscopic ultrasonography (EUS)-guided fine needle aspiration cytology (EUS-FNA) [6]
We found that three patients belonging to simple stricture type (A1) had invasive carcinoma
Summary
Pancreatic cancer (PC) has a poor prognosis, mainly due to delayed diagnosis [1]. Various factors are related to delayed diagnosis, including a poor understanding of symptoms and high-risk factors suggesting PC development, or the use of conventional imaging methods for the diagnosis includingDiagnostics 2019, 9, 15; doi:10.3390/diagnostics9010015 www.mdpi.com/journal/diagnosticsDiagnostics 2019, 9, 15 contrast-enhanced computed tomography (CE-CT) and magnetic resonance imaging (MRI), which have less sensitivity and, cannot always detect small PC [2,3,4].As an alternative to these methods, endoscopic ultrasonography (EUS) has gradually become accepted as a means of diagnosing small PC, because it is more sensitive and accurate than CE-CT or MRI [5]. Various factors are related to delayed diagnosis, including a poor understanding of symptoms and high-risk factors suggesting PC development, or the use of conventional imaging methods for the diagnosis including. Diagnostics 2019, 9, 15 contrast-enhanced computed tomography (CE-CT) and magnetic resonance imaging (MRI), which have less sensitivity and, cannot always detect small PC [2,3,4]. As an alternative to these methods, endoscopic ultrasonography (EUS) has gradually become accepted as a means of diagnosing small PC, because it is more sensitive and accurate than CE-CT or MRI [5]. Diagnosis of carcinoma in situ (CIS) has been improved by the development of a new endoscopic retrograde cholangiopancreatography (ERCP)-related procedure of pancreatic juice cytology using nasopancreatic tube placement (serial pancreatic aspiration cytologic examination (SPACE)) [7,8,9]. The number of reports of CIS and small PC diagnosed by these methods has increased [10]
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