Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer.

Yasutaka Ishii,Yusuke Kiyoshita,Sayaka Miyamoto,Ayami Fukiage,Ryota Kawamura,Takeshi Mori,Kazuaki Chayama,Tetsuro Hirano,Juri Ikemoto,Tomofumi Tsuboi,Shinya Nakamura,Sho Saeki,Masahiro Serikawa,Yosuke Tamura,Ken Tsushima

doi:10.3390/diagnostics11020238

Abstract

Pancreatic cancer has the poorest prognosis among all cancers, and early diagnosis is essential for improving the prognosis. Along with radiologic modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), endoscopic modalities play an important role in the diagnosis of pancreatic cancer. This review evaluates the roles of two of those modalities, endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), in the diagnosis of pancreatic cancer. EUS can detect pancreatic cancer with higher sensitivity and has excellent sensitivity for the diagnosis of small pancreatic cancer that cannot be detected by other imaging modalities. EUS may be useful for the surveillance of pancreatic cancer in high-risk individuals. Contrast-enhanced EUS and EUS elastography are also useful for differentiating solid pancreatic tumors. In addition, EUS-guided fine needle aspiration shows excellent sensitivity and specificity, even for small pancreatic cancer, and is an essential examination method for the definitive pathological diagnosis and treatment decision strategy. On the other hand, ERCP is invasive and performed less frequently for the purpose of diagnosing pancreatic cancer. However, ERCP is essential in cases that require evaluation of pancreatic duct stricture that may be early pancreatic cancer or those that require differentiation from focal autoimmune pancreatitis.

Highlights

The number of patients with pancreatic cancer and their mortality is steadily increasing [1,2]; with a five-year survival rate of less than 10%, pancreatic cancer has the worst prognosis among all cancers
Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosing pancreatic cancer, and in Japanese clinical practice guidelines for pancreatic cancer [4], they are positioned as the first modality to be performed in patients with suspected pancreatic cancer based on clinical symptoms, such as abdominal pain, serum pancreatic enzymes, tumor markers, and transabdominal ultrasonography (US)
The addition of CE-endoscopic ultrasonography (EUS) and EUS elastography can improve the accuracy of the differential diagnosis of pancreatic tumors

Summary

Introduction

The number of patients with pancreatic cancer and their mortality is steadily increasing [1,2]; with a five-year survival rate of less than 10%, pancreatic cancer has the worst prognosis among all cancers. In a systematic review of nine studies and 678 patients, Dewitt et al [5] reported that EUS was more sensitive than CT for the detection of pancreatic cancer (91–100% vs 53–91%). In a systematic review of 22 studies and 1170 patients, Kitano et al [6] reported that EUS was more sensitive than US and CT for the detection of pancreatic tumors (94% vs 67% and 98% vs 74%, respectively). In a meta-analysis [47], the pooled sensitivity and specificity of EUS elastography in the diagnosis of malignant pancreatic tumors were reported to be 98% and 63% by the qualitative evaluation method, and 95% and 61% by the quantitative evaluation method, respectively

Surveillance of Pancreatic Cancer For High-Risk Individuals

EUS-FNA

Findings

Conclusions