Inflammatory Pancreatic Mass Research Articles

Surgical treatment of chronic pancreatitis with an inflammatory pancreatic head mass: a retrospective study

BackgroundConservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis.MethodsAll patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared.ResultsThirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group.ConclusionsBoth pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.

Endoscopic ultrasound-guided resolution of right hydronephrosis secondary to local compression by an inflammatory pancreatic mass.

We present the case of 67 years-old man with unremarkable medical history. He was admitted to our department for abdominal pain compatible with choledocholithiasis associated with acute cholecystitis. ERCP was performed but direct papillary canulation attempts failed by means of conventional sphincterotome. So, pre- cut papillotomy was successfully attempted getting free access to distal choledochus and retrieving a small lithiasis. Unfortunately, the patient developed severe post-ERCP acute pancreatitis.

ALCOHOLIC VS. NON-ALCOHOLIC CHRONIC PANCREATITIS: SURGEONS’ PERSPECTIVE FROM A TERTIARY CENTRE IN INDIA

ABSTRACT Background:Although alcohol is the most common cause for chronic pancreatitis worldwide, idiopathic type is prevalent in India. Natural history and disease progression are different between these two groups. There is paucity of data comparing surgical outcome and quality of life in these patients. Aim:To evaluate clinical features, surgical outcome and quality of life between these two groups of patients. Method:All patients with chronic pancreatitis who underwent surgery were prospectively reviewed. Results:From 98 patients, 42 were alcoholic. Number of male and the mean age at the time of operation was significantly more in alcoholic patients. Smoking, preoperative hospital admission rate and the prevalence of local complications like inflammatory pancreatic head mass, biliary stricture and left sided portal hypertension were distinctly more common in alcoholic group. Frey procedure was required more commonly in alcoholic group. Mean postoperative hospital stay and overall postoperative complication rate were comparable between the two groups. Over a median follow up of 18 months there was significant improvement in quality of life and pain score in both the groups. Improvement of physical functioning score at follow-up was significantly more in alcoholic group but the requirement for analgesic medications were significantly more in alcoholic group. However, appetite loss was more perceived by non-alcoholic group. Conclusion:Alcoholic chronic pancreatitis presents with more local complications associated with chronic pancreatitis. Frey procedure is a safe and well accepted surgery in this group. Though they required more analgesic requirement in short term follow up, other aspects of quality of life are similar to non-alcoholic group.

The "Duct-penetrating sign" in inflammatory pancreatic mass.

The "Duct-penetrating sign" in inflammatory pancreatic mass.

Controversies on the endoscopic and surgical management of pain in patients with chronic pancreatitis: pros and cons!

Pain is the dominating symptom of chronic pancreatitis (CP) causing impairment of quality of life, decreased activity, unemployment and major healthcare costs.1 Opinions differ on the best strategy to treat...

Differentiation of Pancreatic Masses via Endoscopic Ultrasound Strain Ratio Elastography Using Adjacent Pancreatic Tissue as the Reference

The aims of this study were to evaluate diagnostic value of endoscopic ultrasound strain ratio elastography in patients with focal pancreatic masses and to determine the cutoff value between the pancreatic malignancies and inflammatory pancreatic masses using reference areas different than those used by other investigators. In a prospective single-center study, strain ratio was measured in patients with pancreatic masses. After the diagnosis was established, statistical analysis was used to compare the group with pancreatic malignancies to the one with inflammatory masses. Strain ratio cutoff of 7.59 provided 100% sensitivity, 95% specificity, and 97% overall accuracy for differentiation of patients with pancreatic malignancies from those with inflammatory masses. Our data show high sensitivity and specificity for the calculated strain ratio. Adjacent normal pancreatic tissue is adequate as a reference area based on the inclusion criteria. Diverse cutoff values and standardization of methods in the studies published so far require further investigations, before the implementation of the method in a routine clinical practice becomes possible.

Performance of K-ras mutation analysis plus endoscopic ultrasoundguided fine-needle aspiration for differentiating diagnosis of pancreatic solid mass: a meta-analysis

Difficulties persist in differentiating pancreatic ductal adenocarcinomas (PDAC) from pancreatic inflammatory masses (PIM). Auxiliary diagnostic techniques which enhance the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) diagnostic yield have been attempted, for example, K-ras mutation analysis. We aimed to evaluate the accuracy of K-ras mutation analysis combined with EUS-FNA for the differential diagnosis of PDAC and PIM by pooling data of existing trials. We systematically searched the Medline, PubMed, Web of Science, Embase, and Cochrane Central Trials databases for relevant published studies. Meta-analysis was performed. Pooling was conducted in fixed-effect model or random-effect model. In total eight studies, with 696 cases of PDAC and 138 cases of PIM, met our inclusion criteria. The pooled sensitivity, specificity, positive likely ratio and negative likely ratio of K-ras mutation analysis combined with cytopathology for diagnosis of PDAC versus PIM were 90%, 95%, 13.45, and 0.13, respectively. Especially, among total 123 patients whose EUS-FNA results were inconclusive or negative, fifty-nine had K-ras mutations and were finally diagnosed with PDAC (48%, 59/123). Publication bias was not present. Combining K-ras mutation analysis with routine cytology moderately improves the ability of EUS-FNA to differentially diagnose between PDAC and PIM, especially for patients with suspected PDAC yet inconclusive EUS-FNA findings, and may prove to be a valuable supplemental method to EUS-FNA.

Endoscopic ultrasound elastography for differentiating between pancreatic adenocarcinoma and inflammatory masses: A meta-analysis

To evaluate the accuracy of endoscopic ultrasound (EUS) elastography for differentiating between pancreatic ductal adenocarcinoma (PDAC) and pancreatic inflammatory masses (PIM). Electronic databases (updated to December 2012) and manual bibliographical searches were carried out. A meta-analysis of all diagnostic clinical trials evaluating the accuracy of EUS elastography in differentiating PDAC from PIM was conducted. Heterogeneity was assessed among the studies. The meta-analysis was performed to evaluate the accuracy of EUS elastography in differentiating PDAC from PIM in homogeneous studies. Ten studies involving 781 patients were included in the analysis. Significant heterogeneity in sensitivity was observed among the studies (Cochran Q test = 24.16, df = 9, P = 0.0041, I (2) = 62.8%), while heterogeneity in specificity was not observed (Cochran Q test = 5.93, df = 9, P = 0.7473, I (2) = 0.0%). The area under the curve under the Sports Rights Owners Coalition was 0.8227. Evaluation of heterogeneity suggested that the different diagnostic standards used in the included studies were the source of heterogeneity. In studies using the color pattern as the diagnostic standard, the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic OR were 0.99 (0.97-1.00), 0.76 (0.67-0.83), 3.36 (2.39-4.72), 0.03 (0.01-0.07) and 129.96 (47.02-359.16), respectively. In studies using the hue histogram as the diagnostic standard, the pooled sensitivity, specificity, positive LR, negative LR and diagnostic OR were 0.92 (0.89-0.95), 0.68 (0.57-0.78), 2.84 (2.05-3.93), 0.12 (0.08-0.19) and 24.69 (12.81-47.59), respectively. EUS elastography is a valuable method for the differential diagnosis between PDAC and PIM. And a preferable diagnostic standard should be explored and improvements in specificity are required.

Diagnostic Role of Platelet Lymphocyte Ratio(PLR) in Pancreatic Head Masses

Masses in and around pancreas constitute an important clinical entity in gastrointestinal surgical practice. Most common being adenocarcinoma of head of pancreas followed by inflammatory masses due to chronic pancreatitis. Accurate diagnosis is of central importance as therapeutic strategies range from observation to complete surgical removal including total pancreatectomy.Several tumor markers are available which could help in prognostication and diagnosis of carcinoma pancreas. Carbohydrate antigen 19-9(CA 19-9) is traditionally accepted best marker available. The role of new tumor marker platelet lymphocyte ratio (PLR) has been defined recently in prognostication of carcinoma pancreas. Role of PLR in diagnosing and its efficacy after combining it with CA 19-9 is not known. The aim of study was to assess the demographics of histologically proven neoplastic and inflammatory pancreatic head masses in our department. To assess the role of CA19-9 and platelet lymphocyte ratio(PLR) in determining nature of pancreatic head mass. Data consisted of histologically proven 45 patients .23 having head mass due to chronic pancreatitis and 22 because of neoplastic lesions. Demographics in terms of age, sex, previous pain episodes, presence of jaundice, history of alcohol intake were compared in both groups. Also tumor markers CA 19-9 and PLR individually and in combination were compared in both groups. Cancer pancreas significantly (p < 0.001) occurred in older age group, was significantly associated with jaundice (p = 0.005) and weight loss (p < 0.001). Accuracy in diagnosis of cancer pancreas was similar with CA 19-9 and PLR (68.89%), where as combining CA 19-9 with PLR showed increased sensitivity(81.82%) and accuracy(71.11%) in diagnosing cancer pancreas. Other combinations showed no advantage. PLR is at least as good as CA 19-9 as diagnostic marker to differentiate between malignant and inflammatory head mass of pancreas.

Laparoendoscopic Single-Site Lateral Pancreaticojejunostomy

Background: Chronic pancreatitis is mainly managed with drugs, but surgery is required in selected groups of patients. The Partington procedure is still the procedure of choice for patients with a dilated main pancreatic duct but without an inflammatory pancreatic head mass. The same equivalent can be achieved by laparoscopic approach. Laparoendoscopic single-site surgery gained tremendous attention in the past few years. Complex surgeries are being reported using this technique. We report in this paper the first laparoendoscopic single-site lateral pancreaticojejunostomy (LPJ) for chronic calcific pancreatitis with dilated pancreatic duct. Patient and Method: The procedure was performed on a 32-year-old female diagnosed to have chronic calcific pancreatitis. A single vertical 2.5-cm umbilical incision and one 10-mm andtwo5-mm ports were made. The procedure was completed in 220 min without any intraoperative complication. There were no postoperative complications, and the patient was discharged on day 5 when she started taking routine diet. Conclusion: This preliminary experience suggests that single-incision laparoscopic LPJ is feasible and safe when performed by an experienced laparoscopic surgeon. It has a cosmetic advantage over laparoscopic LPJ. However, it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness. Further studies are required to analyze these factors.

Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence

For the surgical management of chronic pancreatitis with an inflammatory pancreatic head mass, extended drainage operations such as Beger and Frey procedures were established in the 1980s as an alternative to resectional procedures like pancreaticoduodenectomy and as opposed to simple drainage operations such as lateral pancreaticojejunostomy, that is, the Partington procedure. With the relatively rapid adoption of the two procedures, it seems that the Partington procedure has become a thing of the past. The Partington procedure was re-evaluated with regard to the historical aspects and its present status by a literature review. The results show that this procedure relieves chronic abdominal pain in 66-91% of patients with a mean follow-up of 3.5-9.1 years. It is important to note that this procedure is generally used for inflammatory disease left of the gastroduodenal artery and is specifically not used as the procedure of choice for inflammatory disease of the pancreatic head. For patients with a dilated main pancreatic duct but without an inflammatory pancreatic head mass, the Partington procedure is still the procedure of choice, since it is technically simple to perform with a minimum of morbidity and mortality, preserving pancreatic endocrine and exocrine function. Because it is a relatively simple technique, the laparoscopic approach will be justified as a treatment of appropriate patients in the near future.

The study of CT features in pancreatic carcinoma and inflammatory pancreatic mass

Objective To compare various CT signs of pancreatic carcinoma (PC) and inflammatory pancreatic mass (IPM), and to study the diagnostic value of these signs for distinguishing two diseases. Methods Eigty-five patients with PC and IPM were proved by surgery, fine needle aspiration or other comprehensive methods. These patients underwent non-enhanced and enhanced CT scans. CT findings were analyzed retrospectively. The occurrance rates of various CT signs in these two diseases were analyzed with Fisher test and were compared with the corresponding clinical and operational results as welL Results Among the 85 patients, 66 patients were proved to have PC, and 19 were proved to have IPM. In PC group,58 were corerectly diagnosed with CT, 3 (4. 5% ) were misdiagnosed, and 5 (7.6%) were omitted. In IPM group, 9 were correctly diagnosed with CT and 10 (52. 6% ) were misdiagnosed. The CT findings were as follows: (1) Pancreatic mass with liver metastases, lymph node metastases, encased celiac arteries, and cancer emboli in portal veins just occurred in PC group. (2) The occurrence rates of mass over 3 cm in diameter, clear boundary, low-density area within the mass, pseudocysts, peripancreatie infiltration, ascites, and slight and moderate pancreatic-bile duct dilation in PC group were 90. 91% (60/66), 15.15% ( 10/66), 54. 55% ( 36/66 ), 10. 61% ( 7/66 ), 4. 55% ( 3/66 ), 22. 73% ( 15/66 ), 24. 24% ( 16/66 ), 45.45% (30/66), and 27. 27% (18/66) respectively, the occurrence rates in IPM group were 94. 74% ( 18/19), 15.79% ( 3/19 ), 52. 63% ( 10/19 ), 15.79% ( 3/19 ), 15. 79% ( 3/19 ), 21.05% (4/19), 31.58% (6/19) ,21.05% (4/19), and 5.26% (1/19) respectively. There was no statistical difference for these CT findings between two groups(P >0. 05). (3) Pancreatic head mass with atrophy of pancreatic body and tail, mass calcification, pancreatic duct-penetrating sign, pancreatic head mass with hypertrophy of pancreatic body and tail, biliary stones with inflammation , and thickening of pre-kidney fascia in PC group were 48.48% ( 32/66 ), 3.03% ( 2/66 ), 1.52% ( 1/66 ), 10. 61% ( 7/66 ), 6. 06% ( 4/66 ) and 3.03% (2/66) respectively, the occurrence rates of those in IPM group were 5. 26% (1/19),47.37% (9/19), 15.79% ( 3/19 ), 84. 21% ( 16/19 ), 36. 84% ( 7/19 ) and 21.05% ( 4/19 ) respectively. There was statistical difference for these CT findings between two groups ( P < 0. 05 ) . Conclusion Accurate evaluation of various CT signs in PC and IPM is of great importance in the diagnosis of the two diseases. Key words: Pancreatic neoplasms; Tomography, X-my computed

The Clinical and Radiological Characteristics of Focal Mass-Forming Autoimmune Pancreatitis

We investigated the clinical and radiological features of focal mass-forming autoimmune pancreatitis (FMF AIP) to help physicians avoid performing unnecessary surgery because of an improper diagnosis. We evaluated 23 patients with chronic inflammatory pancreatic masses and who underwent pancreatectomy for presumed pancreatic cancer from April 1995 to December 2005. These patients were distinguished into 8 FMF AIP patients and 15 ordinary chronic pancreatitis patients through a histological review, along with considering the immunoglobulin G4 staining. Twenty-six randomly selected pancreatic cancer patients were also evaluated as a control group. On the portal venous phase of computed tomography, 6 (85.7%) of 7 FMF AIP patients showed homogeneous enhancement, whereas only 3 chronic pancreatitis patients (25%) and none of the pancreatic cancer patients showed homogeneous enhancement (P < 0.001). None of the FMF AIP patients showed upstream main pancreatic duct dilatation greater than 5 mm or proximal pancreatic atrophy. For patients with a pancreatic mass, if their radiological images show homogeneous enhancement on the portal venous phase, the absence of significant upstream main pancreatic duct dilatation greater than 5 mm, and the absence of proximal pancreatic atrophy, then conducting further evaluations should be considered to avoid performing unnecessary surgery.

Differential diagnosis of benign and malign pancreatic masses with 18F-fluordeoxyglucose-positron emission tomography recorded with a dual-head coincidence gamma camera

Metabolic imaging using 18F-fluordeoxyglucose and a ring-positron emission tomography camera is an established method in the differential diagnosis of pancreatic masses. Ring-positron emission tomography cameras, however, are expensive and available in only few specialized centres. The aim of this study was to investigate how far 18F-fluordeoxyglucose scan with a conventional dual-head gamma-camera could differentiate between benign and malign pancreatic masses. Forty-one patients (male/female: 25/16; mean age: 64.0 years; range: 41-86 years) with a pancreatic mass detected by ultrasound, computed tomography or MRI were included. In all patients 18F-fluordeoxyglucose scan was performed after overnight fasting and injection of 4 mCi 18F-fluordeoxyglucose using an ADAC Vertex MCD dual head gamma-camera (ADAC; Milpitas, California, USA), equipped with a 5/8-inch NaI-crystal. Images were acquired through a 180 degrees grade rotation in the three dimensional mode. The chosen matrix was 128 x 128 x 16, a Butterworthfilter (ADAC) was used and data were transferred into visible sinograms via Fourier-Rebinning. Coronar, sagittal and transversal slices of 3.9 mm thickness each were acquired. Focal tracer enhancement was suspicious for a malignoma and therefore regarded as positive, diffuse or no tracer uptake was suspicious for a benign process and was regarded as negative for cancer. DEFINITION OF GOLD STANDARDS: A diagnosis of cancer had to be confirmed histologically by specimens obtained by 18G-needle biopsy, surgical resection or at autopsy. A diagnosis of an inflammatory mass was considered proven, if no carcinoma could be found histologically in the surgically resected mass or at autopsy, or if there was no progression of the disease during a follow-up of at least 12 months. In 22 patients carcinoma was diagnosed (pancreatic cancer: n=17; endocrine tumour: n=3; carcinoma of the common bile duct: n=2). 18F-fluordeoxyglucose scan showed a focal tracer enhancement in 19 of these 22 patients (sensitivity: 86.4%). False negative results were acquired in two patients with cancer of the common bile duct and in one patient with poorly controlled insulin-dependent diabetes mellitus. In 19 patients the final diagnosis was an inflammatory pancreatic mass. 18F-fluordeoxyglucose scan showed a diffuse tracer enhancement in 15 of these 19 patients (specificity: 78.9%). False positive results were acquired in three patients whose blood tests showed signs of an acute episode of chronic pancreatitis. Positive and negative predictive values of 18F-fluordeoxyglucose scan were 82.6% and 83.3%, respectively. 18F-fluordeoxyglucose scan with a conventional dual-head gamma-camera is a highly sensitive and specific method in the differential diagnosis of benign and malign pancreatic masses.

Value of CT enhancement degree in differential diagnosis between pancreatic carcinoma and inflammatory pancreatic mass

To compare the CT enhancement degree in pancreatic carcinoma (PC) and inflammatory pancreatic mass (IPM), and to study the diagnostic value of CT to these two diseases. Eighty-five patients with PC or IPM, 47 males and 38 females, aged 62 (37-79), underwent plain CT scanning and enhanced CT scanning in pancreatic phase and delay phase. The CT values of the pancreatic mass and relative normal pancreatic tissue were measured. The diagnosis of PC and IPM was verified by operation, biopsy, etc. Sixty persons without pancreatic diseases were used as controls. Among the 85 patients, 66 were proved to be with PC, and 19 patients were proved to be with IPM. In plain CT scanning, pancreatic-phase CT enhancement, and delay-phase CT enhancement, the CT values of PC were (34+/-7) HU, (54+/-10) HU, and (61+/-14) HU respectively; and the CT values of the relatively normal pancreatic tissue were (42+/-6) HU, (105+/-12) HU, and (77+/-10) HU respectively. In plain CT scanning, pancreatic-phase CT enhancement, and delay-phase CT enhancement, the CT values of IPM were (37+/-6) HU, (58+/-17) HU, and (64+/-10) HU respectively; and the CT values of the relatively normal pancreatic tissue were (40+/-8) HU, (85+/-10) HU, and (72+/-9) HU respectively. The pancreatic-phase enhanced CT values of the mass in the PC group and the IPM group showed no remarkable differences (P>0.05). The pancreatic-phase enhancement intensity of the relatively normal pancreatic tissue is greater in PC than in IPM (P<0.01). There is a certain limit for CT enhancement in differentiating between PC and IPM. Comprehensive analysis is necessary in diagnosis of PC and IPM.

Differentiation between malign and inflammatory pancreatic masses by fluorine-18 fluorodeoxyglucose (18F-FDG) scan using a dual-head coincidence gamma-camera

Differentiation between malign and inflammatory pancreatic masses by fluorine-18 fluorodeoxyglucose (18F-FDG) scan using a dual-head coincidence gamma-camera

Inflammatory pancreatic masses: differentiation from ductal carcinomas with contrast-enhanced sonography using carbon dioxide microbubbles.

The aim of this study was to evaluate the clinical efficacy of contrast-enhanced sonography using carbon dioxide microbubbles to differentiate inflammatory pancreatic masses from ductal carcinomas of the pancreas. Fifty-five patients, including 35 patients with ductal carcinomas and 20 with inflammatory pancreatic masses, underwent contrast-enhanced sonography, CT, and digital subtraction angiography (DSA). Carbon dioxide microbubbles were prepared by mixing 10 ml of carbon dioxide and the same amount of 25% soybean oil vigorously. Carbon dioxide microbubbles were injected through an angiographic catheter that was placed in the celiac axis. Vascularity of the tumors as determined by those three techniques was interpreted by three physicians who had no knowledge of the pathologic results. Contrast-enhanced sonography was best at revealing tumor vascularity among the three techniques. On contrast-enhanced sonography, 19 (95%) of the 20 inflammatory pancreatic masses were isovascular and 32 (91%) of the 35 ductal carcinomas were hypovascular. In contrast, the isovascularity of inflammatory masses was five (25%) on CT, and two (10%) on DSA, respectively. The sensitivity and accuracy rate of differentiating both diseases on contrast-enhanced sonography were 98% and 95%, respectively; on CT, they were both 73%; and on DSA they were both 67%. From our results, an isovascular mass is probably an inflammatory mass, whereas a hypovascular mass is most likely a ductal carcinoma on contrast-enhanced sonography. Contrast-enhanced sonography can help differentiate an inflammatory pancreatic mass from a ductal carcinoma.

A CASE OF DUODENAL STENOSIS DUE TO AN INFLAMMATORY PANCREATIC MASS

We experienced a case of inflammatory pancreatic mass causing a duodenal stenosis. Such cases of duodenal stenosis due to chronic pancreatitis can be seen sometimes, but are uncommon A 53-year-old man had been repeatedly admitted to the hospital because of acute aggravation of chronic pancreatitis. This time he complained of right hypochondralgia and nausea. Various examinations revealed a tumor of the panceas head and a stenosis at the descending part of the duodenum. Based on his long-term clinical course and imagings, a pancreatic mass due to chronic pancreatitis was strongly suspected. However, we could not rule out a possible malignancy and had to entertain a persistent abdominal pain which had been resistant to any medical treatments. A pylorous preserving pancreatoduodenectomy was carried out. The excised specimen revealed no inflammatory findings including edema, cell infiltration, and fibrosis in the duodenal wall. It was thought that an expansive growth of the tumor with pseudocyst of the pancreas head was a probable etiology for the stenosis rather than any organic change of the duodenum.

The value of fine-needle aspiration cytology in the diagnosis of inflammatory pancreatic masses.

In order to determine the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of inflammatory pancreatic masses (pseudocyst and abscess), we reviewed 91 FNAC specimens performed during 1985-1989 at the University of Miami/Jackson Memorial Medical Center. All specimens were collected under computed tomographic guidance. A sensitivity of 100% and a specificity of 98% were recorded in the diagnosis of inflammatory pancreatic masses. The sensitivity and specificity of the method in the diagnosis of malignant neoplasms were 79.5% and 100%, respectively. We conclude that fine-needle aspiration cytology of pancreas is not only an important diagnostic tool in patients with pancreatic cancer, but can also be used to diagnose inflammatory masses of the pancreas. In fact, aspiration of such masses may not only be diagnostic, but also therapeutic in some patients.

Endoscopic ultrasound in pancreatic tumor diagnosis

In a prospective study from 1988 to 1990, 132 patients with suspected pancreatic tumor were examined with endoscopic ultrasound (EUS), transabdominal ultrasound (US), computed tomography (CT), and ERCP. The final diagnosis of 102 pancreatic tumors of different origin (76 malignant and 26 inflammatory tumors) and the exclusion of a pancreatic tumor in 30 patients was made by operation (N = 47), puncture (N = 36), autopsy (N = 3), or follow-up of a mean of 51 weeks (N = 46). Sensitivity and specificity in pancreatic tumor diagnosis were significantly higher for EUS (99% and 100%) than for US (67%/40%) and CT (77%/53%) and equal to ERCP (sensitivity 90%). This was even more obvious in small pancreatic tumors of 3 cm and less. However, as with the other imaging procedures, EUS was not able to differentiate reliably malignant from inflammatory pancreatic masses (accuracy 76% for malignancy and 46% for focal inflammation). From analysis of the endosonographic pattern of pancreatic tumors, no consistent morphologic features were identified which could have been specifically attributed to malignant or inflammatory masses. Our results show that EUS is superior to US and CT and equal to ERCP in pancreatic tumor diagnosis. In contrast to the indirect evidence obtained by ERCP, EUS provides direct visualization of tumor size and shape in almost all patients examined. Thus, EUS should be considered early in the evaluation of patients with suspected pancreatic tumors.