The aim of this study was to evaluate the ability of contrast-enhanced endoscopic sonography for discrimination of mural nodules from mucous clots in intraductal papillary mucinous neoplasms of the pancreas.
Contrast-enhanced endoscopic sonography was performed in 17 consecutive patients who had an intraductal papillary mucinous neoplasm with mural lesions. To perform contrast-enhanced endoscopic sonography, we used a second-generation sonographic contrast agent. After reconstitution with 2 mL of sterile water for injection, 0.7 mL of the agent was administered through a peripheral vein. From 10 to 30 seconds after injection of the contrast agent, the presence or absence of vascularity in mural lesions was assessed. All cases were referred to surgery, and diagnoses were finally obtained by pathologic examination. Diagnoses of mural nodules versus mucous clots based on the sonographic results were compared with tumor histopathologic findings.
Pathologic findings revealed 12 cases with mural nodules and 5 cases without. Contrast-enhanced endoscopic sonography depicted vascularity in all 12 cases with pathologically confirmed mural nodules, whereas all 4 cases without vascularity had mucous clots. Only 1 case without a pathologically confirmed mural nodule was overestimated by contrast-enhanced endoscopic sonography as having a mural nodule. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of contrast-enhanced endoscopic sonography for mural nodule detection were 100%, 80%, 92%, 100%, and 94%, respectively.
Evaluation of vascularity by contrast-enhanced endoscopic sonography could be useful for distinguishing mural nodules from mucous clots in intraductal papillary mucinous neoplasms. Contrast-enhanced endoscopic sonography could be a necessary option to determine surgical indications for intraductal papillary mucinous neoplasms when mural lesions are observed.
"This characterization can help in the diagnosis of pancreatic ductal adenocarcinoma in difficult cases by permitting the observation of hypovascularity, one of the signs of ductal adenocarcinoma [6,17] (Fig. 1). In particular, the utility of CE-EUS has been reported to include differentiation of focal pancreatitis and carcinomas [4,28,29], preoperative localization of pancreatic endocrine tumors [30,31], differentiation of mural nodules in intraductal papillary mucinous neoplasms, and detection of malignant transformations [32,33] (Fig. 2). CE-EUS images showed irregular vascularization with only arterial and no venous vessels in pancreatic cancer but regular vascularization with the detection of venous vessels in focal pancreatitis . "
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasonography (EUS) technology has undergone a great deal of progress along with the color and power Doppler imaging, three-dimensional imaging, electronic scanning, tissue harmonic imaging, and elastography, and one of the most important developments is the ability to acquire contrast-enhanced images. The blood flow in small vessels and the parenchymal microvasculature of the target lesion can be observed non-invasively by contrast-enhanced EUS (CE-EUS). Through a hemodynamic analysis, CE-EUS permits the diagnosis of various gastrointestinal diseases and differential diagnoses between benign and malignant tumors. Recently, mechanical innovations and the development of contrast agents have increased the use of CE-EUS in the diagnostic field, as well as for the assessment of the efficacy of therapeutic agents. The advances in and the current status of CE-EUS are discussed in this review.
[Show abstract][Hide abstract] ABSTRACT: An increasing number of patients are being diagnosed with pancreatic cysts. Pancreatic cysts are best evaluated by a team of healthcare professionals that includes gastroenterologists, surgeons, radiologists, pathologists, oncologists and geneticists.
The international consensus guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm were updated in 2012, incorporating research that had been reported over a 5-year span since the publication of the previous guidelines. There are significant changes in the new guidelines, which include redefining main duct IPMN and removing the recommendation for surgical resection based on size alone. In addition, the discovery of molecular markers of cyst type promises to revolutionize the way patients are diagnosed and managed.
The diagnosis and management of patients with pancreatic cysts have progressed significantly in recent years. Large prospective, multicenter trials are now needed to validate the new international consensus guidelines and to assess the accuracy of new molecular markers.
Current opinion in gastroenterology 07/2013; 29(5). DOI:10.1097/MOG.0b013e328363e3b3 · 4.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Contrast-enhanced endoscopic ultrasonography (CE-EUS) is a new imaging modality for pancreatic lesions. The aim of this study was to evaluate if CE-EUS is useful for predicting treatment efficacy before pancreatic cancer chemotherapy by assessing intratumoral vessel flow.
Thirty-nine patients with unresectable advanced pancreatic cancer underwent CE-EUS before chemotherapy. The patients were divided into 2 groups according to the intratumoral vessel flow observed with CE-EUS: vessel sign-positive and vessel sign-negative groups. Patient prognosis was investigated according to presence or absence of the vessel sign.
Two patients were excluded due to poor visualization of CE-EUS images; therefore, 37 patients were analyzed. Contrast-enhanced EUS revealed positive vessel sign in 20 patients, whereas it revealed negative vessel sign in 17 patients. Both progression-free survival and overall survival were significantly longer in the positive- versus negative vessel sign groups (P = 0.037 and P = 0.027, respectively). Multivariate analysis demonstrated that the positive vessel sign was an independent factor associated with longer overall survival (hazard ratio, 0.22; 95% confidence interval, 0.08-0.53).
Evaluation of intratumoral vessel flow by CE-EUS could be useful for predicting efficacy of chemotherapy in patients with pancreatic cancer. Contrast-enhanced EUS could be used before chemotherapy for inoperable pancreatic cancer.
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