Endoscopic Ultrasound (EUS) and Endoscopic ultrasound with Biopsy (EUS-FNB) for Carcinoma in The Pancreas
Article Sidebar
Main Article Content
Abstract
EUS (endoscopic ultrasound) is a procedure utilized to obtain images and information about the digestive tract, hepatobiliary tract, pancreas, and intra-abdominal lymph nodes. EUS can be used for the diagnosis of pancreatic cancer with high sensitivity 90%, as well as for tumors less than 2 centimeters in size that cannot be detected using CT or MRI. The aim of this report is to present EUS findings for carcinoma in the pancreas and describe how to perform EUS fine needle biopsy (FNB).
A 61-year-old male patient presented with epigastric pain radiating in the back and weight loss for 1 month. CT of the upper abdomen revealed an enhanced soft tissue mass comprising a pancreatic body and tail measuring 4.7 x 6.9 x 4.2 cm in diameter encasing both the celiac trunk and splenic artery and superior mesenteric and splenic veins and multiple intraabdominal lymphadenopathy (up to 0.9 cm in diameter). EUS showed a pancreatic mass with features consistent with adenocarcinoma, i.e. heterogenous hypoechoic mass, poorly defined margins, malignant-looking lymph nodes that are more than 1cm, and a well-demarcated round or oval shape with a hypoechoic pattern. EUS-FNA was performed. No complications were apparent.
Article Details
References
Shailesh V Shrikhande, Savio George Barreto, Mahesh Goel, Supreeta Arya. Multimodality imaging of pancreatic ductal adenocarcinoma: a review of literature. HPB (Oxford). 2012;14(10):658-668.
Varadarajulu S, Wallace MB. Applications of endoscopic ultrasonography in pancreatic cancer. Cancer Control 2004; 11:15–22.
Kochman ML.EUS in pancreatic cancer.GastrointestEndosc 2002; 56(4 Suppl): S6-S12.
Katz MH, Savides TJ, Moosa AR, Bouvet M. An evidence-based approach to the diagnosis and staging of pancreatic cancer.Pancreatology 2005; 5:576-90.
Ahmad NA, Lewis JD, Ginsberg GC, Rosato EF, Morris JB, Kochman ML. EUS in preoperative staging of pancreatic cancer.GastrointestEndosc 2000; 52:463-8.
Williams DR, Sahai AV, Aabakken L, Penman ID, van Velse A, Webb J, et al. Endoscopic ultrasound guided fine needle aspirationbiopsy: a large single center experience. Gut 1999; 44:720-6.
Shin HJ, Lahoti S, Sneige N. Endoscopic ultrasound-guided fine-needle aspiration in 179 cases:the M.D. Anderson Cancer Center experience. Cancer 2002;96:174-80.
Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet 2004; 363(9414):1049-57.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96.
Das A, Sivak MV Jr, Chak A. Cervical esophageal perforation during EUS: a national survey. GastrointestEndosc 2001; 53:599-602.
Wang KX, Ben QW, Jin ZD, Du YQ, Zou DW, Liao Z, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. GastrointestEndosc 2011; 73:283-90.
Early DS, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Evans JA, et al. Adverse events associates with EUS and EUS with FNA. GastrointestEndose 2013;77:839-43.
O’Toole D, Palazzo L, ArotcarenaR,Dancour A, Aubert A, Hammel P, et al. Assessment of complications of EUS-guided fine-needle aspiration.GastrointestEndosc 2001; 53:470-4.
Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol 2003;98:2663-8.
Gress F, Michael H, Gelrud D, Patel P, Gottlieb K, Singh F, et al. EUS-guided fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication. GastrointestEndosc 2002;56:864-7.
Bapaye A, Aher A. Linear EUS of the pancreas, biliary tract and liver. In: Akahoshi K, Bapaye A, editors. Practical handbook of endoscopic ultrasonography. Tokyo: ; 2012. p 165-205.
Micames C, JowellPS, White R, Paulson E, Nelson R, Morse M, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percuteneous FNA.GastrointestEndosc2003;58:690-5.