Contrast Harmonic Endoscopic Ultrasonography in the Characterization of Pancreatic Metastases (With Video)

Fusaroli, Pietro; D'Ercole, Maria Cristina; Giorgio, Roberto De; Serrani, Marta; Caletti, Giancarlo

doi:10.1097/mpa.0000000000000081

Cited by 43 publications

(37 citation statements)

References 23 publications

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“…Adenosquamous carcinoma has been previously reported to show a ring enhancement pattern on CT [25], related to its high vascularity, which may explain the hyperenhanced appearance on CH-EUS in our case. The CH-EUS appearance of the one case of colon cancer metastasis was hypoenhanced and well delineated, as described previously [26].…”

Section: Discussionsupporting

confidence: 65%

Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

et al. 2015

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The global accuracy of fine-needle aspiration guided by endoscopic ultrasound (EUS-FNA) for pancreatic adenocarcinoma is about 85 %. The use of contrast agents during EUS to highlight vessels and the necrotic parts of pancreatic masses may improve biopsy guidance. Our aim was to assess whether the guidance of FNA by harmonic contrast-enhanced endoscopic ultrasound (CH-EUS) would increase diagnostic accuracy relative to conventional EUS-FNA in the same pancreatic masses. In a prospective study, EUS-FNA was performed in patients with pancreatic masses on CT scan, followed by harmonic CH-EUS using SonoVue. A second cluster of CH-EUS-FNA was performed on contrast-enhanced images. The final diagnosis was based on the results of EUS-FNA and surgery, or the findings after 12 months' follow-up. The final diagnosis was adenocarcinoma (n = 35), chronic pancreatitis (n = 10), or other (n = 6). The diagnostic accuracy based on core histology was 78.4 % for EUS-FNA and 86.5 % for CH-EUS-FNA (p = 0.35). The accuracy increased to 94 % when the two methods' results were combined. The two false-negative EUS-FNA cases were correctly appreciated by CH-EUS. Neither core histology size nor the presence of necrosis was significant for the true-positive diagnosis of malignancy. CH-EUS-FNA had an insignificant incremental effect on diagnostic accuracy compared with conventional EUS-FNA in our small group. The presence of necrosis did not influence the results of CEUS-FNA. Qualitative assessment of the contrast uptake within the lesion was useful in false-negative EUS-FNA cases.

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Section: Discussionsupporting

confidence: 65%

Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

et al. 2015

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“…Only one study[7] specifically focused on the appearance of pancreatic metastases at CH-EUS. Of 11 lesions, 6 appeared hypoenhanced and 5 were iso/hyperenhanced depending on the origin of the primary tumor.…”

Section: Contrast Harmonic Endoscopic Ultrasonography In Pancreatic Mmentioning

confidence: 99%

Role of contrast harmonic endoscopic ultrasonography in other pancreatic solid lesions: Neuroendocrine tumors, autoimmune pancreatitis and metastases

Palazzo

2016

Endosc Ultrasound

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Contrast harmonic endoscopic ultrasonography (CH-EUS) is a new technique which allows the dynamic study of the microvascularization of a target tissue. Its application is validated for the diagnosis of pancreatic adenocarcinoma but remains unclear for other solid pancreatic tumors (neuroendocrine tumors [NETs], autoimmune pancreatitis [AIP], metastases). The purpose of this review is to outline the potential role of the CH-EUS in these indications. NETs are typically iso/hyperenhanced at CH-EUS, and a heterogeneous enhancement seems a good predictor of malignancy in neuroendocrine pancreatic tumor. AIP is often iso/hyperenhanced at CH-EUS. Quantitative analysis of time-intensity parameters is promising for the distinction between pancreatic adenocarcinoma and AIP. The appearance of pancreatic metastases at CH-EUS is various depending on the origin of the primary tumor. Data from the literature remain to this day weak to determine the role of the CH-EUS in the management of rare solid tumor of the pancreas (NETs, AIP, and metastases). Specific studies are expected to further clarify the impact of this procedure in this field.

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“…The most common primary locations are kidney, lung, and breast [5, 6]. In this particular case, we identified a patient with a previous uveal melanoma that had an isolated pancreatic metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…As for the appearance of pancreatic metastasis in EUS, they are hypoechoic and usually are well-defined with regular margins, [6] with similar characteristics to neuroendocrine tumors [18]. …”

Section: Discussionmentioning

confidence: 99%

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Pancreatic metastases from ocular malignant melanoma: the use of endoscopic ultrasound-guided fine-needle aspiration to establish a definitive cytologic diagnosis: a case report

et al. 2016

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BackgroundWhen encountering solid pancreatic lesions, nonpancreatic primary metastases are rare and differentiating a metastasis from a primary neoplastic lesion is challenging. The clinical presentation and radiologic features can be similar and the possibility of a pancreatic metastasis should be considered when the patient refers to a history of a different primary cancer. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound-guided fine-needle aspiration has become the gold standard method for diagnosing pancreatic lesions.Case presentationA 58-year-old white Hispanic woman with a history of uveal malignant melanoma, presented with abdominal pain and jaundice. On admission, laboratory tests were performed (her total bilirubin was 6.37 mg/dL with a direct fraction of 5.30 mg/dL). Cross-sectional, abdominal computed tomography with contrast, showed a low-attenuating lesion localized in the pancreatic head (measuring 4 × 3 cm) and a thinner section of the distal bile duct suspicious for compression. Our patient was scheduled for an endoscopic ultrasound-guided fine-needle aspiration to establish a diagnosis. Endoscopic ultrasound showed a solid, hypoechoic, well-defined lesion with regular contours (measuring 3.17 × 2.61 cm), localized between the head and neck of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration was performed with a 22G needle and cytology confirmed the diagnosis of metastatic melanoma. Our patient subsequently underwent right orbital exenteration, followed by duodenopancreatectomy without complications. At the moment our patient is receiving adjuvant chemotherapy at an outside oncology clinic.ConclusionsTo the best of our knowledge, this is a very rare presentation of an ocular malignant melanoma with an isolated pancreatic metastasis causing symptomatic biliary obstruction. Endoscopic ultrasound-guided fine-needle aspiration has proven to be the best method to diagnose solid pancreatic lesions. In this particular case, cytology was essential in confirming the diagnosis and guiding the most adequate therapy, which was a pancreatic resection, ocular exenteration of the melanoma, followed by adjuvant chemotherapy.

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Contrast Harmonic Endoscopic Ultrasonography in the Characterization of Pancreatic Metastases (With Video)

Cited by 43 publications

References 23 publications

Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

Harmonic Contrast-Enhanced Endoscopic Ultrasonography for the Guidance of Fine-Needle Aspiration in Solid Pancreatic Masses

Role of contrast harmonic endoscopic ultrasonography in other pancreatic solid lesions: Neuroendocrine tumors, autoimmune pancreatitis and metastases

Pancreatic metastases from ocular malignant melanoma: the use of endoscopic ultrasound-guided fine-needle aspiration to establish a definitive cytologic diagnosis: a case report

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