Diagnosing Pancreatic Adenocarcinoma With Contrast-Enhanced Ultrasonography: A Literature Review of Research in Europe and Asia

Abstract

The National Cancer Institute names pancreatic cancer the 11 th most common type of cancer in the United States. However, even with a somewhat low prevalence, in 2017, the American Cancer Society reported pancreatic cancer as the fourth leading cause of cancer-related death. With a lack of symptomology and a broad range of risk factors, pancreatic cancer is frequently diagnosed in a later phase than many other types of cancers, thus resulting in higher metastasis along with a poorer prognosis. This highlights the need for early detection and diagnosis. Currently, abdominal ultrasound or contrast-enhanced CT imaging of the abdomen are standard of care. A new technology: contrast-enhanced ultrasound (CEUS), which employs contrast agents to act as acoustic enhancers for ultrasound, has FDA approval for use in hepatic and renal lesions, but not pancreatic. By examining seven individual studies from Europe and Asia, this review aims to examine the diagnostic value of CEUS to initially diagnose pancreatic adenocarcinomas, potentially followed by a biopsy to confirm, when compared against modalities currently used such as conventional ultrasound and CT imaging. CEUS would potentially be more accurate when compared to conventional ultrasound due to the addition of contrast, and when compared against CT and MRI, CEUS would be advantageous in its low cost, similar sensitivities, and specificities, limited renal toxicity, lack of ionizing radiation, short half-life, and its safe use in both adult and pediatric patients. Due to this, additional research is warranted for further FDA approval and future clinical implementation.

Recent Advances in Endoscopic Ultrasound for Gallbladder Disease Diagnosis

“…Thus, CH-EUS is a useful approach that addresses the limitations of CH-TUS. The usefulness of CH-EUS in the diagnosis of pancreatic [56][57][58][59][60][61], gastrointestinal [62,63], and GB lesions [9,[46][47][48][49][50][51][52][53] has been reported. CH-EUS is useful for diagnosing GB wall thickening.…”

Clinical value of endoscopic ultrasound sound speed in differential diagnosis of pancreatic solid lesion and prognosis of pancreatic cancer

“…Ultrasonography may show false‐positive contrast signals in non‐vascularized areas of pancreatic masses. At the same time, excessive contrast doses may also cause signal attenuation, and its differential diagnostic rate for benign and malignant pancreatic masses is about 77% to 91% 11,12 . In contrast, sound speed (SS) of EUS is a new noninvasive method for virtual touch tissue quantification, which does not rely on physicians' experience and has the advantages of objectivity, convenience and noninvasiveness.…”

“…At the same time, excessive contrast doses may also cause signal attenuation, and its differential diagnostic rate for benign and malignant pancreatic masses is about 77% to 91%. 11 , 12 In contrast, sound speed (SS) of EUS is a new noninvasive method for virtual touch tissue quantification, which does not rely on physicians' experience and has the advantages of objectivity, convenience and noninvasiveness. Only one research shows that SS can be applied to EUS‐guided tissue collection of pancreatic masses, 13 suggesting that SS has a very promising application in noninvasive adjunctive diagnosis.…”