Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography

Sugiyama, Masanori; Hagi, Hiroo; Atomi, Yutaka; Saito, Mitsuhiro

doi:10.1007/s002619900227

Cited by 87 publications

(53 citation statements)

References 12 publications

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“…The average tumor size did not differ significantly between the patients with pancreatic cancer diagnosed during the first hospitalization versus after discharge, probably because identifying a tumor on CT became possible only when the tumor diameter grew to more than 15 mm. These results are consistent with previous reports indicating that it is difficult to detect pancreatic tumors smaller than 15 mm by CT (15)(16)(17)(18)(19). Nevertheless, the tumor stages detected during the first hospitalization and in the patients followed by regular examination with CT were earlier than those in the patients not followed.…”

Section: Discussionsupporting

confidence: 83%

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

2015

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Objective The aims of this study were to assess the incidence of pancreatic cancer and the contributing factors for the diagnosis of tumors in patients with acute pancreatitis and to gain insight into how patients with acute pancreatitis should be followed up. Methods Using the electronic medical database of Shizuoka General Hospital, 177 patients admitted for acute pancreatitis in the past 6 years were evaluated retrospectively for pancreatic cancer. Results Twelve patients (6.8%) were newly diagnosed with pancreatic cancer. During the first hospitalization, 5 patients (41.7%) with a detected pancreatic mass underwent surgical treatment: the final tumor stages were IA, IIA, and IIB in 1, 2, and 2 patients, respectively. In 7 patients (58.3%) without a detected pancreatic mass at the first admission, a pancreatic mass was recognized on follow-up computed tomography (CT) in 2 patients with main pancreatic duct (MPD) dilatation, and 1 patient with recurrent acute pancreatitis. The tumor stages were IA, IIA, and IA, respectively. Among the remaining 4 patients without follow-up, the tumor stage was IV. The patient gender, age, MPD dilatation, tumor marker, and serum amylase level were not significantly associated with pancreatic cancer. The detection of a pancreatic mass on CT led to the diagnosis of pancreatic cancer. Conclusion Acute pancreatitis should be considered as a possible diagnostic indicator of pancreatic cancer. Various factors associated with acute pancreatitis and pancreatic cancer were not predictive of a diagnosis of pancreatic cancer. Only the detection of a pancreatic mass led to the early diagnosis of pancreatic cancer. Patients hospitalized for acute pancreatitis should be followed up with a diagnostic imaging modality.

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Section: Discussionsupporting

confidence: 83%

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

2015

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“…N/A: We could not evaluate the distance between the RHA and the bile duct of the tumor site on the pathological specimen because the HA could be separated from the tumor during surgery. by cholangiocarcinoma has been reported as 87-100% (11)(12)(13)(14) for CT, whereas EUS offers 88-100% accuracy for predicting PV invasion and performs better than transabdominal US and angiography in this regard (15)(16)(17) (18) reported on combined vascular resection for hilar cholangiocarcinoma. They found that cancer invasion into the adventitia was present in 80% of the 44 resected portal veins and 40% of the 9 resected hepatic arteries, and concluded that caution should be exercised when planning combined hepatic artery resection, because cancer invasion into the adventitia of the HA occurs in only about half of the patients despite clinical findings of apparent invasion.…”

Section: Discussionmentioning

confidence: 99%

Utility of convex EUS for preoperative vascular evaluation of malignant biliary tract neoplasm

et al. 2017

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Abstract. The aim of the present study was to examine the utility of convex endoscopic ultrasonography (EUS) for the preoperative vascular evaluation of malignant biliary tract neoplasm, by comparing EUS findings with histological findings from resected specimens. Between January 2008 and January 2016, the present study retrospectively retrieved 82 cases diagnosed with malignant biliary tract neoplasm to compare findings from convex EUS with histological findings from resected specimens. A total of four groups were defined according to the results of EUS of the hepatic artery (HA) and portal vein (PV): Group 1, hyperechoic tissue between tumor and vessel; group 2, close proximity between tumor and vessel without loss of hyperechoic tissue; group 3, tumor and vessel contiguity, with loss of hyperechoic tissue; and group 4, encasement >180˚. Regarding the HA, all 17 cases in groups 2 and 3 in which the tumor was close to the HA however no obvious encasement was evident, demonstrated no histological invasion, or the HA could be separated from the tumor intraoperatively. However, this was not the case for the portal vein. Of the six cases in group 3, 4 cases (66.7%) demonstrated PV invasion. Overall, convex EUS is useful for the preoperative evaluation of malignant biliary tract neoplasms, and surgery may be considered when the tumor is close to the HA on computed tomography scans, however there is no obvious encasement visualized by convex EUS.

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“…The ERCP technique would be superior to other imaging modalities for this purpose. Endoscopic sonography has been reported to detect vascular invasion of the portal vein associated with extrahepatic tumors of the bile duct with a sensitivity greater than that of transabdominal sonography, CT, and angiography [57]. As previously discussed in HCC, interventional procedures for drainage of obstructive jaundice may be resorted to as a preparatory step before transplantation in the patient with hilar CC.…”

Section: Tumor Staging and Road-mappingmentioning

confidence: 96%

Tumor diagnosis in the adult liver transplant candidate

1999

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Hepatic transplantation has emerged as a potentially curative treatment of certain malignant hepatic neoplasms such as hepatocellular carcinoma, bile duct carcinoma, fibrolamellar hepatocellular carcinoma, metastases from neuroendocrine tumors, and epithelioid hemangioendothelioma. In the early years of hepatic transplantation, there was great enthusiasm to cure patients with unresectable hepatobiliary malignancy. This early enthusiasm was tempered by the unfavorable outcome of transplantation in advanced cases of malignancy and the organ-donor shortage. Presently, patients have to be selected with predictable likelihood for long-term survival. Pre-transplantation imaging is indispensable for detection, characterization, staging, and surgical road-mapping before the procedure. The present article focuses on the role of imaging modalities in these different aspects of preoperative assessment.

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Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography

Abstract: Endoscopic ultrasonography is the most accurate tool for detecting pancreatobiliary carcinomas and assessing portal venous invasion.

Cited by 87 publications

References 12 publications

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

Utility of convex EUS for preoperative vascular evaluation of malignant biliary tract neoplasm

Tumor diagnosis in the adult liver transplant candidate

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