Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography

Harima, Hirofumi; Kaino, Seiji; Shinoda, Shuhei; Kawano, Michitaka; Suenaga, Shigeyuki; Sakaida, Isao

doi:10.3748/wjg.v21.i20.6252

Cited by 69 publications

(65 citation statements)

References 36 publications

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“…EUS, despite the high number of studies published showing its good diagnostic accuracy in PCNs [12][13][14][15][16][17][18][19][20][21], is recommended as an adjunct imaging modality in the European guidelines [3]. Several studies [5,[15][16][17] have shown that the diameter of the main pancreatic duct or a nodule at the time of diagnosis is a predictor of malignant IPMN. Fine needle aspiration (FNA) is an adjunctive procedure performed during EUS that is helpful in reaching a conclusive diagnosis as it allows the aspiration of cystic fluid or tissue collection of a nodule.…”

Section: Discussionmentioning

confidence: 99%

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Blanco

Gesuale

Anselmo

et al. 2019

Clin J Gastroenterol

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Pancreatic cystic neoplasms (PCNs) are a frequent incidental finding during an ultrasound or other radiological investigations. As PCNs may have a potential of malignancy, a precise differential diagnosis between a malignant and benign lesion is crucial to define appropriate management of patients with this kind of lesions. Radiology, with computed tomography (CT) and magnetic resonance imaging, may not be conclusive in the diagnostic assessment of PCNs. Endoscopic ultrasound (EUS), a simple and relatively low invasive technique, is able to identify intra-cystic worrisome features suggesting malignancy. Fine-needle aspiration (FNA) of the cystic fluid or of intra-cystic tissue nodule during EUS is an adjunctive procedure for reaching a conclusive diagnosis. As EUS-FNA is burdened by complications, the use of intravenous contrast may increase the diagnostic accuracy of EUS allowing in many cases a correct diagnosis of PCN at high risk of malignancy, without additional risk of complication during the procedure. The present report deals with the case of a cystic lesion found by CT scan in the pancreatic head of a 59-year-old woman suffering from mild epigastric pain. Once submitted to EUS, malignant nature of PCN was suspected due to the finding of a typical worrisome feature, the presence of a mural nodule. The intravenous administration of contrast medium during the EUS confirmed malignancy and the patient was immediately sent to the surgeon for pancreatic resection. Histology revealed an intraductal papillary mucinous neoplasm, with areas of high-grade dysplasia in the main and secondary ducts, progressed toward an invasive carcinoma.

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Section: Discussionmentioning

confidence: 99%

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Blanco

Gesuale

Anselmo

et al. 2019

Clin J Gastroenterol

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“…One limitation of CH‐EUS is its inability to differentiate between serous and mucinous cysts because their enhancement patterns are similar, although CH‐EUS was able to distinguish between pseudocysts and other pancreatic cysts . CH‐EUS assessment of MN height cut‐off value has also been analyzed . For example, the optimum cut‐off value of MN height was found to be 8.8 mm for diagnosing malignant IPMN, with this height having an accuracy of 93% .…”

Section: Methodsmentioning

confidence: 99%

“…Several studies evaluated the utility of CH-EUS for diagnosing pancreatic cystic lesions ( Table 2). [47][48][49][50][51][52][53][54][55] Detection by B-mode EUS of MN-like structures in dilated pancreatic ducts of patients with IPMN may result in difficulties determining whether these structures are mucous clots or MN. However, CH-EUS can distinguish these structures by evaluating the presence or the absence of blood flow in the lesion 47,48 (Figs 1 and 2).…”

Section: Endoscopic Ultrasound-through-the-needle Biopsymentioning

confidence: 99%

“…47,54 For example, the optimum cut-off value of MN height was found to be 8.8 mm for diagnosing malignant IPMN, with this height having an accuracy of 93%. 54 By contrast, MN assessment by standard EUS alone had an accuracy of 87%. Evaluation of 70 patients with undetermined pancreatic cysts by standard EUS and CH-EUS showed that their accuracies in diagnosing mucinous cysts by the presence or absence of MN were similar (84% vs. 73%).…”

Section: Endoscopic Ultrasound-through-the-needle Biopsymentioning

confidence: 99%

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Endoscopic diagnosis of cystic lesions of the pancreas

Kamata

Kitano

2018

Digestive Endoscopy

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Endoscopic methods are increasingly used in the diagnosis of cystic lesions of the pancreas. The two major endoscopic approaches are endoscopic ultrasonography (EUS) and transpapillary diagnosis. EUS-guided fine-needle aspiration cytology and EUS-guided fine needle-based confocal laser endomicroscopy have been used in the differential diagnosis of mucinous and non-mucinous pancreatic cysts. EUS is the most sensitive modality for detecting mural nodules (MN) in intraductal papillary mucinous neoplasms (IPMN). Contrast-enhanced harmonic EUS (CH-EUS), as an add-on to EUS, is useful for identifying and characterizing MN. Recent studies show that CH-EUS has a sensitivity of 60-100% and a specificity of 75-92.9% for diagnosing malignant cysts. Intraductal ultrasonography and peroral pancreatoscopy are especially useful for detecting MN and IPMN. A recent meta-analysis showed that cytological assessment of pancreatic juice using a transpapillary approach had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, for diagnosing malignant IPMN. Further studies are warranted to determine the indications for each of these novel techniques in assessing cystic lesions of the pancreas.

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“…Contrast-enhanced harmonic (CH)-EUS has been reported also as a useful tool. This technology allows for blood flow assessment in PCLs and better identification of mural nodules, which can be helpful in differentiating between benign, premalignant or malignant lesions with more accuracy [23,24]. EUS elastography is a noninvasive technology that has been recently studied in PCLs, it can be of value in differentiating between serous and mucinous cystic lesions by measuring ultrasound acoustic radiation by force impulse quantification [25].…”

Section: • • Pancreatic Cystic Lesions and The Importance Of Endoscopymentioning

confidence: 99%

State-Of-The-Art Endoscopic Procedures for Pancreatic Cancer

Coronel

Waxman

2016

Future Oncol.

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Pancreatic cancer is the twelfth most common cancer worldwide, taking the fourth place in cancer-related mortality in western countries. Despite significant efforts in understanding the tumor biology of pancreatic cancer and introducing new technologies and therapies to improve the detection, staging and treatment of this disease, pancreatic cancer continues to have a high and almost unchanged mortality. In the last few decades, the development of techniques such as endoscopic retrograde cholangio pancreatography and endoscopic ultrasound have allowed us to directly access the pancreaticobiliary system and fight pancreatic cancer and its complications from different fronts. Our goal with this review is to discuss the most cutting-edge endoscopic techniques available in our armamentarium to diagnose, stage and treat pancreatic cancer.

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Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography

Abstract: Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.

Cited by 69 publications

References 36 publications

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Endoscopic diagnosis of cystic lesions of the pancreas

State-Of-The-Art Endoscopic Procedures for Pancreatic Cancer

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