Endoscopic ultrasound findings and pathological features of pancreatic carcinoma in situ

Abstract

Background and study aims Few studies have evaluated detection of pancreatic carcinoma in situ (PCIS). We evaluated findings of endoscopic ultrasound (EUS) and pathological features of PCIS. Patients and methods We histopathologically studied 16 patients with PCIS following EUS. Diagnostic features evaluated retrospectively included stricture of the main pancreatic duct (MPD) on EUS, presence or absence of hypoechoic areas surrounding the MPD stricture on EUS, the noncancerous part (pancreas of background) on EUS and histopathology, and histological findings adjacent to the area of PCIS. Results On EUS, stricture of the MPD was found in 15 patients (93.8 %). Hypoechoic areas surrounding the MPD stricture were observed in 9 patients (56.3 %), including three (18.8 %) with a 10- to 11-mm hypoechoic mass. EUS findings of the noncancerous part indicated chronic pancreatitis in six patients (37.5 %), pancreatic fatty infiltration in seven (43.8 %), early chronic pancreatitis in two (12.5 %), and normal pancreas in one (6.3 %). Histological findings of the noncancerous part (proximal to the MPD stricture) indicated chronic pancreatitis in 13 patients (81.3 %) and pancreatic fatty infiltration in five patients (31.3 %). Histopathologically, subepithelial inflammatory cell infiltration and fibrosis were present in all 16 patients with PCIS. Conclusions PCIS frequently causes localized changes in inflammation and fibrosis around the pancreatic duct. PCIS often accompanies chronic pancreatitis and pancreatic fatty infiltration in the background of the pancreas. EUS offers sufficient resolution to demonstrate pancreatic changes of PCIS.

Clinical Analysis of Early-Stage Pancreatic Cancer and Proposal for a New Diagnostic Algorithm: A Multicenter Observational Study

“…Izumi et al reported that a hypoechoic area surrounding the MPD stenosis was detected in 56.3% of PCIS, and fatty infiltration was detected in 43.8% of PCIS. They also reported that histopathological examination of the periphery of the lesion revealed inflammation and fibrosis in all PCIS [ 35 ]. It is conceivable that the hypoechoic lesion could reflect the fibrosis ( Figure 2 ).…”

Partial Pancreatic Parenchymal Atrophy Is a New Specific Finding to Diagnose Small Pancreatic Cancer (≤10 mm) Including Carcinoma in Situ: Comparison with Localized Benign Main Pancreatic Duct Stenosis Patients

“…Two diagnostic approaches are available for PC, EUS-fine needle aspiration (FNA), and Serial pancreatic juice aspiration cytologic examination (SPACE). EUS is powerful detection tool for PC ≤ 20 mm in size [ 4 , 5 ] and specific EUS findings in patients with small PCs was recently reported [ 27 , 28 ]. Additionally, EUS-FNA has been widely used for pathological confirmation due to high sensitivity and specificity [ 29 , 30 , 31 ].…”

Modern ultrasound imaging of pancreatic tumors

“…The sensitivity of EUS for tumor detection was 92.4%, whereas transcutaneous ultrasonography (TUS), CT, and MRI had a sensitivity of only 67.3%, 65.8%, and 57.5%, respectively [33]. Other studies using TUS and EUS have highlighted the high diagnostic value of these techniques for the detection of MPD dilatation or stricture in order to diagnose small PDACs [34][35][36]. The unmatched diagnostic ability of EUS was also described for the detection of pancreatic neuroendocrine tumors (PNETs).…”