Factors associated with misdiagnosis of preoperative endoscopic ultrasound in patients with pancreatic cystic neoplasms undergoing surgical resection

Ohno, Eizaburo; Ishikawa, Takuya; Mizutani, Yasuyuki; Iida, Tadashi; Uetsuki, Kota; Yashika, Jun; Yamada, Kenta; Gibo, Noriaki; Aoki, Toshinori; Kawashima, Hiroki

doi:10.1007/s10396-022-01205-7

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…AI may be used as a unique tool to augment the performance of EUS and improve its diagnostic ability [ 47 , 48 , 49 ]. EUS-guided fine-needle aspiration (FNA) provides samples for cytological, biomarker or molecular examination [ 10 , 44 , 50 , 51 , 52 ]. The accuracy of pancreatic EUS-guided fine-needle biopsy (FNB) is high, up to 85% [ 53 , 54 , 55 ], as its molecular analysis [ 56 ].…”

Section: Diagnosismentioning

confidence: 99%

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Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Pavlidis

Sapalidis²,

Pavlidis³

2022

Rom J Morphol Embryol

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Intraductal papillary mucinous neoplasms (IPMNs) account for approximately 35% of all cystic tumors in the pancreas and represent the largest subgroup. They are characterized by mucin production and intraductal papillary epithelium growth. IPMNs range from benign to malignant lesions. Biomarkers combined with 18F-Fluorodeoxyglucose–positron emission tomography (18FDG–PET) is the best diagnostic tool. The risk of malignant transformation for main-duct IPMNs is between 34–68% and for low-risk branch-duct (BD)-IPMNs it is 1.1%. Monitoring is crucial for determining the optimal time of surgical excision. Novel artificial intelligence combining clinical, tumor biomarkers, imaging and molecular genomics plays a determinant role in the evaluation of such lesions. The first diagnostic tool is multidetector helical computed tomography (MDHCT) or up-to-date magnetic resonance imaging (MRI). MRI detects malignancy by enhancing mural nodules ≥3 mm. Novel endosonographic interventional techniques have been added to the diagnostic armamentarium. Pancreatoscopy is feasible and effective but challenging for evaluating the diagnosis, invasiveness, and extent of IPMNs. Its findings may change the surgical approach. Pancreatic juice and duodenal fluid have been used recently for molecular biological analysis. The genes most frequently altered include Kirsten rat sarcoma viral proto-oncogene (KRAS), tumor protein p53 (TP53), cyclin-dependent kinase inhibitor 2A (CDKN2A), SMAD family member 4 (SMAD4), and guanine nucleotide-binding protein, alpha stimulating (GNAS). Despite the advances in diagnostic modalities, assessment of this premalignant lesion of pancreatic cancer, with its poor prognosis, is a challenging task. Pancreatectomy is the indicated approach for malignant or high-risk IPMNs with potent malignancy. Conservative management or enucleation for preserving the pancreas of low-risk BD-IPMNs is recommended, but long-term follow-up for recurrence is necessary. The management of IPMNs must be individualized based on preoperative high-risk stigmata and worrisome features.

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Section: Diagnosismentioning

confidence: 99%

“…EUS-guided fine-needle aspiration (FNA) provides samples for cytological, biomarker or molecular examination [10,44,[50][51][52]. The accuracy of pancreatic EUS-guided fine-needle biopsy (FNB) is high, up to 85% [53][54][55], as its molecular analysis [56].…”

Section:  Diagnosismentioning

confidence: 99%

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Pavlidis

Sapalidis²,

Pavlidis³

2022

Rom J Morphol Embryol

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“…Both endoscopic ultrasound (EUS)- and endoscopic retrograde cholangiopancreatography (ERCP)-based techniques can offer substantial information that can be used for determining the diagnosis of both solid lesions and PCLs, as well as undetermined biliary and/or pancreatic strictures. Additionally, a multidisciplinary approach is required to offer appropriate management and avoid misdiagnosis and unnecessary surgical resections that are potentially related to morbidity and mortality [ 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Using Endoscopy in the Diagnosis of Pancreato-Biliary Cancers

Chaves

Viesca

Arvanitakis

2023

Cancers

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Pancreatic cancer and cholangiocarcinoma are life threatening oncological conditions with poor prognosis and outcome. Pancreatic cystic lesions are considered precursors of pancreatic cancer as some of them have the potential to progress to malignancy. Therefore, accurate identification and classification of these lesions is important to prevent the development of invasive cancer. In the biliary tract, the accurate characterization of biliary strictures is essential for providing appropriate management and avoiding unnecessary surgery. Techniques have been developed to improve the diagnosis, risk stratification, and management of pancreato-biliary lesions. Endoscopic ultrasound (EUS) and associated techniques, such as elastography, contrasted-enhanced EUS, and EUS-guided needle confocal laser endomicroscopy, may improve diagnostic accuracy. In addition, intraductal techniques applied during endoscopic retrograde cholangiopancreatography (ERCP), such as new generation cholangioscopy and in vivo cellular evaluation through probe-based confocal laser endomicroscopy, can increase the diagnostic yield in characterizing indeterminate biliary strictures. Both EUS-guided and intraductal approaches can provide the possibility for tissue sampling with new tools, such as needles, biopsies forceps, and brushes. At the molecular level, novel biomarkers have been explored that provide new insights into diagnosis, risk stratification, and management of these lesions.

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Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies

Yasrab,

Kwak,

Khoshpouri

et al. 2024

Abdom Radiol

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Factors associated with misdiagnosis of preoperative endoscopic ultrasound in patients with pancreatic cystic neoplasms undergoing surgical resection

Cited by 5 publications

References 33 publications

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Using Endoscopy in the Diagnosis of Pancreato-Biliary Cancers

Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies

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