The effect of solid pancreatic mass lesions on pancreatic duct diameter at endoscopic ultrasound

Abstract

Objectives:To evaluate the effect of solid pancreatic masses on the pancreatic duct (PD) at the endoscopic ultrasound (EUS) and the relationship of the location/size of a mass and PD dilation.Materials and Methods:Patients who underwent EUS for pancreatic indications from 2011 to 2013 at a single center were retrospectively identified. Those with biopsies that revealed adenocarcinoma or neuroendocrine tumors in the pancreas were identified and PD size was ascertained from EUS, computed tomography, or magnetic resonance imaging.Results:Of the 475 patients who had a pancreatic EUS, 239 had a dilated PD and 236 had a normal PD. Patients with a dilated PD had a significantly higher incidence of pancreatic malignancy than those with a normal PD diameter (106/239, 44.4% vs. 32/236, 13.6%, P < 0.001). Of the 138 patients with a pancreatic malignancy, 106 (76.8%) had a dilated PD at some location in the pancreas. Over 80% of patients with a mass within the head, neck, or body had a dilated PD. For a mass located at the uncinate process or the tail, PD dilation was 65% and 23%, respectively. Fifty-six (80.0%) of the masses in the head, 11 (78.6%) masses in the neck, and 16 (76.2%) masses in the body had a dilated PD upstream of the mass. In addition, a step-wise increase in the incidence of PD dilation was correlated with an increase in mass size. About 67.6% of patients with masses measuring in the 1st quartile had dilated a PD, while 77.8%, 91.0%, and 71.4% of those with masses measuring in the 2nd, 3rd, and 4th quartiles, respectively, had a dilated PD.Conclusion:PD dilation is a warning sign for pancreatic malignancies, however, small masses or masses at the uncinate process or the tail of the pancreas may not affect the size of the PD.

Construction and validation of an endoscopic ultrasonography-based ultrasomics nomogram for differentiating pancreatic neuroendocrine tumors from pancreatic cancer

“…The ROC curves of different ultrasomics models based on eight machine-learning algorithms for predicting PNET. volume of PNET was notably smaller than that of pancreatic adenocarcinomas (25). In summary, the characteristics of the clinical and EUS ultrasonic features observed in this study were extremely consistent with those of previous reports in the literature, further validating the reliability of the research results.…”

Differentiating pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas by the “Duct-Road Sign”

“…[14] PDACs typically arise from the MPD, whereas PNETs derive from the pancreatic parenchyma. [15] . MPD dilatation is correlated to both PDACs and PNETs but more likely associated with PDACs.…”

Comparison between triphasic CT and EUS pancreatic biopsy in characterization of pancreatic lesions

“…There was a positive correlation and highly significant probability between pancreatic duct dilatation and FNB result, Therefore, after the exclusion of associated pancreatic duct stones, in the CT patients with undetected small sized masses that had prominent/dilated pancreatic duct this is a good clue of raise the suspicious of underlying mass/lesion. Cai et al, (26) said that dilatation of the pancreatic duct is a warning indication for pancreatic cancers; nonetheless, tiny lumps or masses at the pancreatic tail or uncinate process might not have an impact on the pancreatic duct size. Also, Francis (27) agreed with us, as he reported that the indirect signs such as 'upstream' pancreatic duct dilation or the 'double duct' sign due to pancreatic and common bile duct obstruction are helpful in diagnosing the small iso attenuating tumors.…”