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The role of endoscopic ultrasound in diagnosing pancreatic neuroendocrine tumours

100%

Dyrla P., Chmielewska M., Mazur M., Witek P.

OncoReview

2018

vol. 8

issue 1

19-23

Pancreatic tumour imaging poses one of the greatest challenges in gastroenteropancreatic tumour diagnostics. Though much less common than adenocarcinomas, tumours deriving from pancreatic islets are the second most common group of pancreatic tumours. The manifestations and growth rate of neuroendocrine tumours (NETs) differ from adenocarcinomas; thus, these tumour types require different diagnostic and therapeutic approaches. With its high sensitivity and specificity, endoscopic ultrasound (EUS) seems to be indispensable in pancreatic NET diagnostics. A negative EUS practically excludes the presence of a pancreatic tumour, while in definitive tumour cases, EUS is helpful in tumour staging, and in determining its precise anatomical location. One especially important benefit of EUS is the option of performing a biopsy for subsequent cytological and histopathological examinations. The use of contrast and additional computerized image analysis increases the diagnostic accuracy of EUS. This article presents current views on the use of EUS in pancreatic tumour diagnostics, with a particular emphasis on diagnosing NETs.

Endoskopowa ultrasonografia czy endoskopowa cholangiopankreatografia w diagnostyce kamicy żółciowej przewodowej?

75%

Leszczyszyn J.

Journal of Ultrasonography

2014

vol. 14

issue 57

125-129

It is estimated that 3.4% of patients qualified for cholecystectomy due to cholelithiasis have a coexisting choledocholithiasis. For decades, endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected choledocholithiasis. The method is associated with a relatively high rate of complications, including acute pancreatitis, the incidence of which is estimated to range between 0.74% and 1.86%. The mechanism of this ERCP-induced complication is not fully understood, although factors increasing the risk of acute pancreatitis, such as sphincter of Oddi dysfunction, previous acute pancreatitis, narrow bile ducts or difficult catheterization of Vater’s ampulla are known. It has been suggested to discontinue the diagnostic endoscopic retrograde ascending cholangiopancreatography and replace it with endoscopic ultrasonography due to possible and potentially dangerous complications. Endoscopic ultrasonography has sensitivity of 94% and specificity of 95% regardless of gallstone diameter, as opposed to magnetic resonance cholangiography. However, both of these parameters depend on the experience of the performing physician. The use of endoscopic ultrasonography allows to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the Vater’s ampulla followed by a mechanical evacuation of stone deposits from the ducts still remains a golden standard in the treatment of choledocholithiasis. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, the diagnostic endoscopic ultrasonography followed by a simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis.

Kamica przewodu żółciowego u pacjentów zakwalifikowanych do cholecystektomii współistnieje z kamicą pęcherzyka żółciowego u 3,4% chorych. Od kilkudziesięciu lat standardem diagnostycznym w podejrzeniu kamicy żółciowej przewodowej była endoskopowa cholangiopankreatografia wstępująca. Metoda ta obarczona jest relatywnie wysokim odsetkiem powikłań w postaci ostrego zapalenia trzustki, którego częstość ocenia się na 0,74% do 1,86%. Mechanizm tego powikłania po diagnostycznym ERCP nie jest do końca zrozumiały, choć znane są czynniki zwiększające prawdopodobieństwo ostrego zapalenia trzustki, takie jak: zaburzenia motoryki zwieracza Oddiego, przebyte wcześniej ostre zapalenie trzustki, wąskie przewody żółciowe czy trudna kaniulacja brodawki Vatera. Z powodu możliwych, potencjalnie groźnych dla życia powikłań postuluje się całkowite zaniechanie wykonywania diagnostycznej endoskopowej cholangiopankreatografii wstępującej i zastąpienie jej endoskopową ultrasonografią. Endoskopowa ultrasonografia cechuje się czułością 94% i specyficznością 95%. Cechy te są niezależne od średnicy złogów, w przeciwieństwie do cholangiografii w rezonansie magnetycznym, natomiast związane są z doświadczeniem lekarza wykonującego badanie. Zastosowanie endoskopowej ultrasonografii pozwala ograniczyć liczbę wykonywanych endoskopowych cholangiopankreatografii o ponad 2/3. Endoskopowa cholangiopankreatografia wstępująca połączona z endoskopowym nacięciem zwieracza brodawki Vatera i mechaniczną ewakuacją złogów z przewodu nadal pozostaje złotym standardem w leczeniu kamicy przewodowej. Pomimo pewnych wad, takich jak potencjalnie zwiększony koszt leczenia, konieczność wykonywania zabiegu przez lekarza doświadczonego zarówno w endoskopowej cholangiopankreatografii, jak i endoskopowej ultrasonografii, najbardziej efektywnym schematem postępowania diagnostyczno-terapeutycznego w przypadku podejrzenia kamicy przewodowej, jest wykonanie diagnostycznej endoskopowej ultrasonografii, z następową, jednoczasową endoskopową cholangiopankreatografią celem usunięcia złogów.

Benign Histology After Pancreaticoduodenectomy for Suspected Malignancy. Lessons to be Learned – a Single Centre Experience

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Azamfirei L., Zen Y., Peddu P., Jain R., Patel A., Atkinson S., Srinivasan P., Rela M., Heaton N., Prachalias A.

Polish Journal of Surgery

2015

vol. 87

issue 1

6-15

The aim of the study was to perform a comprehensive analysis of patients with a benign final histology after pancreaticoduodenectomies (PD) for suspected pancreatic and periampullary cancer. Material and methods. We searched the pathology database at the King's College Hospital for negative PD specimens submitted between January 2004-December 2010. Clinical, diagnostic, surgical, histopathological and outcome data were collected retrospectively. Pathology specimens and imaging results have been re-evaluated. A literature review was performed to identify factors affecting the incidence across centres. Results. 469 PD were performed for presumed cancer. The incidence of benign disease encountered in this group was 7.25% (34/469). Autoimmune pancreatitis (AIP) was a finding in 26.47% (9/34) of cases. 17.65% of PD were complicated by a pancreatic leak and the overall mortality rate was 8.82% (3/34). Radiologists revised over 75% of pre-operative diagnoses. The incidence of benign disease was correlated with the overall centre experience and utilisation of CT imaging, but not ERCP or EUS. Conclusions. It is impossible with current diagnostics to entirely avoid cases of benign disease in patients undergoing PD for suspected cancer. The mortality rate is higher in this group, but it is possible to avoid unnecessary procedures in experienced centres. AIP represents an important diagnostic entity, which should be actively pursued pre-operatively.

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1 Journal of Ultrasonography

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1 Polish Journal of Surgery

1 2018

1 2015

1 2014

1 Atkinson S.

1 Azamfirei L.

1 Chmielewska M.

1 Dyrla P.

1 Heaton N.

1 Jain R.

1 Leszczyszyn J.

1 Mazur M.

1 Patel A.

1 Peddu P.

1 Prachalias A.

1 Rela M.

1 Srinivasan P.

1 Witek P.

1 Zen Y.

Search results

The role of endoscopic ultrasound in diagnosing pancreatic neuroendocrine tumours

Endoskopowa ultrasonografia czy endoskopowa cholangiopankreatografia w diagnostyce kamicy żółciowej przewodowej?

Benign Histology After Pancreaticoduodenectomy for Suspected Malignancy. Lessons to be Learned – a Single Centre Experience