Endoscopic ultrasound in solid pancreatic masses - current state and review of the literature [Endoskopski ultrazvuk u dijagnostici solidnih tvorbi gušterače - trenutno stanje i pregled literature]

Tadić, Mario and Štoos-Veić, Tajana and Vukelić-Marković, Mirjana and Ćurić, Josip and Banić, Marko and Čabrijan, Željko and Grgurević, Ivica and Kujundžić, Milan (2010) Endoscopic ultrasound in solid pancreatic masses - current state and review of the literature [Endoskopski ultrazvuk u dijagnostici solidnih tvorbi gušterače - trenutno stanje i pregled literature]. Collegium Antropologicum, 34 (1). pp. 337-340. ISSN 0350-6134

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Abstract

Some 25 years ago endoscopic ultrasound (EUS) was introduced in clinical practice for better visualization of pancreas. At the time of introduction EUS was superior to other methods in detection of pancreatic masses allowing tissue diagnosis by later introduced EUS-guided fine needle aspiration (FNA). During the time EUS was improved, electronic probes replaced mechanical probes adding ability of color Doppler, power Doppler, contrast enhanced endosonography as well as EUS elastography analysis. Meanwhile, CT technology has also experienced significant improvements raising the question whether EUS has lost ground in diagnostics of solid pancreatic masses. The aim of this review was to discuss the current evidence of clinical impact of EUS and EUS-FNA in evaluation of solid pancreatic masses with special emphasis on differentiation between benign and malignant pancreatic lesions. According to the literature, the detection of small pancreatic tumors, preoperative localization of pancreatic endocrine tumors and tissue sampling by fine-needle aspiration of pancreatic masses in cases with therapeutic consequences are considered firm indications for EUS. Cytological tissue analysis remains undisputed in differentiation benign from malignant lesions, but the question when FNA is needed is discussed. Color Doppler, power Doppler, contrast enhanced endosonography and especially elastography are also discussed as tools that are bringing additional information in evaluation of pancreatic masses, however insufficient for definitive judgment of the lesion’s nature. Pancreatic cancer staging as indication for EUS is discussed controversially, inconsistent results and conflicting evidence in literature making adequate conclusion impossible. However, this indicates that at least the role of EUS is no longer undisputed in this matter. Resuming the role of EUS we can state that despite some controversies EUS is very valuable method in evaluation of solid pancreatic masses and with EUS guided FNA is nowadays by far the best method for obtaining tissue diagnosis.

Abstract in Croatian

Prije otprilike 25 godina endoskopski ultrazvuk (EUS) uveden je u kliničku praksu kako bi omogućio bolji pregled promjena u gušterači. U to vrijeme, EUS je bio nadmoćan ostalim metodama u otkrivanju tvorbi u gušterači, a uz kasnije uvedenu citološku punkciju vođenu EUS-om omogućeno je i postavljanje tkivne dijagnoze. Tijekom vremena EUS je tehnološki napredovao. Mehanička sonda zamijenjena je elektroničkom koja je omogućila dodatne analize obojenim Dopplerom i power Dopplerom, te analizu kontrastom pojačanim EUS-om i EUS elastografiju. Istovremeno je znatno napredovala i tehnologija kompjuterizirane tomografije (CT) te neki autori postavljaju pitanje je li EUS izgubio prednost u dijagnostici solidnih tvorbi gušterače. Cilj ovog pregleda je iznijeti najnovije literaturne dokaze o utjecaju EUS-a i EUS-FNA na dijagnostiku promjena u gušterači s posebnim osvrtom na razlikovanje dobroćudnih od zloćudnih promjena. Prema podatcima iz literature, neupitne indikacije za EUS su otkrivanje malih tumora gušterače, preoperativna lokalizacija endokrinih tumora te dobivanje uzoraka za tkivnu dijagnozu u slučajevima kad to ima utjecaj na daljnji postupak s bolesnikom. Citološka tkivna dijagnoza je i dalje neupitna za razlikovanje malignog od benignog, međutim postavlja se pitanje kad je tkivna dijagnoza i citološka punkcija neophodna. Prema literaturnim podatcima obojeni Doppler, power Doppler, EUS pojačan kontrastom i EUS elastografija su se pokazali kao metode koje nude dodatne informacije u evaluaciji solidnih promjena gušterače, ali nedovoljno da bi otkrile definitivnu prirodu lezije. Uloga EUS-a u procjeni proširenosti tumora gušterače je prema literaturnim podatcima kontroverzna, a kako neki upućuju na superiornost EUS-a a drugi na superiornost CT-a nije moguće dati kvalitetan zaključak. Međutim, to ukazuje da EUS nije neprikosnoven u procjeni proširenosti tumora.

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