Pancreatic cancer ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sudarshana Datta, MD [2]

## Overview

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The appearance of pancreatic cancer relative to normal pancreatic tissue may be hypoechoic, isoechoic or hyperechoic on transabdominal ultrasound. An ill defined hypoechoic mass is seen infiltrating into a bright pancreatic parenchyma in majority of the cases. This may be accompanied by pancreatic and biliary duct dilatation. Endoscopic Ultrasound (EUS) has a higher resolution than transabdominal ultrasound, due to the small distance between the endoscope and pancreas through the wall of the duodenum. EUS plays an important role in the preoperative staging of pancreatic cancer and also has a high efficacy in the detection of tumors smaller than 2 cm, for local T and N staging, and prediction of vascular invasion. Moreover, EUS-guided fine needle aspiration biopsy (FNA) is the best modality for obtaining a tissue diagnosis.

## Transabdominal Ultrasound

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* Pancreatic cancer has a variable appearance on USG.
* The appearance relative to normal pancreatic tissue may be:[1]
* Hypoechoic
* Isoechoic
* Hyperechoic
* In majority of the cases, an ill defined hypoechoic mass is seen infiltrating into a bright pancreatic parenchyma. Ascites may also be visible.
* Pancreatic and biliary duct dilatation is seen in case of carcinoma of the head of pancreas (Double duct sign [2])

* The drawbacks of transabdominal USG are as follows:[3]
* USG does not clearly demarcate
* Lymphadenopathy
* Tumor margins
* The relation of the tumor to vessels around the pancreas

* USG has lower sensitivity as compared to other modalities in the detection of pancreatic cancer smaller than 2 cm.
* For pancreatic cancer detection:
* Sensitivity= 70%
* Specificity= 95%

## Endoscopic Ultrasound (EUS)

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Advantages of EUS are as follows:[4][5]

* EUS has a high efficacy in the detection of tumors smaller than 2 cm, for local T and N staging, and prediction of vascular invasion.
* EUS has a higher resolution than transabdominal ultrasound, due to the small distance between the endoscope and pancreas through the wall of the duodenum.
* EUS has a role in the preoperative staging of pancreatic cancer particularly in cases where CT evaluation suggests equivocal findings.
* EUS-guided fine needle aspiration biopsy (FNA) is the best modality for obtaining a tissue diagnosis.

Drawbacks of EUS are as follows: [6]

* EUS is inferior to CT for evaluation of distant metastasis.

* EUS is also operator-dependent; hence its value varies with physician expertise.

## References

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1. ↑ Shin LK, Brant-Zawadzki G, Kamaya A, Jeffrey RB (2009). "Intraoperative ultrasound of the pancreas". Ultrasound Q. 25 (1): 39–48, quiz 48. doi:10.1097/RUQ.0b013e3181901ce4. PMID 19276960.
2. ↑ Pancreatic ductal carcinoma. Dr Ahmed Abd Rabou and Dr Frank Gaillard et al. Radiopedia.org 2015. http://radiopaedia.org/articles/pancreatic-ductal-carcinoma
3. ↑ Tawada K, Yamaguchi T, Kobayashi A, Ishihara T, Sudo K, Nakamura K, Hara T, Denda T, Matsuyama M, Yokosuka O (2009). "Changes in tumor vascularity depicted by contrast-enhanced ultrasonography as a predictor of chemotherapeutic effect in patients with unresectable pancreatic cancer". Pancreas. 38 (1): 30–5. PMID 19117085.
4. ↑ Tamburrino D, Riviere D, Yaghoobi M, Davidson BR, Gurusamy KS (2016). "Diagnostic accuracy of different imaging modalities following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer". Cochrane Database Syst Rev. 9: CD011515. doi:10.1002/14651858.CD011515.pub2. PMID 27631326.
5. ↑ Yoon WJ, Daglilar ES, Fernández-del Castillo C, Mino-Kenudson M, Pitman MB, Brugge WR (2014). "Peritoneal seeding in intraductal papillary mucinous neoplasm of the pancreas patients who underwent endoscopic ultrasound-guided fine-needle aspiration: the PIPE Study". Endoscopy. 46 (5): 382–7. doi:10.1055/s-0034-1364937. PMID 24619804.
6. ↑ Horton KM, Fishman EK (2002). "Multidetector CT angiography of pancreatic carcinoma: part I, evaluation of arterial involvement". AJR Am J Roentgenol. 178 (4): 827–31. doi:10.2214/ajr.178.4.1780827. PMID 11906856.

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