Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

Early diagnosis of pancreatic cancer remains a difficult task, and multiple imaging tests have been proposed over the years. The aim of this review is to describe the current role of endoscopic ultrasound (EUS) for the diagnosis and staging of patients with pancreatic cancer. A detailed search of MEDLINE between 1980 and 2007 was performed using the following keywords: pancreatic cancer, endoscopic ultrasound, diagnosis, and staging. References of the selected articles were also browsed and consulted. Despite progress made with other imaging methods, EUS is still considered to be superior for the detection of clinically suspected lesions, especially if the results of other cross-sectional imaging modalities are equivocal. The major advantage of EUS is the high negative predictive value that approaches 100%, indicating that the absence of a focal mass reliably excludes pancreatic cancer. The introduction of EUS-guided fine needle aspiration allows a preoperative diagnosis in patients with resectable cancer, as well as a confirmation of diagnosis before chemoradiotherapy for those that are not. This comprehensive review highlighted the diagnostic capabilities of EUS including the newest refinements such as contrast-enhanced EUS, EUS elastography, and 3-dimensional EUS. The place of EUS-guided biopsy is also emphasized, including the addition of molecular marker techniques.     

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling in gastroenterology, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB), of submucosal tumors, diffuse esophageal/gastric wall thickening, pancreatic solid masses and cystic-appearing lesions, mediastinal lesions unrelated to lung or esophageal cancer, cancer of the esophagus, stomach, and rectum, lymph nodes of unknown origin, adrenal gland masses, and focal liver lesions. False-positive cytopathological results and needle tract seeding are also discussed. The present Clinical Guideline describes the results of EUS-guided sampling in the different clinical settings, considers the role of this technique in patient management, and makes recommendations on circumstances that warrant its use. A two-page executive summary of evidence statements and recommendations is provided. A separate Technical Guideline describes the general technique of EUS-guided sampling, particular techniques to maximize the diagnostic yield depending on the nature of the target lesion, and sample processing. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling.     

内镜超声引导下腹腔神经丛阻滞联合局部化疗在胰腺癌长期镇痛治疗中的研究

目的评价内镜超声引导下腹腔神经丛阻滞联合局部注射化疗对进展期胰腺癌患者的长期镇痛作用。方法选择无手术指征进展期胰腺癌患者23例，在内镜超声引导下行腹腔神经丛阻滞联合局部注射化疗，治疗后随访20周，通过视觉疼痛类比量表（VAS）评分、每周镇痛药注射次数、肿瘤最大径等指标评价治疗效果。结果23例胰腺癌患者均成功进行了腹腔神经丛阻滞和局部化疗，未出现严重并发症。治疗后患者疼痛明显缓解，第4周视觉疼痛类比量表评分下降69．1％（P〈0．05），而治疗后第20周仍下降52．9％。疼痛的缓解与肿瘤的部位及大小无关。镇痛药物的应用次数在治疗前后差异无显著性意义。局部化疗后肿瘤最大径无明显变化。结论内镜超声引导下腹腔神经丛阻滞联合局部化疗控制进展期胰腺癌疼痛长期疗效确切，安全性好。     

经腹超声引导下经皮穿刺活检对内镜超声引导下穿刺活检诊断胰腺肿瘤的补充价值

目的 观察经腹超声引导下经皮穿刺活检对内镜超声(EUS)引导下穿刺活检诊断胰腺肿瘤的补充价值。方法 回顾性分析30例因EUS引导下穿刺活检诊断结果不满意(未见肿瘤细胞20例、可见异常细胞但无法明确诊断10例)而接受经腹超声 引导下经皮穿刺活检的胰腺肿瘤患者,评价后者的补充诊断价值。结果 20例EUS引导下穿刺活检未见肿瘤细胞患者中,经腹超声引导下穿刺活检明确诊断11例肿瘤及其病理类型,7例可见异常细胞但未能明确诊断,2例仍未见肿瘤细胞;10例EUS引导下穿刺结果无法明确诊断患者中, 经腹超声引导下穿刺活检明确诊断9例肿瘤及其病理类型,1例为非典型细胞。结论 经腹超声引导下经皮穿刺活检对EUS引导下穿刺活检诊断胰腺肿瘤具有较高补充价值。     

MSCT后处理技术在诊断胰腺导管内乳头状黏液瘤中的应用

目的 探讨MSCT后处理技术在胰腺导管内乳头状黏液瘤(IPMN)中的诊断价值.方法 对18例经手术病理或超声内镜引导下细针穿刺证实的IPMN患者的临床、病理及MSCT检查资料进行回顾性分析,对MSCT双期增强扫描的原始数据均行MPR、MinIP及CPR,观察病变本身及其与胰管、周围结构的关系.结果 18例IPMN患者中,病变与扩张胰管相通18例(18/18,100%),胰管扩张 >1.0 cm 7例(7/18,38.89%),囊性病变17例(17/18,94.44%),囊实性病变1例(1/18,5.56%).主胰管型6例(6/18,33.33%)、分支胰管型9例(9/18,50.00%)、混合型3例(3/18,16.67%).MPR图像能清晰显示IPMN病变的大小、边界、有无强化的壁结节,也可较好显示病变与扩张胰管间的关系以及病变与周围结构之间的关系;MinIP图像在显示扩张胰管的全貌及病变与扩张胰管间关系等方面优于MPR图像及CPR图像;CPR图像有助于显示主胰管扩张的全貌.结论 利用MSCT多种后处理技术可整体显示病变、扩张胰管以及周围结构,在IPMN诊断方面具有重要价值.     

miR-93表达与内镜黏膜下剥离术治疗老年早期胃癌预后的关系及其靶向抑癌基因的生物信息学分析

目的研究miR-93表达与内镜黏膜下剥离术(ESD)治疗老年早期胃癌预后的关系,利用生物信息学分析miR-93的靶向抑癌基因。方法选择2015年1月-2017年12月在该院接受ESD的老年胃癌患者,收集早期胃癌组织并检测miR-93、PTEN和TIMP2的表达量,随访术后复发情况;另取同期经病理证实为正常胃黏膜的组织作为对照,检测miR-93、PTEN和TIMP2的表达量。结果早期胃癌组织中miR-93的表达量高于正常胃黏膜组织,PTEN和TIMP2的表达量低于正常胃黏膜组织(P 0.05),且miR-93的表达量与PTEN和TIMP2的表达量呈负相关,T_2期、低分化和未分化、黏膜下浸润、发生复发的早期胃癌组织中miR-93的表达量高于T_1期、中分化和高分化、黏膜内浸润、未复发的早期胃癌组织,PTEN、TIMP2的表达量明显低于T_1期、中分化和高分化、黏膜内浸润、未复发的早期胃癌组织(P 0.05);黏膜下浸润、miR-93表达增多、PTEN及TIMP2表达减少是早期胃癌患者术后复发的危险因素;miR-93高表达的早期胃癌患者未复发率低于miR-93低表达患者;miR-93预测早期胃癌复发的最佳截点为0.72。结论 miR-93表达是早期胃癌患者ESD后复发的危险因素,对术后复发具有预测价值,靶向抑癌基因PTEN、TIMP2是其可能的生物学作用。     

肿瘤型M2丙酮酸激酶与癌类抗原19-9联合检测在胰腺癌诊断中的应用

目的:探讨肿瘤型M2丙酮酸激酶(TumorM2-PK,TuM2-PK)、糖类抗原19-9(CA19-9)在胰腺癌中的表达特性。方法:采用ELISA法分别检测50例胰腺癌患者、35例胰腺炎患者及80名健康体检人血中TuM2-PK、CA19-9含量。结果:胰腺癌患者血中TuM2-PK、CA19-9值分别是(164.9±41.3)U/mL、(630.1±200.3)U/mL。在胰腺癌的诊断中单独检测时TuM2-PK、CA19-9敏感性分别为75%、74.5%,特异性分别为90%、85%,联合测定敏感性、特异性分别达到82.3%、100%。结论:联合检测TuM2-PK、CA19-9有助于提高对胰腺癌诊断的特异性和敏感性。     

Endoscopic ultrasound: contrast enhancement

The development of ultrasound contrast agents has allowed for the evaluation of vascularity in digestive organs by contrast-enhanced endoscopic ultrasonography (EUS). Contrast-enhanced Doppler EUS and contrast-enhanced?harmonic EUS (CH-EUS) have improved characterization of pancreatic tumors, lymph nodes, and gastrointestinal submucosal tumors and compliment EUS fine-needle aspiration (FNA) in identifying malignant tumors. Moreover, CH-EUS can be used to identify the target for EUS-guided FNA by clearly depicting the outline of the lesions.     

胰腺导管内乳头状黏液性肿瘤的MSCT征象

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MSCT特点。方法回顾性分析27例经病理证实的IPMN的MSCT表现。所有患者均接受16层或64层CT平扫及增强检查,其中7例接受ERCP检查。结果27例IPMN中,主胰管型11例,包括2例交界性肿瘤,4例原位癌,5例腺癌;CT表现为胰腺不同程度萎缩,主胰管扩张,8例内部可见壁结节,1例见多发斑块状钙化。分支胰管型9例,包括腺瘤和交界性肿瘤各3例,1例原位癌,2例腺癌;其中7例位于胰头部,表现为与主胰管相通的囊性病灶,内见分隔和乳头状壁结节,呈"葡萄串"样,1例可见点状钙化;2例位于胰尾部,呈类圆形囊性病灶,增强无强化。混合型7例,包括交界性肿瘤和腺癌各3例,原位癌1例,表现为主胰管及分支胰管扩张伴腔内壁结节,3例病变内可见不同程度钙化。7例接受ERCP,其中5例明确显示囊性病灶与主胰管相通。结论 IPMN的MSCT表现具有一定特征。MSCT结合ERCP检查有助于术前准确诊断。     

Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline

This article is the second of a two-part publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic ultrasound (EUS)-guided sampling, including EUS-guided fine needle aspiration (EUS-FNA) and EUS-guided Trucut biopsy. The first part (the Clinical Guideline) focused on the results obtained with EUS-guided sampling, and the role of this technique in patient management, and made recommendations on circumstances that warrant its use. The current Technical Guideline discusses issues related to learning, techniques, and complications of EUS-guided sampling, and to processing of specimens. Technical issues related to maximizing the diagnostic yield (e.g., rapid on-site cytopathological evaluation, needle diameter, microcore isolation for histopathological examination, and adequate number of needle passes) are discussed and recommendations are made for various settings, including solid and cystic pancreatic lesions, submucosal tumors, and lymph nodes. The target readership for the Clinical Guideline mostly includes gastroenterologists, oncologists, internists, and surgeons while the Technical Guideline should be most useful to endoscopists who perform EUS-guided sampling. A two-page executive summary of evidence statements and recommendations is provided.     

Guillotine needle biopsy as a supplement to endosonography in the diagnosis of gastric submucosal tumors.

The presumptive diagnosis of gastric submucosal tumors can be made by endoscopic ultrasonography (EUS) but histological confirmation is still required. A special guillotine biopsy device (Flexi-Temno) which enables collection of adequate submucosal samples by the endoscopic approach was therefore evaluated. After visualization by EUS the guillotine needle biopsy was performed in 21 patients with submucosal tumors of the stomach. There were 2 failures in 2 patients with leiomyomas. The diagnosis suggested by EUS was confirmed by guillotine biopsy in 17 cases. Guillotine biopsy detected 2 cases of unsuspected leiomyosarcoma which were confirmed surgically. In cases of solid submucosal tumors confirmed on EUS, the guillotine needle biopsy enables a definitive histologic diagnosis. Thus malignancies can be detected when EUS findings are not significant.     

Endoscopic ultrasound-guided fine needle aspiration in hollow viscus cancer

Accurate cancer staging is essential in patients with hollow viscus malignancy to decide therapeutic modalities. Endoscopic ultrasound (EUS) is considered as the best modality for local staging of hollow viscus cancer. EUS-guided fine needle aspiration (FNA) is a minimally invasive and effective sampling method. EUS-FNA should be applied when positive diagnosis of malignancy can possibly change the choice of therapeutic options. EUS in conjunction with EUS-FNA can optimize stage-directed therapy which is helpful in selecting minimally invasive treatment option including endoscopic treatment and avoiding unnecessary surgery in advanced cases.     

Endoscopic ultrasonography.

Over the past two decades, endoscopic ultrasonography (EUS) has undergone a transition from being a novel imaging technique to a clinical diagnostic test that is necessary for the optimal management of gastrointestinal diseases. EUS has established itself as an important diagnostic modality, mainly for the detection and staging of gastrointestinal cancers. As EUS has become more widespread, research has gradually shifted towards studies that explore the effect of EUS on patient management and outcome. These outcome studies have examined the primary clinical applications of EUS, such as esophageal, gastric, pancreatic, and colorectal cancer staging, as well as the role of EUS in the diagnosis of inflammatory pancreatic diseases. Widespread use of EUS has recently led to studies that examine complications associated with the performance of the procedure. Endosonographers have continued efforts to define a clinical role for EUS in other gastrointestinal diseases, such as portal hypertension. EUS-guided fine-needle aspiration (FNA) is continuing to develop into a powerful diagnostic tool for the management of lung cancer and other mediastinal diseases. New applications for EUS-FNA are also emerging. Finally, investigators are continuing to explore the remaining frontier of EUS-guided therapy.     

早期食管癌和高级别上皮内瘤变行内镜黏膜下剥离术后非治愈性切除的危险因素探讨

目的 探讨早期食管癌和高级别上皮内瘤变行内镜黏膜下剥离术(ESD)后非治愈性切除的危险因素.方法 回顾性分析南京医科大学附属淮安第一医院消化内科收治的153例行ESD的早期食管癌和高级别上皮内瘤变患者的临床资料,根据术后病理结果,分为治愈性切除组和非治愈性切除组,对可能影响非治愈性切除的相关因素进行多因素分析.结果 早...     

白光内镜联合超声内镜检查术在早期胃癌诊断中的应用价值

目的 分析早期胃癌患者经白光内镜联合超声内镜检查术（EUS）的病情评估情况。方法 回顾性分析2019年1月－2022年1月该院45例早期胃癌患者的临床资料，所有患者均完成白光内镜和EUS。分析早期胃癌不同形态病变的白光内镜特征，EUS和白光内镜对早期胃癌浸润深度的评估情况，早期胃癌在EUS和白光内镜下的T分期情况，白光内镜联合EUS在早期胃癌患者中的诊断结果。结果 45例早期胃癌患者的白光内镜结果显示，4例为隆起性，40例为平坦性，1例为凹陷性。以术后病理检查结果为金标准，EUS诊断早期胃癌T分期结果与病理检查结果有较高的一致性，白光内镜诊断早期胃癌T分期结果与病理检查结果一致性较低。白光内镜联合EUS诊断T_is期、T_1a期和T_1b期均具有较高的灵敏度、特异度和准确度。结论 白光内镜能够较好地评估早期胃癌患者的浸润深度，EUS可较好地评估病灶T分期情况，两者联合应用具有较高的诊断价值。     

胰腺癌患者不同体液中CA19-9检测及其临床意义

目的:探讨肿瘤标记物糖类抗原19-9(CA19-9)在胰腺癌及胆胰良性疾病患者的多种体液(血清、胰液、胆汁、胃液和尿液)中的表达及其临床意义。方法:收集2007年1月至3月上海交通大学医学院附属瑞金医院收治的胰腺癌患者16例、胰腺良性疾病患者13例及胆总管结石患者13例,采用化学发光微颗粒免疫分析法对其体液标本进行CA19-9检测。结果:胰腺癌组患者的血清、胰液、胆汁、胃液中CA19-9平均值均高于胰腺良性疾病组和胆总管结石组,且胰腺癌组患者胃液中的CA19-9值与胰腺良性疾病组患者间存在显著差异(P=0.022);而胆总管结石组患者尿液中CA19-9平均测值高于其他2组,且与胰腺良性疾病组间存在显著差异(P=0.047)。结论:对不同体液标本进行CA19-9测定可能有助于鉴别胰腺良、恶性疾病及胆道良性疾病,其具体机制有待进一步研究。     

胰腺占位性病变的超声内镜引导下穿刺诊断与治疗

目的：评价胰腺占位性病变的超声内镜引导下穿刺诊断与治疗价值。方法：采用Olympus GF-UM30P穿刺超声内镜及18G穿刺针对胰腺占位性病灶经胃壁穿刺活检及置入塑料支架行胰腺囊肿胃内引流术。结果：①所穿刺病灶最小烃胰腺癌为3cm,囊肿为2．3cm；②穿刺成功率、取样满意率和诊断准确率均达100％；③胰腺囊肿穿刺后最大径减少均超过50％，2例囊肿消失，术后1、2、3个月复查5例中4例囊肿增大，术后3个月2例囊肿达术前大小，术后1年2例囊肿仍较术前减小50％；④1例行囊肿胃置管内引流术者术后1周囊肿缩小50％，6个月无复发；⑤11例穿刺者未发生任何近期和远期并发症。结论：超声内镜引导下穿刺对胰腺占位性病变的诊断与治疗均有较大价值。     

Power Doppler endoscopic ultrasonography for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis.

OBJECTIVE: The accuracy of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration for the differential diagnosis of pancreatic masses is variable in the literature, being as low as 75% in some studies. The aim of the study was to assess the accuracy of power Doppler EUS for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis. METHODS: We included 42 consecutive patients with pancreatic tumor masses (27 men and 15 women) examined by EUS between January 2002 and August 2004. Endoscopic ultrasonographic procedures included power Doppler EUS as well as EUS-guided fine-needle aspiration in all patients. Final diagnosis of pancreatic cancer was confirmed in 29 patients on the basis of a combination of information provided by imaging tests, follow-up of at least 6 months, and laparotomy in 18 patients for diagnostic or palliative reasons. RESULTS: Sensitivity and specificity of the absence of power Doppler signals inside the suggestive pancreatic mass were 93% and 77%, respectively, with accuracy of 88%. Moreover, the addition of the information provided by the presence of peripancreatic collaterals improved the sensitivity and specificity to 97% and 92%, with accuracy of 95%. CONCLUSIONS: Power Doppler EUS provides useful information for the differential diagnosis of pancreatic masses. The results were in concordance with previous studies that showed a hypovascular pattern of pancreatic carcinoma, as well as the formation of collaterals in advanced cases due to the invasion of the splenic or portal veins. Further studies of dynamic EUS with contrast agents are necessary to better characterize pancreatic masses.     

Diffuse xanthoma in early esophageal cancer: A case report

BACKGROUNDGastrointestinal xanthomas are asymptomatic and infrequent non-neoplastic lesions that commonly occur in the stomach with Helicobacter pylori-associated gastritis and rarely in the esophagus. To date, there have been no reports of esophageal xanthoma combined with esophageal cancer. Herein, we present the first case in the literature of a diffuse xanthoma complicated with early esophageal cancer. Moreover, this combination makes the endoscopic diagnosis difficult if it is not in mind.CASE SUMMARYA 68-year-old man visited our department with a 2-mo history of epigastric discomfort. He underwent surgery for gastric cancer 6 years ago. Esophagogastroduodenoscopy showed a semi-circumferential irregular yellowish-colored and granular lesion in the esophagus (30-35 cm from the incisors). Using magnifying endoscopy with narrow band imaging, aggregated minute and yellowish-colored spots with tortuous microvessels on the surface were observed, and background coloration was clearly seen in the lesion. As endoscopic biopsy suggested a histologically high-grade dysplasia; the lesion was completely resected en bloc by endoscopic submucosal dissection (ESD). The resected specimen was confirmed to be a squamous cell carcinoma in situ with extensive foamy cells in the superficial mucosal layer. Immunohistochemically, the observed foamy cells were strongly positive for CD68, which is characteristic of xanthoma. The clinical course was favorable, and no recurrence was observed 2 years and 7 mo after ESD.CONCLUSIONDiffuse xanthoma concurrent with early esophageal cancer is extremely rare. The characteristic endoscopic features may assist endoscopists in diagnosing similar lesions.