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EUS for Diagnosis and Staging of Pancreatic Cancer

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Pancreatic Cancer

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Abstract:

Endoscopic ultrasonography (EUS) was introduced into clinical practice in the end-seventies with the primary aim of better visualization of the pancreas compared with transabdominal ultrasonography. Today, EUS seems to be an important and widely recognized imaging procedure for the diagnosis and preoperative staging of pancreatic cancer. Several studies support the superiority of EUS compared with other imaging tests, in the diagnosis of pancreatic cancer, especially when small tumors are concerned.

Development of EUS-guided fine needle aspiration (EUS-FNA) in pancreatic masses in the early nineties played an important role in establishing EUS in the management of patients suspected of having pancreatic neoplasia. Here, the diagnosis of a pancreatic carcinoma or the differential diagnosis of pancreatic masses or smaller lesions is among its best indications. Despite its small complication risk and its high accuracy rates, EUS-FNA should only be performed when having an impact on patient management.

On the other hand, the exact role of EUS in pancreatic cancer staging is nowadays more controversial and conflicting, as the studies evaluating this role are extremely inconsistent, their criteria are partially ill-defined and their gold standards very different. Here, EUS has lately lost some grounds compared with computed tomography (CT), due to the drastic improvements in technology of cross-sectional imaging tests but mostly due to the increased availability and more widespread expertise of CT. EUS should definitely be used in cases of an indeterminate CT or when EUS-FNA is necessary for diagnostic or even therapeutic reasons.

In this chapter classical knowledge is presented, together with recent evidence in areas of ongoing interest in the role of EUS in the diagnosis and staging of cancer of the pancreas. Current comparative data between EUS and cross-sectional imaging modalities, including transabdominal ultrasonography, CT, magnetic resonance imaging, and positron emission tomography are also analyzed, despite the relativity of these comparisons, due to the ongoing evolution in medical imaging technology.

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  1. Hepatogastroenterology Unit, Department of Internal Medicine, Attikon University General Hospital, University of Athens,  , Greece

    Ioannis S. Papanikolaou

  2. Department of Interdisciplinary Endoscopy, Eppendorf University Hospital of Hamburg,  , Germany

    Thomas Rösch

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Papanikolaou, I.S., Rösch, T. (2010). EUS for Diagnosis and Staging of Pancreatic Cancer. In: Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77498-5_31

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