Identifying contraindications to resection in patients with pancreatic carcinoma: the role of endoscopic ultrasound.
OBJECTIVE
To present recently published material comparing the performance of endosonography relative to other imaging modalities when evaluating the patient with a suspected or known pancreas carcinoma.


METHODS
Medline was searched using the terms "endosonography" and "pancreas neoplasms". References from retrieved papers were reviewed to identify other reports. Emphasis was placed on peer-reviewed material published within the past three years that included comparison with other imaging modalities.


RESULTS
Despite advances in cross-sectional imaging modalities, endosonography remains the most sensitive and specific method for identifying pancreatic mass lesions. The resectability of pancreatic carcinoma is best determined with dual-phase helical computed tomography, although endosonography may be slightly more accurate for lymph node assessment. Endoscopic ultrasound-guided fine needle aspiration biopsy has a high sensitivity (93%) and specificity (100%) when used in patients with masses in whom pancreatic cancer is suspected but prior biopsies have been negative.


CONCLUSIONS
Endosonography helps in the diagnosis of pancreatic neoplasms through definitive inclusion or exclusion of a mass lesion as well as biopsy confirmation of malignancy. The role of endosonography in the determination of resectability has been eclipsed by dual-phase helical computed tomography. However, endoscopic ultrasound with fine needle aspiration of nonperitumoral lymph nodes may identify advanced disease with sufficient frequency to justify its routine use in patients with lesions that are thought to be resectable based on helical computed tomography.
Wiersema
Maurits J
MJ
Eisenberg 8A, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. wiersema.maurits@mayo.edu
D001707:Biopsy, Needle; D019160:Endosonography; D006801:Humans; D008279:Magnetic Resonance Imaging; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed