title: Differential diagnosis of small solid pancreatic lesions.
abstract: OBJECTIVE
  Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical management.
  
  
  METHODS
  Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients.
  
  
  RESULTS
  The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%).
  
  
  CONCLUSIONS
  Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.
authors.affiliation: Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China; Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany.
authors.forename: Christoph Frank
authors.initials: CF
authors.lastname: Dietrich
authors.affiliation: Division of Gastroenterology, CHUM, Hopital Saint Luc, Montreal, Quebec, Canada.
authors.forename: Anand Vasante
authors.initials: AV
authors.lastname: Sahai
authors.affiliation: Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: D'Onofrio
authors.affiliation: SRH Wald Klinikum Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Will
authors.affiliation: PancreatoBiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.affiliation: PancreatoBiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Petrone
authors.affiliation: Medical Department, Helios Klinikum Meiningen, Meiningen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hocke
authors.affiliation: Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Barbara
authors.initials: B
authors.lastname: Braden
authors.affiliation: Medical Department I, Sana Hospital Lübeck, Lübeck, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Burmester
authors.affiliation: Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Möller
authors.affiliation: Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania; Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Adrian
authors.initials: A
authors.lastname: Săftoiu
authors.affiliation: Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Ignee
authors.affiliation: Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China; Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany.
authors.forename: Xin-Wu
authors.initials: XW
authors.lastname: Cui
authors.affiliation: Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania.
authors.forename: Sevastita
authors.initials: S
authors.lastname: Iordache
authors.affiliation: Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Potthoff
authors.affiliation: Gastroenterology and Hepatology Department, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Iglesias-Garcia
authors.affiliation: Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna and Hospital of Imola, Imola, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Fusaroli
authors.affiliation: Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jenssen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D003287:Contrast Media