Pancreatic cancer echocardiography or ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2];Parminder Dhingra, M.D. [3];Faizan Sheraz, M.D. [4]
Overview
Pancreatic cancer has a variable appearance on USG. The appearance relative to normal pancreatic tissue may be hypoechoic , isoechoic or hyperechoic. In majority of the cases, an ill defined hypoechoic mass is seen infiltrating into a bright pancreatic parenchyma. Pancreatic and biliary duct dilatation is seen in case of carcinoma of the head of pancreas (Double duct sign). The disadvantage of a transabdominal USG is its inability to clearly demarcate lymphadenopathy, tumor margins and the relation of the tumor to vessels around the pancreas. Endoscopic Ultrasound (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. It 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 particularly in cases where CT evaluation suggests equivocal findings. Moreover, EUS-guided fine needle aspiration biopsy (FNA) is the best modality for obtaining a tissue diagnosis.
Ultrasound
- Pancreatic cancer has a variable appearance on USG.
- The appearance relative to normal pancreatic tissue may be:
- 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 [1])
Drawbacks of Transabdominal USG:
- 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 USG (EUS):
Advantages
- 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
- EUS is inferior to CT for evaluation of distant metastases.
- EUS is also operator-dependent; hence its value varies with physician expertise.
References
- ↑ Pancreatic ductal carcinoma. Dr Ahmed Abd Rabou and Dr Frank Gaillard et al. Radiopedia.org 2015. http://radiopaedia.org/articles/pancreatic-ductal-carcinoma