Differential diagnosis of small solid pancreatic lesions

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• 作者：Christoph Frank Dietrich ; MD ; PhD¹ ; ² ; ; Anand Vasante Sahai ; MD ; PhD³ ; Mirko D&rsquo ; Onofrio ; MD⁴ ; Uwe Will ; MD ; PhD⁵ ; Paolo Giorgio Arcidiacono ; MD ; PhD⁶ ; Maria Chiara Petrone ; MD⁶ ; Michael Hocke ; MD ; PhD⁷ ; Barbara Braden ; MD ; PhD⁸ ; Eike Burmester ; MD⁹ ; Kathleen Mö ; ller ; MD¹⁰ ; Adrian Săftoiu ; MD ; PhD¹¹ ; ¹² ; Andre Ignee ; MD² ; Xin-Wu Cui ; MD ; PhD¹ ; ² ; Sevastita Iordache ; MD¹¹ ; Andrej Potthoff ; MD¹³ ; Julio Iglesias-Garcia ; MD ; PhD¹⁴ ; Pietro Fusaroli ; MD ; PhD¹⁵ ; Yi Dong ; MD ; PhD² ; ¹⁶ ; Christian Jenssen ; MD¹⁷
• 关键词：EUS-FNA ; EUS-guided FNA ; fine needle aspiration ; MRI ; magnetic resonance imaging ; PDAC ; pancreatic ductal adenocarcinoma ; PAMUS ; pancreatic multicenter ultrasound study
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：84
• 期：6
• 页码：933-940
• 全文大小：636 K

文摘

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.