Skip to main content
SpringerLink
Log in

Place de l’échoendoscopie pancréatique dans la prise en charge des tumeurs intracanalaires papillaires et mucineuses du pancréas (TIPMP)

Place of endoscopic ultrasonography in IPMN

  • Mise au Point / Update
  • Published:
Acta Endoscopica

Résumé

Environ 10 % de la population de plus de 70 ans est atteinte d’une lésion kystique du pancréas. Les tumeurs intracanalaires papillaires et mucineuses du pancréas (TIPMP) et les cystadénomes mucineux font partie des tumeurs kystiques pancréatiques qui ont un risque de dégénérescence. l’échoendoscopie (EE) est au moins aussi sensible que l’IRM pour diagnostiquer une communication entre un kyste et un canal pancréatique. En cas de doute diagnostique, le dosage de l’ACE dans le liquide de ponction du kyste permet d’orienter vers une origine mucineuse. l’analyse cytologique est utile pour rechercher des cellules en dysplasie dans les TIPMP des canaux secondaires avec un kyste de 20–30 mm. Il est recommandé de réaliser une ponction après une antibioprophylaxie et arrêt des antiagrégants plaquettaires et anticoagulants. Grâce à sa haute résolution, l’EE est l’examen le plus performant pour rechercher des critères morphologiques de mauvais pronostic (taille des kystes, nodules muraux, épaississement pariétal). l’utilisation du contraste en EE permettrait de mieux différencier le mucus d’un nodule mural. La microscopie confocale et l’EE endocanalaire sont en cours d’évaluation. Des protocoles de surveillance des TIPMP ont été établis, mais leur rationnel scientifique est encore faible, c’est pourquoi une étude nationale est en cours.

Abstract

About 10% of the population more than 70 years is suffering from a cystic lesion of the pancreas. IPMN and mucinous cystic neoplasm are pancreatic cysts with a malignantrisk. Endoscopic ultrasonography (EUS) is at least as sensitive as MRI to diagnose a communication between the cyst and pancreatic duct. In case of doubtful diagnostic of mucinous cystic lesion of the pancreas, biochemical assay for cyst fluid ACE is an accurate discriminative test. Cytology adds value to the radiological assessment to predict malignancy in mucinous cysts in detecting high-grade dysplasia, particularly in small branch duct IPMN a cyst of 20 to 30 mm. Thanks to its high resolution, EUS is the most efficient tool to determine high-risk malignancy factors (cyst size, mural nodule, thickened/enhancing cyst walls). It is recommended to perform fine-needle aspiration after antibiotic treatment without antiplatelet agents and anticoagulants. Contrast EUS is better differentiating mucus from a mural nodule. Confocal microscopy and IDUS are being evaluated. Follow-up protocols have been established but their scientific rational is still low, that’s why a national study is ongoing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Références

  1. Kleihues P, Sobin LH. World Health Organization classification of tumors. International Agency for Research on Cancer, World Health Organization, Lyon, France. Cancer 2000;88:2887.

    Article  CAS  PubMed  Google Scholar 

  2. Levy P, Jouannaud V, O’Toole D, Couvelard A, Vullierme MP, Palazzo L, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol 2006;4:460–8.

    Article  PubMed  Google Scholar 

  3. Chari ST, Yadav D, Smyrk TC, DiMagno EP, Miller LJ, Raimondo M, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 2002;123:1500–7.

    Article  PubMed  Google Scholar 

  4. Waters JA, Schnelldorfer T, Aguilar-Saavedra JR, Chen JH, Yiannoutsos CT, Lillemoe KD, et al. Survival after resection for invasive intraductal papillary mucinous neoplasm and for pancreatic adenocarcinoma: a multi-institutional comparison according to American Joint Committee on Cancer Stage. J Am Coll Surg 2011;213:275–83.

    Article  PubMed  Google Scholar 

  5. Kimura W, Sasahira N, Yoshikawa T, Muto T, Makuuchi M. Duct-ectatic type of mucin producing tumor of the pancreasnew concept of pancreatic neoplasia. Hepatogastroenterology 1996;43:692–709.

    CAS  PubMed  Google Scholar 

  6. Perez-Johnoson R, Narin O, Mino-Kenudson M, Ingkakul T, Warshaw AL, Fernandez-Del Castillo C, et al. Frequency and signifiance of calcification in IPMN. Pancreatology 2013;13:43–7.

    Article  Google Scholar 

  7. Palazzo L. Tumeur intra-canalaire papillaire et mucineuse du pancréas (TIPMP). Acta Endosc 2002;36:269–79.

    Google Scholar 

  8. Kim JH, Eun HW, Park HJ, Hong SS, Kim YJ. Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct. Eur J Radiol 2012;81:2927–35.

    Article  PubMed  Google Scholar 

  9. Kim SY, Lee JM, Kim SH, Shin KS, Kim YJ, An SK, et al. Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. Am J Roentgenol 2006;187:1192–8.

    Article  Google Scholar 

  10. Barbe L, Ponsot P, Vilgrain V, Terris B, Flejou JF, Sauvanet A. Tumeurs intracanalaires papillaires mucineuses pancréatiques. Aspects cliniques et morphologiques chez 30 malades. Gastroenterol Clin Biol 1997;21:278–86.

    CAS  PubMed  Google Scholar 

  11. Adimoolam V, Sanchez MJ, Siddiqui UD, Yu S, Dzuira JD, Padda MS, et al. Endoscopic ultrasound identifies synchronous pancreas cystic lesions not seen on initial cross-sectional Imaging. Pancreas 2011;40:1070–2.

    Article  PubMed  Google Scholar 

  12. Kubo H, Nakamura K, Itaba S, Yoshinaga S, Kinukawa N, Sadamoto Y, et al. Differential diagnosis of cystic tumors of the pancreas by endoscopic ultrasonography. Endoscopy 2009;41:684–9.

    Article  CAS  PubMed  Google Scholar 

  13. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of IPMT and mucinous cystic neoplasms of the pancréas. Pancreatology 2006;6:17–32.

    Article  PubMed  Google Scholar 

  14. Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12:183–97.

    Article  PubMed  Google Scholar 

  15. Kanno A, Satoh K, Hirota M, Hamada S, Umino J, Itoh H, Masamune A, et al. Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas. J Gastroenterol 2010;45:952–9.

    Article  PubMed  Google Scholar 

  16. Shimizu Y, Yamaue H, Maguchi H, Yamao K, Hirono S, Osanai M, et al. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas 2013;42:883–8.

    Article  CAS  PubMed  Google Scholar 

  17. Kitano M, Sakamoto H, Komaki T, Kudo M. New techniques and future perspective of EUS for the differential diagnosis of pancreatic malignancies: contrast harmonic imaging. Dig Endosc 2011;23:46–50.

    Article  PubMed  Google Scholar 

  18. Hwang DW, Jang JY, Lee SE, Lim CS, Lee KU, Kim SW. Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution Langenbecks. Arch Surg 2012;397:93–102.

    Article  Google Scholar 

  19. Maire F, Couvelard A, Palazzo L, Aubert A, Vullierme MP, Rebours V, et al. Pancreatic intraepithelial neoplasia in patients with intraductal papillary mucinous neoplasms: the interest of endoscopic ultrasonography. Pancreas 2013;42:1262–6.

    Article  CAS  PubMed  Google Scholar 

  20. Wong J, Weber J, Centeno BA, Vignesh S, Harris CL, Klapman JB, et al. High-grade dysplasia and adenocarcinoma are frequent in side-branch intraductal papillary mucinous neoplasm measuring less than 3 cm on endoscopic ultrasound. J Gastrointest Surg 2013;17:78–84.

    Article  PubMed  Google Scholar 

  21. Yamaguchi T, Baba T, Ishihara T, Kobayashi A, Nakamura K, Tadenuma H, et al. Long-term follow-up of intraductal papillary mucinous neoplasm of the pancreas with ultrasonography. Clin Gastroenterol Hepatol 2005;3:1136–43.

    Article  PubMed  Google Scholar 

  22. Brune K, Abe T, Canto M, O’Malley L, Klein AP, Maitra A, et al. Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer. Am J Surg Pathol 2006;30:1067–76.

    PubMed Central  PubMed  Google Scholar 

  23. Canto MI, Goggins M, Hruban RH, Petersen GM, Giardiello FM, Yeo C, et al. Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 2006;4:766–81.

    Article  PubMed  Google Scholar 

  24. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126:1330–6.

    Article  PubMed  Google Scholar 

  25. Tseng JF, Warshaw AL, Sahani DV, Lauwers GY, Rattner DW, Fernandez-del Castillo C. Serous ystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg 2005;242:413–21.

    PubMed Central  PubMed  Google Scholar 

  26. Maire F, Voitot H, Aubert A, Palazzo L, O’Toole D, Couvelard A, et al. Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy. Am J Gastroenterol 2008;103:2871–7.

    Article  PubMed  Google Scholar 

  27. Nikiforova MN, Khalid A, Fasanella KE, McGrath KM, Brand RE, Chennat JS, et al. Integration of KRAS testing in the diagnosis of pancreatic cystic lesions: a clinical experience of 618 pancreatic cysts. Mod Pathol 2013;26:1478–87.

    Article  CAS  PubMed  Google Scholar 

  28. Genevay M, Mino-Kenudson M, Yaeger K, Ioannis T, Konstantinidis IT, Ferrone CR, et al. Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. Ann Surg 2011;254:977–83.

    Article  PubMed  Google Scholar 

  29. Maire F, Couvelard A, Hammel P, Ponsot P, Palazzo L, Aubert A, et al. Intraductal papillary mucinous tumors of the pancreas: the preoperative value of cytologic and histopathologic diagnosis. Gastrointest Endosc 2003;58:701–6.

    Article  PubMed  Google Scholar 

  30. Lim LG, Lakhtakia S, Ang TL, Vu CK, Dy F, Chong VH, et al. Factors determining diagnostic yield of endoscopic ultrasound guided fine-needle aspiration for pancreatic cystic lesions: a multicentre Asian study. Dig Dis Sci 2013;58:1751–7.

    Article  PubMed  Google Scholar 

  31. Hong SK, Loren DE, Rogart JN, Siddiqui AA, Sendecki JA, Bibbo M. Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts. Gastrointest Endosc 2012;75:775–82.

    Article  PubMed  Google Scholar 

  32. Tarantino I, Fabbri C, Di Mitri R, Pagano N, Barresi L, Mocciaro F, et al. Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. Dig Liver Dis 2014;46:41–4.

    Article  PubMed  Google Scholar 

  33. Boustière C, Heresbach D. Apprentissage, techniques et complications de la ponction guidée par échoendoscopie (PGEE) en gastroentérologie: texte court des recommandations techniques de l’ESGE, recommandation de la SFED. Acta Endosc 2012;42:134–7.

    Article  Google Scholar 

  34. Heresbach D, Barthet M, Michelet C, Sotto A, Verdon R, Richard-Molard B, et al. Consensus en endoscopie digestive. Antibioprophylaxie en endoscopie digestive. Acta Endosc 2008;4:401–13.

    Article  Google Scholar 

  35. Boustière C, Veitch A, Vanbiervliet G, Bulois P, Deprez P, Laquiere A, et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. European Society of Gastrointestinal Endoscopy. Endoscopy 2011;43: 445–61.

    Article  PubMed  Google Scholar 

  36. Hocke M, Menges M, Topalidis T, Dietrich CF, Stallmach A. Contrast-enhanced endoscopic ultrasound in discrimination between benign and malignant mediastinal and abdominal lymph nodes. J Cancer Res Clin Oncol 2008;134:473–80.

    Article  PubMed  Google Scholar 

  37. Becker D, Strobel D, Bernatik T, Hahn EG. Echo-enhanced color- and power-Doppler EUS for the discrimination between focal pancreatitis and pancreatic carcinoma. Gastrointest Endosc 2001;53:784–9.

    Article  CAS  PubMed  Google Scholar 

  38. Sofuni A, Iijima H, Moriyasu F, Nakayama D, Shimizu M, Nakamura K, et al. Differential diagnosis of pancreatic tumors using ultrasound contrast imaging. J Gastroenterol 2005;40:518–25.

    Article  PubMed  Google Scholar 

  39. Nagase M, Furuse J, Ishii H, Yoshino M. Evaluation of contrast enhancement patterns in pancreatic tumors by coded harmonic sonographic imaging with a microbubble contrast agent. J Ultrasound Med 2003;22:789–95.

    PubMed  Google Scholar 

  40. Itoh T, Hirooka Y, Itoh A, Hashimoto S, Kawashima H, Hara K, et al. Usefulness of contrast-enhanced transabdominal ultrasonography in the diagnosis of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 2005;100:144–52.

    Article  PubMed  Google Scholar 

  41. Gincul R. Contrast harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trail. Endoscopy 2014, à paraître.

    Google Scholar 

  42. Cheon YK, Cho YD, Jeon SR, Moon JH, Jeong SW, Hur KY, et al. Pancreatic resection guided by preoperative intraductal ultrasonography for intraductal papillary mucinous neoplasm. Am J Gastroenterol 2010;105:1963–9.

    Article  PubMed  Google Scholar 

  43. Takuma K, Kamisawa T, Anjiki H, Egawa N, Kurata M, Honda G, et al. Predictors of malignancy and natural history of mainduct intraductal papillary mucinous neoplasms of the pancreas. Pancreas 2011;40:371–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’hépatogastroentérologie, pôle « DACCORD », hôpital de la Timone, 264, rue St-Pierre, F-13385, Marseille, France

    M. Barraud-Blanc, P. Grandval & R. Laugier

  2. Service d’hépatogastroentérologie, hôpital Saint-Joseph, 26, boulevard de Louvain, F-13285, Marseille, France

    C. Boustière & A. Laquière

Authors
  1. M. Barraud-Blanc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Grandval
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Boustière
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Laugier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Laquière
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Barraud-Blanc.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barraud-Blanc, M., Grandval, P., Boustière, C. et al. Place de l’échoendoscopie pancréatique dans la prise en charge des tumeurs intracanalaires papillaires et mucineuses du pancréas (TIPMP). Acta Endosc 44, 367–377 (2014). https://doi.org/10.1007/s10190-014-0394-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10190-014-0394-9

Mots clés

Keywords

Search

Navigation