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Punktionsdiagnostik von Pankreasneoplasien

Preoperative diagnostics of pancreatic neoplasms

Zusammenfassung

Während Patientinnen und Patienten mit Verdacht auf ein Pankreaskarzinom bei Operabilität leitliniengemäß einer primären Tumorresektion zugeführt werden, spielt die Punktionsdiagnostik des Pankreas insbesondere bei Inoperabilität und in der Evaluation von Pankreasneoplasien mit unklaren klinisch-radiologischen Befunden eine wichtige Rolle. Letzteres betrifft häufig zystische Pankreasläsionen, deren Spektrum von inflammatorischen Pseudozysten bis hin zu invasiven Pankreaskarzinomen auf dem Boden intraduktaler papillär-muzinöser Neoplasien (IPMN) oder muzinös-zystischer Neoplasien (MCN) reicht. Insbesondere in der präoperativen Diagnostik an Material, das durch EUS-FNA (endosonographisch gestützte Feinnadelaspiration) gewonnen wurde, gibt es einige mögliche Fallstricke. Neben der Kontamination des Untersuchungsguts mit Zellen und Muzin aus dem Punktionsweg und degenerativen Veränderungen, insbesondere bei längerer Latenz von der Materialgewinnung zur Untersuchung, kann auch sehr zellarmes oder gar zellfreies Material eine Herausforderung darstellen. Next-Generation-Sequencing-(NGS)-basierte molekulare Untersuchungen können die Treffsicherheit der Punktionsdiagnostik des Pankreas, insbesondere bei zystischen Läsionen, erheblich verbessern. Eine Integration morphologischer und molekularer Ergebnisse mit klinischen Daten und Befunden der Bildgebung ist dabei unabdingbar. Während zuverlässige molekulare Marker zur Diagnostik von muzinösen und speziellen nichtmuzinösen Pankreasneoplasien bereits existieren, ist die Etablierung solider Marker für das Vorhandsein von High-grade-Neoplasien ein wichtiges Ziel für die Zukunft.

Abstract

While patients with clinico-radiologically diagnosed resectable pancreatic cancer usually undergo surgery without preoperative cytological or histopathological diagnostics, patients with inoperable tumors or ambiguous findings in imaging often undergo EUS-FNA or EUS-FNB (endoscopic ultrasound-guided fine-needle aspiration or endoscopic ultrasound-guided fine-needle biopsy). In many cases, this concerns pancreatic cystic lesions, which can range from benign inflammatory pseudocysts to invasive pancreatic cancer emerging from intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasms (MCNs). However, the evaluation of EUS-FNA material can be especially hampered by contamination with gastric or enteric cells or mucin, degenerative changes, or low or even no cellularity of the sample. Next-generation-sequencing-based molecular analyses, especially of cystic lesions, can significantly increase the accuracy of EUS-FNA diagnostics of the pancreas. Interpretation of morphological and molecular data considering each case’s clinico-radiological context is crucial. While reliable molecular markers for the detection of mucinous and specific nonmucinous pancreatic neoplasms already exist, establishing valid markers for the detection of high-grade lesions is an urgent future goal.

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Correspondence to Lena Häberle.

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Interessenkonflikt

L. Häberle, M. Schramm und I. Esposito geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schwerpunktherausgeber

M. Gaida, Mainz

I. Esposito, Düsseldorf

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Häberle, L., Schramm, M. & Esposito, I. Punktionsdiagnostik von Pankreasneoplasien. Pathologe 42, 491–500 (2021). https://doi.org/10.1007/s00292-021-00972-3

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Schlüsselwörter

  • Biopsie
  • Endosonographie
  • Endosonographisch gestützte Feinnadelaspiration
  • Pankreaskarzinom
  • Hochdurchsatz-Nukleotidsequenzierung

Keywords

  • Biopsy
  • Endosonography
  • Endoscopic ultrasound-guided fine-needle aspiration
  • Pancreatic carcinoma
  • High-throughput nucleotide sequencing