Endoscopic Ultrasonography in Pancreatic Tumors: When and Why?

  • Angels Ginès
  • Gloria Fernández-Esparrach
  • Carmen Ayuso
Part of the Medical Radiology book series (MEDRAD)


EUS has shown to be superior to other imaging techniques in the diagnosis of pancreatic cancer, especially in tumors < 2cm in diameter. Since the negative predictive value of EUS is 95-100%, EUS should be considered the technique of choice to rule out pancreatic cancer in patients with clinical suspicion and inconclusive previous image techniques. However, there is no agreement on the best technique (EUS or CT) to stage and assess ressectability in pancreatic adenocarcinoma. The most reliable sequential approach consists of a helical CT as the initial test and EUS as a confirmatory technique. EUS FNA is the most accurate and safe modality for tissue diagnosis in patients with suspected pancreatic cancer and is mandatory in unresectable disease. In the case of resectable tumors, the need of EUS FNA is still controversial.


Pancreatic Cancer Chronic Pancreatitis Negative Predictive Value Intraductal Papillary Mucinous Neoplasm Autoimmune Pancreatitis 
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  1. Ahmad NA (2000) EUS in preoperative staging of pancreatic cancer. Gastrointest Endosc 52:463–468PubMedCrossRefGoogle Scholar
  2. Agarwal B (2004) Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol 99:844–850PubMedCrossRefGoogle Scholar
  3. Bournet B (2006) Early morbidity of endoscopic ultrasound: 13 years’ experience at a referral center. Endoscopy 38:349–354PubMedCrossRefGoogle Scholar
  4. Buthani MS (2004) The no endosonographic detection of tumor (NEST) study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy 36:385–389CrossRefGoogle Scholar
  5. Chang KJ (1997) The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 45:387–393PubMedCrossRefGoogle Scholar
  6. DeWitt J (2004) Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 141:753–763PubMedCrossRefGoogle Scholar
  7. DeWitt J (2005) EUS-guided FNA of pancreatic metastases: a multicenter experience. Gastrointest Endosc 61:689–696PubMedCrossRefGoogle Scholar
  8. Eloubeidi MA (2004) Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc 60:385–389PubMedCrossRefGoogle Scholar
  9. Fernández-Esparrach G (2007) Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study. Endoscopy 39:720–724PubMedCrossRefGoogle Scholar
  10. Giovannini M (1995) Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients. Endoscopy 27:171–177PubMedCrossRefGoogle Scholar
  11. Gress FG (1997) Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography. Gastrointest Endosc 45:243–250PubMedCrossRefGoogle Scholar
  12. Gress FG (1999) Role of endoscopic ultrasound in the preoperative staging of pancreatic cancer: a large single-center experience. Gastrointest Endosc 50:786–791PubMedCrossRefGoogle Scholar
  13. Itoi T (2005) Immunohistochemical analysis of p53 and MIB-1 in tissue specimens obtained from endoscopic ultrasonongraphy-guided fine needle aspiration biopsy for the diagnosis of solid pancreatic masses. Oncol Rep 13:229–234PubMedGoogle Scholar
  14. Khalid A (2006) Endoscopic ultrasound fine needle aspirate DNA analysis to differentiate malignant and benign pancreatic masses. Am J Gastroenterol 101:2493–2500PubMedCrossRefGoogle Scholar
  15. Klapman JB (2005) Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 100:1–4CrossRefGoogle Scholar
  16. Krishna NB (2009) Diagnostic value of EUS-FNA in patients suspected of having pancreatic cancer with a focal lesion on CT scan/MRI but without obstructive jaundice. Pancreas 38:625–630PubMedCrossRefGoogle Scholar
  17. Levy MJ (2006) Chronic pancreatitis: focal pancreatitis or cancer. is there a role for FNA/biopsy? Autoimmune pancreatitis. Endoscopy 38(suppl 1):S30–S35PubMedCrossRefGoogle Scholar
  18. Levy MJ (2007) Endoscopic ultrasound-guided trucut biopsy of the pancreas: prospects and problems. Pancreatology 7:163–166PubMedCrossRefGoogle Scholar
  19. Mertz HR (2000) EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc 52:367–371PubMedCrossRefGoogle Scholar
  20. Micames C (2003) Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-FNA vs. percutaneous FNA. Gastrointest Endosc 58:690–695PubMedCrossRefGoogle Scholar
  21. Mishra G (2006) Determination of qualitative telomerase activity as an adjunct to the diagnosis of pancreatic adenocarcinoma by EUS-guided fine-needle aspiration. Gastrointest Endosc 63:648–654PubMedCrossRefGoogle Scholar
  22. Mortensen MB (2005) Prospective evaluation of patient tolerability, satisfaction with patient information, and complications in endoscopic ultrasonography. Emdoscopy 37:146–153CrossRefGoogle Scholar
  23. Muller MF (1994) Pancreatic tumors: evaluation with endoscopic US, CT and MR imaging. Radiology 190:745–751PubMedGoogle Scholar
  24. Pellisé M (2003) Usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by means of endosonography-guided fine-needle aspiration biopsy. Aliment Pharmacol Ther 17:1299–1307PubMedCrossRefGoogle Scholar
  25. Puli SR (2007) Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc 65:788–797PubMedCrossRefGoogle Scholar
  26. Raut C (2003) Diagnostic accuracy of endoscopic-ultrasound guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg 7:118–128PubMedCrossRefGoogle Scholar
  27. Rösch T (1990) Preoperative localization of endocrine tumors of the pancreas: endoscopic ultrasound is superior to transabdominal sonography and computed tomography. Gastrointest Endosc 36:199–200Google Scholar
  28. Rösch T (1991) Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc 37:347–352PubMedCrossRefGoogle Scholar
  29. Rösch T (1992) Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography and angiography. Gastroenterology 102:188–199PubMedGoogle Scholar
  30. Rösch T (2000) Endoscopic ultrasound criteria of vascular invasion in the staging of pancreatic head cancer: a blinded reevaluation of videotapes. Gastrointest Endosc 52:469–477PubMedCrossRefGoogle Scholar
  31. Rösch T, Classen M (1992) Gastroenterologic endosonography. Textbook and atlas. Thieme Verlag, New YorkGoogle Scholar
  32. Snady H (1992) Endoscopic ultrasonography compared with computed tomography with ERCP in patients with obstructive jaundice or small peri-pancreatic mass. Gastrointest Endosc 38:27–34PubMedCrossRefGoogle Scholar
  33. Soriano A (2004) Preoperative staging and tumor respectability assessment on pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 99:492–501PubMedCrossRefGoogle Scholar
  34. Tada M (2002) Quantitative analysis of K-ras gene mutation in pancreatic tissue obtained by endoscopic ultrasonography-guided fine needle aspiration: clinikcal utility for diagnosis of pancreatic tumor. Am J Gastroenterol 97:2263–2270PubMedCrossRefGoogle Scholar
  35. Wiersema MJ (1997) Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastrointest Endosc 112:1087–1095Google Scholar
  36. Wiersema MJ (2001) Accuracy of endoscopic ultrasonography in diagnosis and staging pancreatic carcinoma. Pancreatology 1:625–632PubMedCrossRefGoogle Scholar
  37. Williams DB (1999) Endoscopic ultrasound guided fine needle aspiration biopsy: a large centre experience. Gut 44:720–726PubMedCentralPubMedCrossRefGoogle Scholar
  38. Yasuda K (1988) The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc 34:1–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Angels Ginès
    • 1
  • Gloria Fernández-Esparrach
    • 1
  • Carmen Ayuso
    • 2
  1. 1.Endoscopy Unit, Department of Gastroenterology, Hospital Clínic, ICMDM, IDIBAPS, CIBERehdUniversity of BarcelonaBarcelonaSpain
  2. 2.Department of Radiology, Hospital ClínicUniversity of BarcelonaBarcelonaSpain

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