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Abstract
In patients with solid pancreatic lesions, the differential diagnosis must be evaluated to determine whether radical surgery, pancreatic parenchyma-saving strategies, or follow-up is indicated. Contrastenhanced (endoscopic) ultrasonography and elastography facilitate the further characterization of SPLs. The majority of cases of pancreatic ductal adenocarcinoma exhibit hypoenhancement with contrastenhanced ultrasonography. Elastographically soft SPLs are benign with very few exceptions, whereas stiffer SPLs can be malignant or benign. This article reviews the current use of modern ultrasound imaging techniques, including contrast-enhanced ultrasonography and elastography, for the detection and characterization of SPLs. In particular, the unexcelled diagnostic potential of multiparametric endoscopic ultrasonography to detect and characterize small SPLs is highlighted.
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References
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- Christoph F. Dietrich, et al.6 Ultrasonography 2019 Aug 27 [Epub] e-ultrasonography.org2013;51:1395-1440.
- Tempero MA, Arnoletti JP, Behrman S, Ben-Josef E, Benson AB 3rd, Berlin JD, et al. Pancreatic adenocarcinoma. J Natl Compr Canc Netw 2010;8:972-1017.
- Asbun HJ, Conlon K, Fernandez-Cruz L, Friess H, Shrikhande SV, Adham M, et al. When to perform a pancreatoduodenectomy in the absence of positive histology. A consensus statement by the International Study Group of Pancreatic Surgery. Surgery 2014;155:887-892.
- Wang W, Shpaner A, Krishna SG, Ross WA, Bhutani MS, Tamm EP, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a denitive mass on CT. Gastrointest Endosc 2013;78:73-80.
- Matsuoka L, Selby R, Genyk Y. The surgical management of pancreatic cancer. Gastroenterol Clin North Am 2012; 41:211-221.
- Also A, Ihara E, Osoegawa T, Nakamura K, Itaba S, Igarashi H, et al. Key endoscopic ultrasound features of pancreatic ductal adenocarcinoma smaller than 20 mm. Scand J Gastroenterol 2014;49:332-338.
- Gleason MX, Mdzinarishvili T, Are C, Sasson A, Sherman A, Shats O, et al. Prognostic estimator of survival for patients with localized and extended pancreatic ductal adenocarcinoma. Cancer Inform 2013;12:103-114.
- Chari ST. Detecting early pancreatic cancer: problems and prospects. Semin Oncol 2007;34:284-294.
- Hur C, Tramontano AC, Dowling EC, Brooks GA, Jeon A, Brugge WR, et al. Early pancreatic ductal adenocarcinoma survival is dependent on size: positive implications for future targeted screening. Pancreas 2016;45:1062-1066.
- Egawa S, Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, et al. Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas 2012;41:985-99