EUS is particularly valuable in assessing lesions not clearly detected, but suspected on CT or MRI, and the “borderline resectable” lesions observed on cross-sectional imaging. Is tissue acquisition by FNA always necessary during evaluation of pancreatic INCB018424 masses? It often depends on the clinical scenario and the practice of the individual institution.
In clearly unresectable lesions, tissue diagnosis by FNA before committing patients to chemotherapy and/or radiation therapy is desirable. On the other hand, there is still considerable controversy regarding whether FNA of a focal, apparently resectable lesion should be performed given the potential risk of cancer cell seeding through the needle tract, and the fact that a negative FNA may not completely exclude malignancy. In this situation, transduodenal FNA of a pancreatic head lesion may be less problematic since the needle tract is along tissues that would eventually be resected in pancreaticoduodenectomy. If an alternative diagnosis such as immunoglobulin G subtype 4 (IgG4)-related inflammation (i.e. pseudotumor) or a neoplasm of more favorable prognosis (e.g. neuroendocrine tumor) is suspected, then tissue acquisition of such potentially resectable lesion may be better justified. Despite the high sensitivity of EUS for small
pancreatic lesions in general, there are situations in which false-negative examinations can result. In a multicenter study of 20 cases of missed pancreatic cancers by nine experienced endosonographers, chronic Dorsomorphin cell line pancreatitis, a diffusely infiltrating carcinoma, a prominent ventral/dorsal split, and a recent episode (less
than 4 weeks) of acute pancreatitis were reported to be factors associated with missed lesions on the initial EUS. If clinical suspicion for a pancreatic neoplasm is still high after an initial negative EUS, a repeat EUS should be considered in 2 to 3 months for follow up. Is there a role for EUS in screening for early, potentially resectable pancreatic cancer or high grade dysplastic precursor lesions in selected patient population? Based on current evidence, a recently published expert consortium statement suggests screening using EUS and/or MRI can be considered in high-risk individuals, including first-degree 上海皓元 relatives of patients with pancreatic cancer from a familial pancreatic cancer kindred with at least two affected first-degree relatives; patients with Peutz–Jeghers syndrome; and p16, breast cancer 2, early onset (BRCA2), and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with more than one affected first-degree relatives. However, there was no consensus regarding the age to initiate or stop screening, or the optimal intervals for follow-up imaging. Screening in the general population is not justified given the low incidence of pancreatic cancer in general.