Differential diagnosis of small solid pancreatic lesions

作者：Dietrich, Christoph Frank^*; Sahai, Anand Vasante; D'Onofrio, Mirko; Will, Uwe; Arcidiacono, Paolo Giorgio; Petrone, Maria Chiara; Hocke, Michael; Braden, Barbara; Burmester, Eike; Moeller, Kathleen; Saftoiu, Adrian; Ignee, Andre; Cui, Xin-Wu; Iordache, Sevastita; Potthoff, Andrej; Iglesias-Garcia, Julio; Fusaroli, Pietro; Dong, Yi; Jenssen, Christian

来源：Gastrointestinal Endoscopy, 2016, 84(6): 933-940.

DOI：10.1016/j.gie.2016.04.034

• FINE-NEEDLE-ASPIRATION
• ENHANCED ENDOSCOPIC ULTRASOUND
• EUS-GUIDED FNA
• DUCTAL ADENOCARCINOMA
• CONSENSUS GUIDELINES
• COMPUTED-TOMOGRAPHY
• CANCER
• MANAGEMENT
• TUMORS
• CT

Background and Aims: Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (<= 15 mm) to optimize clinical management. @@@ Methods: Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions <= 15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients. @@@ Results: The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%). @@@ Conclusions: Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions <= 15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.

• 出版日期2016-12
• 单位郑州大学; 复旦大学