Department of Gastroenterology and Hepatology, Endoscopy and Endosonography Center, San Giovanni Battista Hospital (Molinette), University of Turin, Italy.
J Gastrointest Oncol. 2013 Jun;4(2):220-30. doi: 10.3978/j.issn.2078-6891.2013.002.
A suspected pancreatic lesion can be a difficult challenge for the clinician. In the last years we have witnessed tumultuous technological improvements of the radiological and nuclear medicine imaging. Taking this into account, we will try to delineate the new role of endoscopic ultrasound (EUS) in pancreatic imaging and to place it in a shareable diagnostic and staging algorithm of pancreatic cancer (PC). To date the most accurate imaging techniques for the PC remain contrast-enhanced computed tomography (CT) and EUS. The latter has the highest accuracy in detecting small lesions, in assessing tumor size and lymph nodes involvement, but helical CT or an up-to-date magnetic resonance imaging (MRI) must be the first choice in patients with a suspected pancreatic lesion. After this first step there is place for EUS as a second diagnostic level in several cases: negative results on CT/MRI scans and persistent strong clinical suspicion of PC, doubtful results on CT/MRI scans or need for cyto-histological confirmation. In the near future there will be great opportunities for the development of diagnostic and therapeutic EUS and pancreatic pathology could be the best testing bench.
疑似胰腺病变对临床医生来说是一个难题。在过去的几年中，我们见证了放射学和核医学成像技术的飞速发展。有鉴于此，我们将尝试描述内镜超声（EUS）在胰腺成像中的新作用，并将其置于胰腺癌（PC）的可共享诊断和分期算法中。迄今为止，用于 PC 的最准确的成像技术仍然是增强对比的计算机断层扫描（CT）和 EUS。后者在检测小病变、评估肿瘤大小和淋巴结受累方面具有最高的准确性，但对于疑似胰腺病变的患者，螺旋 CT 或最新的磁共振成像（MRI）必须是首选。在这第一步之后，EUS 在几种情况下可以作为第二诊断水平：CT/MRI 扫描结果为阴性，且对 PC 的强烈临床怀疑持续存在，CT/MRI 扫描结果可疑，或需要细胞组织学确认。在不久的将来，EUS 的诊断和治疗将有很大的发展机会，而胰腺病理学可能是最好的检测平台。
