Bispo Miguel, Marques Susana, Rio-Tinto Ricardo, Fidalgo Paulo, Devière Jacques
Department of Gastroenterology and Digestive Endoscopy, Champalimaud Foundation, Lisbon, Portugal.
Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital - Université Libre de Bruxelles, Brussels, Belgium.
GE Port J Gastroenterol. 2021 Feb;28(2):111-120. doi: 10.1159/000509197. Epub 2020 Sep 7.
Precise staging of pancreatic cancer is crucial for treatment choice. In clinical practice, this includes the TNM staging and determination of tumour resectability, based on a multimodality imaging workup. International guidelines recommend multi-detector computed tomography (CT), with a dedicated pancreatic protocol, as the first-line tool for TNM staging and evaluation of tumour-vessel relationships. In non-metastatic disease upon initial CT assessment, both magnetic resonance imaging and endoscopic ultrasound (EUS) may add relevant information, potentially changing treatment sequence. EUS may have distinct advantages in pancreatic cancer diagnosis and staging when compared with other modalities, being particularly valuable in the determination of portal venous confluence involvement (particularly in small and ill-defined/isoattenuating tumours on CT), in locoregional nodal staging and in the detection of ascites. As we step forward to a more frequent use of neoadjuvant chemotherapy and to personalised medicine, the importance of EUS-guided fine-needle biopsy (EUS-FNB) also increases. The recent availability of third-generation biopsy needles significantly increased the diagnostic yield of EUS-guided tissue acquisition, providing diagnostic cell blocks in approximately 95% of cases with only two dedicated passes and allowing ancillary testing, such as immunohistochemistry and molecular profiling of the tumour. In this article, the authors present an updated perspective of the place of EUS and EUS-FNB in the staging algorithm of pancreatic cancer. Data supporting the increasing role of neoadjuvant therapy and the importance of a patient-tailored treatment selection, based on tumoural subtyping and molecular profiling, are also discussed.
胰腺癌的精确分期对于治疗方案的选择至关重要。在临床实践中，这包括基于多模态影像学检查的TNM分期以及肿瘤可切除性的判定。国际指南推荐采用具有专门胰腺扫描方案的多排螺旋计算机断层扫描（CT）作为TNM分期及评估肿瘤与血管关系的一线工具。在初次CT评估为非转移性疾病时，磁共振成像和内镜超声（EUS）均可能提供相关信息，从而可能改变治疗顺序。与其他检查方式相比，EUS在胰腺癌的诊断和分期方面可能具有独特优势，在判定门静脉汇合处受累情况（特别是对于CT上显示的小的、边界不清/等密度肿瘤）、局部区域淋巴结分期以及腹水检测方面尤其有价值。随着我们越来越频繁地使用新辅助化疗并走向个性化医疗，EUS引导下细针穿刺活检（EUS-FNB）的重要性也日益增加。最近第三代活检针的出现显著提高了EUS引导下组织获取的诊断率，在仅进行两次专门穿刺的情况下，约95%的病例可获得诊断性细胞块，并允许进行辅助检测，如肿瘤的免疫组织化学和分子分析。在本文中，作者阐述了EUS和EUS-FNB在胰腺癌分期算法中地位的最新观点。还讨论了支持新辅助治疗作用日益增加以及基于肿瘤亚型和分子分析进行患者个体化治疗选择重要性的数据。
