Chaves Julia, Fernandez Y Viesca Michael, Arvanitakis Marianna
Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium.
Cancers (Basel). 2023 Jun 28;15(13):3385. doi: 10.3390/cancers15133385.
Pancreatic cancer and cholangiocarcinoma are life threatening oncological conditions with poor prognosis and outcome. Pancreatic cystic lesions are considered precursors of pancreatic cancer as some of them have the potential to progress to malignancy. Therefore, accurate identification and classification of these lesions is important to prevent the development of invasive cancer. In the biliary tract, the accurate characterization of biliary strictures is essential for providing appropriate management and avoiding unnecessary surgery. Techniques have been developed to improve the diagnosis, risk stratification, and management of pancreato-biliary lesions. Endoscopic ultrasound (EUS) and associated techniques, such as elastography, contrasted-enhanced EUS, and EUS-guided needle confocal laser endomicroscopy, may improve diagnostic accuracy. In addition, intraductal techniques applied during endoscopic retrograde cholangiopancreatography (ERCP), such as new generation cholangioscopy and in vivo cellular evaluation through probe-based confocal laser endomicroscopy, can increase the diagnostic yield in characterizing indeterminate biliary strictures. Both EUS-guided and intraductal approaches can provide the possibility for tissue sampling with new tools, such as needles, biopsies forceps, and brushes. At the molecular level, novel biomarkers have been explored that provide new insights into diagnosis, risk stratification, and management of these lesions.
胰腺癌和胆管癌是危及生命的肿瘤疾病，预后和转归较差。胰腺囊性病变被认为是胰腺癌的前驱病变，因为其中一些有进展为恶性肿瘤的可能。因此，准确识别和分类这些病变对于预防浸润性癌症的发生很重要。在胆道系统中，准确鉴别胆管狭窄对于提供恰当的治疗和避免不必要的手术至关重要。已经开发出一些技术来改善胰胆病变的诊断、风险分层和治疗。内镜超声（EUS）及其相关技术，如弹性成像、对比增强EUS和EUS引导下针式共聚焦激光内镜检查，可能会提高诊断准确性。此外，在内镜逆行胰胆管造影（ERCP）过程中应用的导管内技术，如新一代胆管镜检查和通过基于探头的共聚焦激光内镜检查进行体内细胞评估，可提高鉴别不明原因胆管狭窄的诊断率。EUS引导和导管内方法都可以使用针、活检钳和刷子等新工具进行组织采样。在分子水平上，已经探索了新的生物标志物，为这些病变的诊断、风险分层和治疗提供了新的见解。
