[Endosonography in the assessment of pancreatic tumors. A comparison of the endosonographic findings of carcinomas and segmental inflammatory changes].

AIM OF STUDY

To examine the value of endoscopic ultrasonography in distinguishing malignant and benign tumours of the pancreas.

PATIENTS AND METHODS

Endoscopic ultrasonography (EUS) was performed on 130 consecutive patients (35 women and 95 men; mean age 56.6 [38-71] years), 61 with carcinoma of the pancreas (CP), 69 with segmental inflammatory (pseudotumorous) lesions of the pancreas (SILP). The diagnosis was confirmed by histology in 41 cases of CP, by autopsy in 4, by clinical follow-up (4-56 weeks, mean of 7 months) in 16. It was confirmed histologically in 39 cases of SILP, by clinical follow-up in 30 (12-93 weeks, mean of 12 months). All EUS findings were performed and recorded according to a standardized protocol and subsequently compared.

RESULTS

There were no significant differences in EUS findings between CP and SILP. Statistical analysis between the two groups revealed any differential diagnostic relevance only with regard to some individual findings: coarse echo-dense deposits were seen by EUS in 16 of SILP cases (23%), but in only 4 of those with CP (7%), and then only in the face of similar changes in the rest of the organ or if there was additional chronic pancreatitis. Absence of demarcation from the duodenal or gastric wall was recorded in 18 cases of CP (30%), but in only 5 of SILP (7%). Lack of demarcation from the portal vein, splenic vein or coeliac artery was noted in 17 cases of CP (28%) and 6 of SILP (9%). Extension of tumour into vessel lumens was seen only in CP, but even here in only 7 cases (11%).

CONCLUSION

Despite the high resolution of EUS it does not provide reliable differentiation of benign and malignant lesions of the pancreas in the individual case.