The importance of pancreatic inflammation in endosonographic diagnostics of solid pancreatic masses

Vitali F, Strobel D, Frulloni L, Heinrich MC, Pfeifer L, Görtz R, Hundorfean G, Wachter DL, Wachter D, Grützmann R, Bernatik T, Neurath M, Wildner D (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Medical Ultrasonography Iuliu Hatieganu Medical Publishing House

Book Volume: 20

Pages Range: 427-435

Journal Issue: 4

DOI: 10.11152/mu-1641

Abstract

AIMS: Endosonography (EUS) is one of the main diagnostic tools for the differential diagnosis of pancreatic masses. The aim of our study was to describe the value of this technique in the work-up of solid pancreatic lesions, considering the influence of the morphological evidence of pancreatic inflammation in the diagnostic process. MATERIAL AND METHODS: Retrospective analysis of prospectively collected data in our tertiary University center. From March 2007 to October 2015, 218 patients underwent EUS for a suspected solid pancreatic neoplasm (based on previous cross-sectional imaging results, idiopatic acute pancreatitis, weight loss, pancreatic hyperenzymemia, painless jaundice or elevated Ca 19-9 values). RESULTS: Malignant lesions were diagnosed in 98 (45%) patients. Sensitivity of EUS for malignancy was 91% and specificity 89.2%. Signs of pancreatic inflammation in the surrounding pancreatic parenchyma around the focal lesion were present in 97 patients (44.4%)(more often in men, smokers and drinkers, and the most common etiology was focal chronic pancreatitis) and in these patients the sensitivity and sensibility dropped to 44% and 87.1%, respectively. In patients without signs of pancreatic inflammation, the pancreatic focal lesions were adenocarcinoma, neuroendocrine tumor, ventral/dorsal split, non-pancreatic pathology, pancreatic lipomatosis and autoimmune pancreatitis. CONCLUSION: Pancreatic inflammation (either focal or involving the whole gland) lowers the diagnostic sensibility of EUS in the work- up of pancreatic masses suspected for cancer, requiring further invasive diagnostic methods. Focal autoimmune pancreatitis and paraduodenal pancreatitis are still confused with pancreatic cancer, even in the absence of pancreatic inflammation.

Authors with CRIS profile

Francesco Vitali Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Deike Strobel Medizinische Fakultät Lukas Pfeifer Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Rüdiger Görtz Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology David Wachter Institute of Pathology Robert Grützmann Lehrstuhl für Allgemein- und Viszeralchirurgie Markus Neurath Lehrstuhl für Innere Medizin I Dane Wildner Medizinische Fakultät

Involved external institutions

Kreisklinik Ebersberg DE Germany (DE) University of Verona / Università degli Studi di Verona IT Italy (IT)

How to cite

APA:

Vitali, F., Strobel, D., Frulloni, L., Heinrich, M.C., Pfeifer, L., Görtz, R.,... Wildner, D. (2018). The importance of pancreatic inflammation in endosonographic diagnostics of solid pancreatic masses. Medical Ultrasonography, 20(4), 427-435. https://doi.org/10.11152/mu-1641

MLA:

Vitali, Francesco, et al. "The importance of pancreatic inflammation in endosonographic diagnostics of solid pancreatic masses." Medical Ultrasonography 20.4 (2018): 427-435.

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