Original article—liver, pancreas, and biliary tractImproved Differentiation of Pancreatic Tumors Using Contrast-Enhanced Endoscopic Ultrasound
Section snippets
Patients
From 1999 to 2006 we prospectively examined more than 300 patients with pancreatic lesions using CE-EDUS. Institutional Board approval and oral informed consent according to the ethical guidelines from Helsinki were obtained from all patients after informing the patient about the purpose and aim of the study before the endoscopic ultrasound examination was started.
Inclusion Criteria for Study Analysis
Inclusion criteria for study analysis were an undetermined, solitary, predominantly solid, lesion 40 mm or less with a definite
Methods
Endoscopic ultrasound was performed using an electronic linear ultrasound probe (Pentax FG 34 or Pentax FG 38 UX; [Pentax, Hamburg, Germany]; Hitachi EUB 525, Hitachi 6500, or Hitachi 8500 [Hitachi, Wiesbaden, Germany]). The pancreas was evaluated as recently described.32 A contrast-enhancing agent (Levovist) was applied in all patients (4 g, 400 mg/dL, bolus injection) via a catheter of 1.2-mm diameter or larger into a cubital vein.33 Levovist consists of air and a galactose palmitate shell
Ductal Adenocarcinoma
During the study period we observed 212 patients with histologically proven ductal adenocarcinoma of the pancreas. Ninety-eight patients were excluded because of liver and/or lung metastases or metastases of other organs. A total of 114 patients with undetermined lesions were examined by endoscopic ultrasound, all with solitary nodules of the pancreas. In 52 patients, lesions were greater than 40 mm with or without chronic pancreatitis and, therefore, also excluded from study analysis.
Discussion
If a pancreatic tumor is diagnosed, its differentiation is mandatory for adequate therapy and important for prognosis. The role of conventional endoscopic ultrasound and other imaging methods (eg, computerized tomography and magnetic resonance imaging) in the differential diagnosis of pancreatic masses were reported to be disappointing.37, 38, 39, 40 Therefore, a method with high sensitivity and specificity for tumor differentiation is necessary. The vascularity pattern of pancreatic tumors has
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