Endoscopy 2006; 38: 56-60
DOI: 10.1055/s-2006-946654
Invited papers
Pancreato-biliary tumors
© Georg Thieme Verlag KG Stuttgart · New York

State of the art lecture: Endoscopic ultrasound (EUS) and FNA in pancreatico-biliary tumors

K. J. Chang1
  • 1University of California, Irvine
Further Information

Publication History

Publication Date:
26 June 2006 (online)

Introduction

In the past few decades, there has been relatively little change in the epidemiology, therapy, or over-all survival of pancreatico-biliary tumors. However, we are now in an era where diagnostic and therapeutic paradigms are finally going beyond traditional approaches (cytology/pathology for diagnosis and cytotoxic agents for therapy) with the potential of changing the natural history of these tumors. Many of these new approaches are made possible with emerging diagnostic and interventional EUS techniques. This state-of-the-art paper will review the role of EUS-guided FNA in the diagnosis of pancreaticobiliary lesions such as pancreatic tumors, cystic and neuroendocrine tumors of the pancreas, as well as the less appreciated applications to biliary and ampullary cancers. I will also discuss the specific role of EUS-guided FNA in the staging of various pancreaticobiliary cancers. The role of EUS-guided therapies, including celiac neurolysis, cyst-gastrostomy, and delivery of anti-tumor agents via EUS-guided fine needle aspiration (FNI) will be covered in the accompanying article ”FNI and Anti-tumor therapy”.

References

  • 1 Rosch T, Lorenz R, Braig C, Feuerbach S, Siewert J R, Schusdziarra V. et al . Endoscopic ultrasound in pancreatic tumor diagnosis.  Gastrointest Endosc. 1991;  37 (3) 347-352
  • 2 Chang K J, Wiersema M, Giovannini M, Vilmann P, Erickson R A. Multi-center Collaborative Study on Endoscopic Ultrasound (EUS) Guided Fine Needle Aspiration (FNA) of the Pancreas.  Gastrointest Endosc. 1996;  43 (4) A507
  • 3 Williams D B, Sahai A V, Aabakken L, Penman I D, van Velse A, Webb J. et al . Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience.  Gut. 1999;  44 (5) 720-726
  • 4 Hocke M, Schulze E, Gottschalk P, Topalidis T, Dietrich C F. Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer.  World J Gastroenterol. 2006;  12 (2) 246-250
  • 5 van Kouwen M C, Jansen J B, van Goor H, de Castro S, Oyen W J, Drenth J P. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis.  Eur J Nucl Med Mol Imaging. 2005;  32 (4) 399-404
  • 6 Heinrich S, Goerres G W, Schafer M, Sagmeister M, Bauerfeind P, Pestalozzi B C. et al . Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness.  Ann Surg. 2005;  242 (2) 235-243
  • 7 Lytras D, Connor S, Bosonnet L, Jayan R, Evans J, Hughes M. et al . Positron emission tomography does not add to computed tomography for the diagnosis and staging of pancreatic cancer.  Dig Surg. 2005;  22 (1 - 2) 55-61; discussion 62
  • 8 Rasmussen I, Sorensen J, Langstrom B, Haglund U. Is positron emission tomography using 18F-fluorodeoxyglucose and 11C-acetate valuable in diagnosing indeterminate pancreatic masses?.  Scand J Surg. 2004;  93 (3) 191-197
  • 9 Orlando L A, Kulasingam S L, Matchar D B. Meta-analysis: the detection of pancreatic malignancy with positron emission tomography.  Aliment Pharmacol Ther. 2004;  20 (10) 1063-1070
  • 10 Gress F, Gottlieb K, Sherman S, Lehman G. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer.  Annals of Internal Medicine. 2001;  134 (6) 459-464
  • 11 Erickson R A, Garza A A. Impact of endoscopic ultrasound on the management and outcome of pancreatic carcinoma.  Am J Gastroenterol. 2000;  95 (9) 2248-2254
  • 12 Chang K J, Nguyen P, Erickson R A, Durbin T E, Katz K D. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma.  Gastrointestinal Endoscopy. 1997;  45 (5) 387-393
  • 13 Erickson R A, Garza A A. EUS with EUS-guided fine-needle aspiration as the first endoscopic test for the evaluation of obstructive jaundice.  Gastrointest Endosc. 2001;  53 (4) 475-484
  • 14 Jin G, Hu X G, Ying K, Tang Y, Liu R, Zhang Y J. et al . Discovery and analysis of pancreatic adenocarcinoma genes using cDNA microarrays.  World J Gastroenterol. 2005;  11 (41) 6543-6548
  • 15 Ashida R, Nakata B, Inoue H, Mizuno N, Higuchi K, Hirakawa K. et al .Chemoresistance-related genes profile in specimens obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Gastrointest Endosc 2006: DDW abstract
  • 16 Song M H, Lee S K, Kim M H, Lee H J, Kim K P, Kim H J. et al . EUS in the evaluation of pancreatic cystic lesions.  Gastrointest Endosc. 2003;  57 (7) 891-896
  • 17 Ahmad N A, Kochman M L, Brensinger C, Brugge W R, Faigel D O, Gress F G. et al . Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions.  Gastrointest Endosc. 2003;  58 (1) 59-64
  • 18 Brugge W R, Lewandrowski K, Lee-Lewandrowski E, Centeno B , Szydlo T, Regan S. et al . Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.  Gastroenterology. 2004;  126 (5) 1330-1336
  • 19 Powis M E, Nguyen P T, Chang K J. A Novel Endoscopic Ultrasound (EUS) Guided Fine Needle Aspiration (FNA) Technique for the Diagnosis of Malignant Cystic Lesions of the Pancreas.  Gastrointest Endosc. 2000;  51 (4) 164
  • 20 Zimmer T, Scherubl H, Faiss S, Stolzel U, Riecken E O, Wiedenmann B. Endoscopic ultrasonography of neuroendocrine tumours.  Digestion. 2000;  62 (Suppl 1) 45-50
  • 21 Bansal R, Tierney W, Carpenter S, Thompson N, Scheiman J M. Cost effectiveness of EUS for preoperative localization of pancreatic endocrine tumors.  Gastrointestinal Endoscopy. 1999;  49 (1) 19-25
  • 22 Gines A, Vazquez-Sequeiros E, Soria M T, Clain J E, Wiersema M J. Usefulness of EUS-guided fine needle aspiration (EUS-FNA) in the diagnosis of functioning neuroendocrine tumors.  Gastrointest Endosc. 2002;  56 (2) 291-296
  • 23 Gress F G, Barawi M, Kim D, Grendell J H. Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing.  Gastrointest Endosc. 2002;  55 (4) 594-597
  • 24 Hunt G C, Faigel D O. Assessment of EUS for diagnosing, staging, and determining resectability of pancreatic cancer: a review.  Gastrointest Endosc. 2002;  55 (2) 232-237
  • 25 Tamm E, Charnsangavej C, Szklaruk J. Advanced 3-D imaging for the evaluation of pancreatic cancer with multidetector CT.  Int J Gastrointest Cancer. 2001;  30 (1 - 2) 65-71
  • 26 Xu A M, Cheng H Y, Jiang W B, Chen D, Jia Y C, Wu M C. Multi-slice three-dimensional spiral CT cholangiography: a new technique for diagnosis of biliary diseases.  Hepatobiliary Pancreat Dis Int. 2002;  1 (4) 595-603
  • 27 Harewood G C, Wiersema M J. A cost analysis of endoscopic ultrasound in the evaluation of pancreatic head adenocarcinoma.  Am J Gastroenterol. 2001;  96 (9) 2651-2656
  • 28 Ozaki H, Hiraoka T, Mizumoto R, Matsuno S, Matsumoto Y, Nakayama T. et al . The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection.  Surgery Today. 1999;  29 (1) 16-22
  • 29 Wiersema M J, Vilmann P, Giovannini M, Chang K J, Wiersema L M. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 (4) 1087-1095
  • 30 Yamada T, Nakamori S, Ohzato H, Higaki N, Aoki T, Oshima S. et al . Outcome of pancreatic cancer patients based on genetic lymph node staging.  International Journal of Oncology. 2000;  16 (6) 1165-1171
  • 31 Nguyen P, Chang K. Endoscopic Ultrasound (EUS) and EUS-Guided Fine Needle Aspiration (FNA) of Liver Lesions in Patients with Gastrointestinal Malignancies.  Gastrointest Endosc. 1999;  50 (3) 357-361
  • 32 tenBerge J, Hoffman B J, Hawes R H, Van Enckevort C, Giovannini M, Erickson R A. et al . EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases.  Gastrointest Endosc. 2002;  55 (7) 859-862
  • 33 Nguyen P T, Chang K J. EUS in the detection of ascites and EUS-guided paracentesis.  Gastrointest Endosc. 2001;  54 (3) 336-339
  • 34 Fritscher-Ravens A, Broering D C, Sriram P V, Topalidis T, Jaeckle S, Thonke F. et al . EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: a case series.  Gastrointest Endosc. 2000;  52 (4) 534-540
  • 35 Sharma A, Chang K J, Nguyen P T. The Role of Endoscopic Ultrasound (EUS) and EUS-guided Fine Needle Aspiration (FNA) in the Diagnosis of Proximal Biliary Strictures.  Gastrointest Endosc. 2003;  57 (5) AB681
  • 36 Cannon M E, Carpenter S L, Elta G H, Nostrant T T, Kochman M L, Ginsberg G G. et al . EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms.  Gastrointestinal Endoscopy. 1999;  50 (1) 27-33
  • 37 Muthusamy R, Jafri S F, Jivcu C, Chang K J, Nguyen P T. Endoscopic Ultrasound (EUS) Guided Fine Needle Aspiration (FNA) in the Diagnosis and Staging of Ampullary Neoplasms.  Gastrointest Endosc. 2001;  53(5) 176

Kenneth J. Chang, M.D.

University of California, Irvine

Director, H. H. Chao Comprehensive Digestive Disease Center

101 The City Drive, Bldg 22C, RT99

Orange, CA 92868

Phone: (714) 456-6187

Fax: (714) 456-7520

Email: kchang@uci.edu

    >