Background and Aims
Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little
is known about the incidental finding of early-stage PDAC. The aim of the current
study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to
optimize clinical management.
Methods
Inclusion criterion for the retrospective study analysis was the incidental finding
of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic
patients. Final diagnoses were based on histology or cytology obtained by imaging-guided
biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced
EUS was performed in 219 patients.
Results
The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine
tumors, 28 metastases into the pancreas from other primary sites, and 64 various other
etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC
in 189 of 219 patients (86%).
Conclusions
Approximately 40% of patients with small solid pancreatic lesions had very early stage
PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and,
therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably
large proportion of patients would be exposed to radical surgery with significant
morbidity and mortality.
Abbreviations:
EUS-FNA (EUS-guided FNA, fine needle aspiration), MRI (magnetic resonance imaging), PDAC (pancreatic ductal adenocarcinoma), PAMUS (pancreatic multicenter ultrasound study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 04, 2016
Accepted:
April 25,
2016
Received:
December 24,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 1021.
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
