Role of EUS in the early detection of small pancreatic cancer

The prognosis of pancreatic cancer is extremely poor as a result of the difficulty in early detection of small pancreatic cancer and the intractable nature of appropriate anti-cancer therapies. Computed tomography (CT) is generally used for initial screening, but imaging sensitivities are generally insufficient to detect small masses. Endoscopic ultrasonography (EUS), in contrast, exhibits higher sensitivity than other imaging modalities for the detection of pancreatic cancers, because of the high resolution of images.

Aims: The goal of this study was to evaluate the role of EUS in the early detection of small pancreatic cancer.

Methods: We retrospectively reviewed the Gifu University Hospital EUS database (November 2007 to October 2010), and extracted the data of patients whose aim was to confirm the presence or absence of pancreatic cancer subsequent to no tumor detection by abdominal CT.

Results: In a 3 year period, 132 patients underwent EUS to confirm the presence or absence of small pancreatic cancer. All patients had previously tested negative for pancreatic mass using abdominal CT, but had showed pancreatic cancer risk factors, including increased serum carcinoembryonic antigen and/or CA 19-9 (n = 106), serum amylase (n = 38), and/or mild to moderate dilation of the main pancreatic duct as determined by imaging (n = 88). EUS detected pancreatic mass in three of these patients. The masses in all three patients were minute (≤10 mm) and their presence was correlated with the detection of mild dilation of the main pancreatic duct in earlier CT scans. Increase of tumor markers was observed in two patients and hyperamylasemia and aggravation of diabetes were observed in one patient.

Conclusions: EUS is strongly recommended for early detection of small pancreatic cancer in patients in whom the dilation of the main pancreatic duct was detected in previous imaging tests, with or without increase of pancreatic enzymes or tumor markers.