review of literature on clinical pancreatology - The Pancreapedia

provide conclusive evidence for the absence <strong>of</strong> cancer. Patients for whom vascular invasionand lymphadenopathy are detected on EUS are more likely to have a true malignant lesionand should be followed closely. When a patient has been monitored for six months or morewith no cancer being diagnosed, there appears to be much less chance that a pancreaticmalignancy is present [426].It was also described an acute hemorrhage with retroperitoneal hematoma after endoscopicultrasound-guided fine-needle aspiration <strong>of</strong> an intraductal papillary mucinous neoplasm <strong>of</strong> thepancreas [427].Endoscopic ultrasound-guided trucut biopsyEndoscopic ultrasound-guided trucut biopsy (EUS-TCB) technique has the advantage <strong>of</strong>obtaining tissue for histological examination rather than for cytology alone. However, thediagnostic yield may depend on factors related to both technical aspects and the lesionssampled. Safety <strong>of</strong> EUS-TCB is yet to be established in a large number <strong>of</strong> procedures. Theaim <strong>of</strong> one study was to determine factors predicting a positive diagnostic yield, and safetyfor EUS-TCB in a large tertiary referral center-based service. All patients were referred forEUS-guided tissue sampling as a part <strong>of</strong> their diagnostic workup. Linear-arrayechoendoscope (GF-2000-OL5, KeyMed) with a 19-gauge trucut needle (Quick-Core,Wilson-Cook) was used by two operators to obtain tissue samples. In total, 247 patients (143men) aged 57-73 (median 66) had EUS-TCB performed. Lesions sampled were in thepancreas (113), esophagogastric wall (34), and extra-pancreatic areas (100) (lymph nodes:52). The maximum diameter <strong>of</strong> the lesion/wall thickness ranged from 0.6 to 5.4 cm (median3). One to five passes were made (median 3) to obtain tissue cores 2-18 mm (median 10) inlength. The procedure failed in 6 percent <strong>of</strong> cases. The overall diagnostic accuracy was 75percent. The overall complication rate was 2 percent (bronchopneumonia, minor hemoptysis,minor hematemesis, mucosal tear, retropharyngeal abscess) with no procedure-relateddeaths. Site <strong>of</strong> lesion (pancreatic vs extra-pancreatic), site <strong>of</strong> biopsy (stomach vs duodenumvs esophagus), and number <strong>of</strong> passes (2) were signifikant predictors <strong>of</strong> a positivediagnostic yield in univariate analysis. However, only the site <strong>of</strong> biopsy and number <strong>of</strong>passes were independent predictors in multinominal logistic regression. It was concludedthat the diagnostic yield <strong>of</strong> EUS-TCB is higher when lesion is approached through thestomach and better when more than two passes were made. In this large series, thecomplication rate <strong>of</strong> 2 percent associated with EUS-TCB was similar to that reported withEUS-fine needle aspiration technique [428].Computed tomographyFatty infiltration <strong>of</strong> the pancreas is generally a diffuse process; however, it may be unevenlydistributed in the pancreas. Focal fatty infiltration <strong>of</strong> the pancreas is usually most prominentin the anterior aspect <strong>of</strong> the head <strong>of</strong> the pancreas and seen as a region <strong>of</strong> decreasedattenuation on computed tomography and may simulate pancreatic neoplasm. It may bediscussed and illustrated the various features <strong>of</strong> focal fatty infiltration <strong>of</strong> the pancreas onmultidetector row helical computed tomography with multiplanar reformation images andshow how this imaging modality helps to differentiate between focal fatty infiltration <strong>of</strong> thepancreas and actual pancreatic tumors [429].Fatty infiltration <strong>of</strong> the pancreas is generally a diffuse process; however, it may be unevenlydistributed in the pancreas. Focal fatty infiltration <strong>of</strong> the pancreas is usually most prominentin the anterior aspect <strong>of</strong> the head <strong>of</strong> the pancreas and seen as a region <strong>of</strong> decreasedattenuation on computed tomography and may simulate pancreatic neoplasm. It wasdiscussed and illustrated the various features <strong>of</strong> focal fatty infiltration <strong>of</strong> the pancreas onmultidetector row helical computed tomography with multiplanar reformation images and