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Endoscopic Ultrasound in the Diagnosis and Staging of Pancreatic Cancer

Endoscopic Ultrasound in the Diagnosis and Staging of Pancreatic Cancer

The article by Drs. Levy and Wiersema is an excellent
overview of the indications, technical nuances, and efficacy of endoscopic
ultrasound in the diagnosis and staging of pancreatic neoplasms. Endoscopic
ultrasonography was introduced into the diagnostic armamentarium for
gastroenterology approximately 15 years ago. Although the literature suggests a
general increase in the utility and experience with endoscopic ultrasound, the
technique remains most effective in the hands of experienced experts like Drs.
Levy and Wiersema. Their article is a complete and thorough review of the
indications and expected accuracy of the technique when evaluating a variety of
different pancreatic lesions.

The authors, however, understate the technical expertise required to achieve
the level of results summarized in their overview. There is no question that
endoscopic ultrasound has become a common procedure used in centers specializing
in pancreatic diseases. It must be clearly understood, however, that this is a
very operator-dependent technology. The ability to accurately characterize
pancreatic masses as inflammatory or neoplastic is very much dependent upon the
technical skills of the person performing the endoscopic ultrasound. Similarly,
its utility for obtaining tissue biopsy using endoscopic ultrasound fine-needle
aspiration (FNA) techniques is directly related to the aggressiveness,
experience, and technical competency of the physician performing the study.

Advantages and Limitations

In their review, the authors carefully and appropriately point out the
strengths and weaknesses of this technique. One limitation that deserves more
attention is the impact that operator inexperience can have on the utility of
the procedure when interpreting what often may be ambiguous or equivocal images
of complicated pancreatic lesions. This is the most obvious drawback of the
procedure, since it needs to be done in centers of excellence by physicians with
significant experience and considerable diagnostic skills.

The authors thoroughly review endoscopic ultrasound and its utility in the
diagnosis and staging of pancreatic solid mass and cystic lesions. The technique
of endoscopic ultrasound has become essential in the characterization and
localization of pancreatic islet tumors. As they pointed out, the endoscopic
ultrasound’s ability to successfully localize small islet cell tumors imbedded
in the substance of the pancreatic parenchyma has diminished the utilization of
invasive technology such as venous sampling and angiography.

Cost-Effectiveness

Both of the latter techniques are considerably more expensive than endoscopic
ultrasound, and are associated with potential morbidity not found in endoscopic
ultrasound. Use of endoscopic ultrasound technology has resulted in significant
cost savings in terms of localizing neuroendocrine tumors and assessing
resectability of the pancreas.

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