Endoscopic ultrasound in the diagnosis of pancreatic intraductal papillary mucinous neoplasms

Abstract

Pancreatic cystic lesions are increasingly recognised due to the widespread use of different imaging modalities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a common, but also heterogeneous group of cystic tumors with a significant malignant potential. These neoplasms must be differentiated from other cystic tumors and properly classified into their different types, main-duct IPMNs vs branch-duct IPMNs. These types have a different malignant potential and therefore, different treatment strategies need to be implemented. Endoscopic ultrasound (EUS) offers the highest resolution of the pancreas and can aid in the differential diagnosis, classification and differentiation between benign and malignant tumors. The addition of EUS fine-needle aspiration can supply further information by obtaining fluid for cytology, measurement of tumor markers and perhaps DNA analysis. Novel techniques, such as the use of contrast and sophisticated equipment, like intraductal probes can provide information regarding malignant features and extent of these neoplasms. Thus, EUS is a valuable tool in the diagnosis and appropriate management of these tumors.

Keywords: Endoscopic ultrasound; Pancreatic intraductal papillary mucinous neoplasms

Core tip: This review shows that endoscopic ultrasound initially provides differential diagnosis of pancreatic cystic tumors and subsequently can classify intraductal papillary mucinous neoplasms of the pancreas into their different types. With the use of endoscopic ultrasound (EUS) fine-needle aspiration and other techniques, such as contrast enhancement, EUS can differentiate between benign and malignant neoplasms and help the clinician to implement the proper treatment strategy.