Hirooka Y, Itoh A, Kawashima H, Ohno E, Ishikawa T, Itoh Y, Nakamura Y, Hiramatsu T, Nakamura M, Miyahara R, Ohmiya N, Ishigami M, Katano Y, Goto H. Clinical oncology for pancreatic and biliary cancers: Advances and current limitations. World J Clin Oncol 2011; 2(5): 217-224 [PMID: 21611098 DOI: 10.5306/wjco.v2.i5.217]
Corresponding Author of This Article
Yoshiki Hirooka, Associate Professor, Doctor of Medical Science, Department of Endoscopy, Nagoya University Hospital, 65, Tsuruma-Cho, Showa-Ku, Nagoya City, Aichi Prefecture 81-466-8550, Japan. hirooka@med.nagoya-u.ac.jp
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Yoshiki Hirooka, Yosuke Nakamura, Ryoji Miyahara, Hidemi Goto, Department of Endoscopy, Nagoya University Hospital, 65, Tsuruma-Cho, Showa-Ku, Nagoya City, Aichi Prefecture 81-466-8550, Japan
Akihiro Itoh, Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Yuya Itoh, Takeshi Hiramatsu, Masanao Nakamura, Naoki Ohmiya, Masatoshi Ishigami, Yoshiaki Katano, Hidemi Goto, Department of Gastroenterology, Nagoya University Graduate School of Medicine, 65, Tsuruma-Cho, Showa-Ku, Nagoya City, Aichi Prefecture 81-466-8550, Japan
Author contributions: Hirooka Y designed this review and wrote the manuscript; Hirooka Y, Itoh A, Kawashima H, Ohno E and Ishikawa T performed the majority of EUS procedures; Itoh Y, Nakamura Y and Hiramatsu T assisted EUS procedures; Nakamura M, Miyahara R, Ohmiya N, Ishigami M and Katano Y were also involved in editing this manuscript; Goto H advised and supervised this work.
Correspondence to: Yoshiki Hirooka, Associate Professor, Doctor of Medical Science, Department of Endoscopy, Nagoya University Hospital, 65, Tsuruma-Cho, Showa-Ku, Nagoya City, Aichi Prefecture 81-466-8550, Japan. hirooka@med.nagoya-u.ac.jp
Telephone: +81-52-7358806 Fax: +81-52-7358806
Received: October 30, 2010 Revised: December 15, 2010 Accepted: December 22, 2010 Published online: May 10, 2011
Abstract
In the early 2000s, the main stream of endoscopic ultrasonography (EUS) changed from a mechanical scanning method to electronic radial or linear scanning methods. Subsequently, useful applications in trans-abdominal ultrasonography came within reach of EUS. In particular, contrast-enhanced EUS (CE-EUS) and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders. Each type of pancreatic disorder has characteristic hemodynamics. CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions. EUS-elastography can assess tissue hardness by measuring its elasticity. This parameter appears to correlate with the malignant potential of the lesions. Tissue elasticity studies can provide information on both its pattern and distribution. The former is the conventional method of morphological diagnosis, but it is restricted to observations made in a region of interest (ROI). The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant, regardless of the ROI. Though EUS-fine needle aspiration (FNA) is also a very useful diagnostic tool, there are several limitations. Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity. Therefore, in particular, endoscopists should keep this limitation in mind.
