Christoph Frank Dietrich1, Anand Vasante Sahai2, Mirko D'Onofrio3, Uwe Will4, Paolo Giorgio Arcidiacono5, Maria Chiara Petrone5, Michael Hocke6, Barbara Braden7, Eike Burmester8, Kathleen Möller9, Adrian Săftoiu10, Andre Ignee11, Xin-Wu Cui1, Sevastita Iordache12, Andrej Potthoff13, Julio Iglesias-Garcia14, Pietro Fusaroli15, Yi Dong16, Christian Jenssen17. 1. Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China; Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany. 2. Division of Gastroenterology, CHUM, Hopital Saint Luc, Montreal, Quebec, Canada. 3. Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy. 4. SRH Wald Klinikum Gera, Germany. 5. PancreatoBiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy. 6. Medical Department, Helios Klinikum Meiningen, Meiningen, Germany. 7. Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom. 8. Medical Department I, Sana Hospital Lübeck, Lübeck, Germany. 9. Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany. 10. Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania; Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Herlev, Denmark. 11. Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany. 12. Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania. 13. Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany. 14. Gastroenterology and Hepatology Department, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain. 15. Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna and Hospital of Imola, Imola, Italy. 16. Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China. 17. Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Germany.
Abstract
BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical management. METHODS: Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients. RESULTS: The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%). CONCLUSIONS: Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.
BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical management. METHODS: Inclusion criterion for the retrospective study analysis was the incidental finding of primarily undetermined small solid pancreatic lesions ≤15 mm in 394 asymptomatic patients. Final diagnoses were based on histology or cytology obtained by imaging-guided biopsy (and at least 12-month follow-up) and/or surgery. Contrast-enhanced US or contrast-enhanced EUS was performed in 219 patients. RESULTS: The final diagnoses of 394 patients were as follows: 146 PDACs, 156 neuroendocrine tumors, 28 metastases into the pancreas from other primary sites, and 64 various other etiologies. Contrast-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%). CONCLUSIONS: Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical surgery. Without preoperative diagnosis, an unacceptably large proportion of patients would be exposed to radical surgery with significant morbidity and mortality.
Authors: Guido Michels; Rudolf Horn; Andreas Helfen; Andreas Hagendorff; Christian Jung; Beatrice Hoffmann; Natalie Jaspers; Horst Kinkel; Clemens-Alexander Greim; Fabian Knebel; Johann Bauersachs; Hans-Jörg Busch; Daniel Kiefl; Alexander O Spiel; Gernot Marx; Christoph F Dietrich Journal: Med Klin Intensivmed Notfmed Date: 2022-02 Impact factor: 0.840
Authors: Barbara Braden; Christian Jenssen; Mirko D'Onofrio; Michael Hocke; Uwe Will; Kathleen Möller; Andre Ignee; Yi Dong; Xin-Wu Cui; Adrian Sãftoiu; Christoph F Dietrich Journal: Endosc Ultrasound Date: 2017 Jan-Feb Impact factor: 5.628
Authors: Christoph F Dietrich; Yi Dong; Christian Jenssen; Valentina Ciaravino; Michael Hocke; Wen-Ping Wang; Eike Burmester; Kathleen Moeller; Nathan Ss Atkinson; Paola Capelli; Mirko D'Onofrio Journal: World J Gastroenterol Date: 2017-08-14 Impact factor: 5.742