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Z Gastroenterol 2021; 59(10): 1083-1090
DOI: 10.1055/a-1515-3123
Übersicht

Frühdiagnose des Pankreaskarzinoms – Die Rolle von Endosonografie und Sonografie

Early detection of pancreatic cancer – The role of endoscopic and transabdominal ultrasound
Friedrich Schorr
1   Gastroenterologie - Division Stadtspital/Landspitäler, Insel Gruppe AG, Bern, Switzerland
,
Manfred Walter Essig
1   Gastroenterologie - Division Stadtspital/Landspitäler, Insel Gruppe AG, Bern, Switzerland
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Zusammenfassung

Pankreaskarzinome sind im Vergleich zu anderen Tumorarten relativ selten, die Prognose ist aber weiterhin schlecht, da die Tumoren meist in einem fortgeschrittenen Stadium diagnostiziert werden. Eine Frühdiagnostik wäre für das Überleben sinnvoll, ein generelles Screening ist für die Allgemeinbevölkerung aufgrund der niedrigen Prävalenz nicht möglich. Ein Screening ist nur für spezielle Risikogruppen mit einem hohen/erhöhten Karzinomrisiko (Keimbahnmutationen, familiäres Pankreaskarzinom, muzinöse zystische Pankreastumoren) etabliert. Weitere Risikokonstellationen (Pankreatitis, Diabetes mellitus, Zigaretten- und Alkoholabusus) sollten jedoch beachtet werden, um frühe Neoplasien nicht zu übersehen. Bedeutung kommt insbesondere der transabdominellen Ultraschalluntersuchung als weit verbreitetem erstem Untersuchungsverfahren zu. Damit können bereits erste Verdachtsmomente mit hoher Sensitivität beschrieben und der Tumorverdacht kann durch Einsatz von Ultraschallkontrastmittel erhärtet werden. Die Endosonografie hat in der weiteren Diagnostik eine herausragende Bedeutung. Durch zusätzliche Verfahren mit Einsatz von Ultraschallkontrastmittel, Elastografie und Feinnadelpunktion ist in der Regel eine definitive Klärung mit hoher Sensitivität und Spezifität möglich mit dem Ziel, die bislang schlechte Prognose des Pankreaskarzinoms weiter zu verbessern.

Abstract

Pancreatic neoplasms are less common tumors and have a poor prognosis when advanced. Early diagnosis would be beneficial for survival, but screening of the whole population cannot be justified with a satisfying benefit-effort correlation. Subgroups of patients with a higher than average risk are those with germ-like mutations, familial cancers risks, and mucinous cystadenomas that would benefit from surveillance programs. Other risk groups, like patients with pancreatitis, new onset diabetes, and heavy smokers, should be considered as well. Transabdominal ultrasonography is of great advantage as a first-line imaging method because of its easy access. The accuracy for adenocarcinoma diagnosis is nearly 90% while using CEUS. Endosonography is of extraordinary importance in the diagnostic approach of pancreatic tumors because of high sensitivity and specificity while using advanced imaging techniques like CEUS, elastography, and fine needle biopsy. Screening by means of EUS is also possible in high-risk situations, and a favourable cost-benefit ratio must be shown by future data.

Schlüsselwörter

Bauchspeicheldrüsenkrebs - Früherkennung - endoskopischer Ultraschall - transabdominaler Ultraschall - Personen mit hohem Risiko - familiärer Krebs - kontrastverstärkter Ultraschall - Elastografie - endoskopische Feinnadelbiopsie

Keywords

pancreatic cancer - early detection - endoscopic ultrasound - transabdominal ultrasound - high risk individuals - familiar cancer - contrast enhanced ultrasound - elastography - endoscopic fine needle biopsy


Publication History

Received: 05 March 2021

Accepted after revision: 16 May 2021

Article published online:
09 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Ducreux M, Cuhna AS, Caramella C. et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (05) v56-68
    CrossrefPubMedSearch in Google Scholar
  • 2 Bericht zum Krebsgeschehen in Deutschland 2016. Zentrum für Krebsregisterdaten im Robert Koch-Institut (Hrsg). Berlin. 2016
    PubMedSearch in Google Scholar
  • 3 Krebs in der Schweiz. Nationale Krebsregistrierungsstelle Schweiz. Zürich. 2020
    PubMedSearch in Google Scholar
  • 4 Capello M, Bantis LE, Scelo G. et al Sequential validation of blood-based protein biomarker candidates for earlystage pancreatic cancer. J Natl Cancer Inst 2017; 109 (04)
    CrossrefPubMedSearch in Google Scholar
  • 5 Cohen JD, Li L, Wang Y. et al. Detection and localization of surgically resectable cancers with a multi-analyte blood test. Science 2018; 359: 926-930
    CrossrefPubMedSearch in Google Scholar
  • 6 Wood LD, Yurgelun MB, Goggins MG. Genetics of Familial and Sporadic Pancreatic Cancer. Gastroenterology 2019; 156 (07) 2041-2055
    CrossrefPubMedSearch in Google Scholar
  • 7 Grover S, Syngal S. Hereditary Pancreatic Cancer. Gastroenterology 2010; 139: 1076-1080
    CrossrefPubMedSearch in Google Scholar
  • 8 Canto MI, Harinck F, Hruban RH. et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013; 62: 339-347
    CrossrefPubMedSearch in Google Scholar
  • 9 Singhi AD, Koay EJ, Chari ST. et al. Early Detection of Pancreatic Cancer: Opportunities and Challenges. Gastroenterology 2019; 156 (07) 2024-2040
    CrossrefPubMedSearch in Google Scholar
  • 10 Goggins M, Overbeek KA, Brand R. et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2020; 69 (01) 7-17
    CrossrefPubMedSearch in Google Scholar
  • 11 Tanaka M, Chari S, Adsay V. et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6: 17-32
    CrossrefPubMedSearch in Google Scholar
  • 12 Del Chiaro M, Verbeke C, Salvia R. et al. European experts consensus statement on cystic tumors of the pancreas. Dig Liver Dis 2013; 45: 703-711
    CrossrefPubMedSearch in Google Scholar
  • 13 Elta GH, Enestvedt BK, Sauer BG. et al. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol 2018; 113 (04) 464-479
    CrossrefPubMedSearch in Google Scholar
  • 14 Tanaka M, Fernandez-Del Castillo C, Kamisawa T. et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17: 738-753
    CrossrefPubMedSearch in Google Scholar
  • 15 Singhi AD, McGrath K, Brand RE. et al. Preoperative next-generation sequencing of pancreatic cyst fluid is highly accurate in cyst classification and detection of advanced neoplasia. Gut 2018; 67 (12) 2131-2141
    CrossrefPubMedSearch in Google Scholar
  • 16 Sadr-Azodi O, Oskarsson V, Discacciati A. et al. Pancreatic Cancer Following Acute Pancreatitis: A Population-based Matched Cohort Study. Am J Gastroenterol 2018; 113 (11) 1711-1719
    CrossrefPubMedSearch in Google Scholar
  • 17 Kirkegard J, Mortensen FV, Cronin-Fenton D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112: 1366-1372
    CrossrefPubMedSearch in Google Scholar
  • 18 Chari ST, Leibson CL, Rabe KG. et al. Probability of pancreatic cancer following diabetes: a population based study. Gastroenterology 2005; 129: 504-511
    CrossrefPubMedSearch in Google Scholar
  • 19 Grote VA. et al. Diabetes mellitus, glycated haemoglobin and C-peptide levels in relation to pancreatic cancer risk: a study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Diabetologia 2011; 54: 3037-3046
    CrossrefPubMedSearch in Google Scholar
  • 20 Sah RP, Nagpal SJ, Mukhopadhyay D. et al. New insights into pancreatic cancer-induced paraneoplastic diabetes. Nat Rev Gastroenterol Hepatol 2013; 10 (07) 423-433
    CrossrefPubMedSearch in Google Scholar
  • 21 Pereira SP, Oldfield L, Ney A. et al. Early detection of pancreatic cancer. Lancet Gastroenterol Hepatol 2020; 5 (07) 698-710
    CrossrefPubMedSearch in Google Scholar
  • 22 Kim JY, Hong SM. Precursor Lesions of Pancreatic Cancer. Oncol Res Treat 2018; 41 (10) 603-610
    CrossrefPubMedSearch in Google Scholar
  • 23 Basturk O, Hong SM, Wood LD. et al. A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas Am. J Surg Pathol 2015; 39 (12) 1730-1741
    CrossrefPubMedSearch in Google Scholar
  • 24 Al-Hawary MM, Francis IR, Chari ST. et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensusstatement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 2014; 270 (01) 248-260
    CrossrefPubMedSearch in Google Scholar
  • 25 Ansari NA, Ramalho M, Semelka RC. et al. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: an update. World J Radiol 2015; 7 (11) 361-374
    CrossrefPubMedSearch in Google Scholar
  • 26 Al-Hawary M. Role of imaging in diagnosing and staging pancreatic cancer. JNatl Compr Canc Netw 2016; 14 (05) 678-680
    CrossrefPubMedSearch in Google Scholar
  • 27 Dewitt J, Devereaux BM, Lehman GA. et al. Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol 2006; 4 (05) 717-725
    CrossrefPubMedSearch in Google Scholar
  • 28 Nawaz H, Fan CY, Kloke J. et al. Performance characteristics of endoscopic ultrasound in the staging of pancreatic cancer: a meta-analysis. JOP 2013; 14 (05) 484-497
    CrossrefPubMedSearch in Google Scholar
  • 29 Luz LP, Al-Haddad MA, Sey MSL, DeWitt JM. Applications of endoscopic ultrasound in pancreatic cancer. World J Gastroenterol 2014; 20 (24) 7808-718
    CrossrefPubMedSearch in Google Scholar
  • 30 Vilmann P, Jacobsen GK, Henriksen FW. et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992; 38 (02) 172-173
    CrossrefPubMedSearch in Google Scholar
  • 31 Fisher L, Segarajasingam DS, Stewart C. et al. Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: performance and outcomes. J Gastroenterol Hepatol 2009; 24 (01) 90-96
    CrossrefPubMedSearch in Google Scholar
  • 32 Matsubayashi H, Matsui T, Yabuuchi Y. et al. Endoscopic ultrasonography guided-fine needle aspiration for the diagnosisof solid pancreaticobiliary lesions: clinical aspects to improve the diagnosis. World J Gastroenterol 2016; 22 (02) 628-640
    CrossrefPubMedSearch in Google Scholar
  • 33 Collins BT, Murad FM, Wang JF. et al. Rapid on-site evaluation for endoscopic ultrasound-guided fine-needle biopsy of the pancreas decreases the incidence of repeat biopsy procedures. Cancer Cytopathol 2013; 121 (09) 518-524
    CrossrefPubMedSearch in Google Scholar
  • 34 Iglesias-García J, Larino-Noia J, Domínguez-Munoz JE. New imaging tech-niques: endoscopic ultrasound-guided elastography. Gastrointest Endosc ClinN Am 2017; 27 (04) 551-567
    PubMedSearch in Google Scholar
  • 35 Ignee A, Jenssen C, Arcidiacono PG. et al. Endoscopic ultrasound elastography of small solid pancreatic lesions: a multicenter study. Endoscopy 2018; 50: 1071-1079
    Thieme ConnectPubMedSearch in Google Scholar
  • 36 Kitano M, Yamashita Y. New imaging techniques for endoscopic ultrasonography: contrast-enhanced endoscopic ultrasonography. Gastrointest Endosc ClinN Am 2017; 27 (04) 569-583
    CrossrefPubMedSearch in Google Scholar
  • 37 Mei S, Wang M, Sun L. Contrast-Enhanced EUS for Differential Diagnosis of Pancreatic Masses: A Meta-Analysis. Gastroenterol Res Pract 2019; 2019: 1670183
    CrossrefPubMedSearch in Google Scholar
  • 38 Owens DK, Davidson KW, Krist AH. et al. Screening for Pancreatic Cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2019; 322 (05) 438-444
    CrossrefPubMedSearch in Google Scholar
  • 39 Tacelli M, Celsa C, Magro B. et al. Diagnostic performance of endoscopic ultrasound through-the-needle microforceps biopsy of pancreatic cystic lesions: Systematic review with meta-analysis. Dig Endosc 2020; 32 (07) 1018-1030
    CrossrefPubMedSearch in Google Scholar
  • 40 de la Fuente J, Majumder S. Molecular Diagnostics and Testing for Pancreatic Cysts. Curr Treat Options Gastroenterol 2020;
    CrossrefPubMedSearch in Google Scholar
  • 41 Larino-Noia J, Iglesias-Garcia J, de la Iglesia-Garcia D. et al. EUS-FNA in cystic pancreatic lesions: where are we now and where are we headed in the future?. Endosc Ultrasound 2018; 7 (02) 102-109
    CrossrefPubMedSearch in Google Scholar
  • 42 Umans DS, Rangkuti CK, Sperna Weiland CJ. et al. Dutch Pancreatitis Study Group. Endoscopic ultrasonography can detect a cause in the majority of patients with idiopathic acute pancreatitis: a systematic review and meta-analysis. Endoscopy 2020; 52 (11) 955-964
    Thieme ConnectPubMedSearch in Google Scholar
  • 43 Greenhalf W, Lévy P, Gress T. et al. International consensus guidelines on surveillance for pancreatic cancer in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020; 20 (05) 910-918
    CrossrefPubMedSearch in Google Scholar
  • 44 Sah RP, Nagpal SJ, Mukhopadhyay D. et al. New insights into pancreatic cancer-induced paraneoplastic diabetes. Nat Rev Gastroenterol Hepatol 2013;
    CrossrefPubMedSearch in Google Scholar
  • 45 Singhi AD, Koay EJ, Chari ST, Maitra A. Early Detection of Pancreatic Cancer: Opportunities and Challenges. Gastroenterology 2019; 156 (07) 2024-2040
    CrossrefPubMedSearch in Google Scholar
  • 46 Dietrich CF, Sahai AV, D'Onofrio M. et al. Differential diagnosis of small solid pancreatic lesions. Gastrointest Endosc 2016; 84 (06) 933-940
    CrossrefPubMedSearch in Google Scholar
  • 47 Schorr F, Wente MN, Riemann JF, Büchler M. Papillentumore-endoskopische und/oder chirurgische Therapie?. Gastroenterologe 2009; 5: 403-410
    CrossrefPubMedSearch in Google Scholar
  • 48 Gandolfi L, Torresan F, Solmi L. et al. The role of ultrasound in biliary and pancreatic diseases. Eur J Ultrasound 2003; 16 (03) 141-59
    CrossrefPubMedSearch in Google Scholar
  • 49 Dietrich CF, Braden B, Hocke M. et al. Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol 2008; 134 (06) 635-43
    CrossrefPubMedSearch in Google Scholar
  • 50 D’Onofrio M, Barbi E, Dietrich CF. et al. Pancreatic multicenter ultrasound study (PAMUS). Eur. J. Radiol 2012; 81 (04) 630-638
    CrossrefPubMedSearch in Google Scholar
  • 51 Simon C. Hydrosonography of the pancreas. Preliminary results of a pilot study. Der Radiologe 1996; 36: 389-–396
    CrossrefPubMedSearch in Google Scholar
  • 52 Ashida R, Tanaka S, Yamanaka H. et al. The Role of Transabdominal Ultrasound in the Diagnosis of Early Stage Pancreatic Cancer: Review and Single-Center Experience. Diagnostics (Basel) 2018; 9 (01) 2
    CrossrefPubMedSearch in Google Scholar
  • 53 Toft J, Hadden WJ, Laurence JM. et al. Imaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy. Eur J Radiol 2017; 92: 17-23
    CrossrefPubMedSearch in Google Scholar
  • 54 Morelli L, Guadagni S, Borrelli V. et al. Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging. World J Gastroenterol 2019; 25 (18) 2217-2228
    CrossrefPubMedSearch in Google Scholar
  • 55 Fukuda J, Ikezawa K, Nakao M. et al. Predictive Factors for Pancreatic Cancer and Its Early Detection Using Special Pancreatic Ultrasonography in High-Risk Individuals. Cancers (Basel) 2021; 13 (03) 502
    CrossrefPubMedSearch in Google Scholar