摘要
Pancreatic cancer is a highly lethal disease with a ge-netic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prog-nosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer de-velopment. The aim of this strategy is to identify pre-malignant precursors or asymptomatic pancreatic can-cer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration(FNA) seems to be the most promising technique for early de-tection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in high-risk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced en-dosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-en-hanced harmonic EUS, computer-aided diagnostic tech-niques, confocal laser endomicroscopy miniprobe andthe detection of DNA abnormalities or protein markersby FNA, promise improvement of the diagnostic yield ofEUS. As the resolution of imaging improves and as ourknowledge of precursor lesions grows, we believe thatEUS could become the most suitable method to detectcurable pancreatic neoplasms in correctly identifiedasymptomatic at-risk patients.
Pancreatic cancer is a highly lethal disease with a ge-netic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prog-nosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer de-velopment. The aim of this strategy is to identify pre-malignant precursors or asymptomatic pancreatic can-cer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration(FNA) seems to be the most promising technique for early de-tection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in high-risk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced en-dosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-en-hanced harmonic EUS, computer-aided diagnostic tech-niques, confocal laser endomicroscopy miniprobe andthe detection of DNA abnormalities or protein markersby FNA, promise improvement of the diagnostic yield ofEUS. As the resolution of imaging improves and as ourknowledge of precursor lesions grows, we believe thatEUS could become the most suitable method to detectcurable pancreatic neoplasms in correctly identifiedasymptomatic at-risk patients.
