NEW OPPORTUNITIES OF THE QUALIFYING ENDOSCOPIC DIAGNOSTICS OF PANCREAS NEOPLASMS

Objective: the aim of study was testing and introduction in clinical practice combination of EUS with sonoelastography, fine-needle biopsy and needle-based confocal laser endomicroscopy in advanced diagnostic of pancreatic disease. Materials and methods: in the period from February 2014 to December 2015, we accumulated experience of EUS-FNA in 72 patients mostly with tumor pathology of the pancreas. In 16 cases we used 19G, in 49-22G, and in 7 patients - 25G needles. In 5 patients we used COOK Echotip Procore needle. In 8 cases we performed confocal laser endomicroscopy through the 19G needle (nCLE) in 3 patients with cystic and in 5 - with solid tumors. In 20 patients, there we used HITACHI-PENTAX sonoelastography was performed. Results: There were no complications in EUS-FNA. In all cases we received pathology verification of disease. nCLE results always confirmed by morphological examination of material. In elastography examination normal pancreatic tissue had a equable green-yellow color, in chronic pancreatitis on the same background there were areas of blue seal parenchyma, in the cases pancreatic adenocarcinoma it was marked predominance of blue color scale, in neuroendocrine tumors - diffuse distribution of green and blue areas. Using nCLE in patients with adenocarcinoma revealed the destruction of certain glands, polymorphic nuclei of epithelial cells, with their enlargement, deformation, loss of polarity. Appliance of Procore needle has its technical features, but allowed us to obtain more material with less bloody - due to fewer number of passes. Conclusion: Thus, our study confirms the effectiveness of EUS-FNA with sonoelastography and nCLE. It defines objectives for improvement and expansion of the range for their clinical use.

pancreatic cancer, EUS, FNA, sonoelastography, nCLE, confocal laser endomicroscopy

1. Siegel R., Ma J., Zou Z., Jemal A. Cancer statistics// CA Cancer J Clin. - 2014. - p. 64:9-29

2. Маев И. В., Кучерявый Ю. А. Болезни поджелудочной железы. В 2-х томах. - М.: ОАО «Издательство «Медицина», издательство «Шико», 2008. - 976 с.

3. DiMagno M.J., DiMagno E. P. Chronic pancreatitis // Curr Opin Gastroenterol. 2012; 28(5): 523-531

4. Seicean A. Endoscopic ultrasound in chronic pancreatitis: Where are we now? // World J Gastroenterol. 2010 Sep 14; 16(34): 4253-4263

5. The International Working Group for Minimum Standard Terminology for Gastrointestinal Endosonography. Reproduction of minimal standard terminology in gastrointestinal endosonography. Dig Endosc. 1998;10:158-188.

6. Kahl S, Glasbrenner B, Leodolter A, et al. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study.// Gastrointest Endosc. 2002;55:507-511

7. Othman M. O., Wallace M. B. The role of endoscopic ultrasonography in the diagnosis and management of pancreatic cancer.// Gastroenterol Clin North Am 2012; 41: 179-188

8. Săftoiu A, Vilmann P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer.// J Clin Ultrasound 2009; 37: 1-17

9. Eloubeidi MA, Jhala D, Chhieng DC. et al. Yield of endoscopic ultrasound-guided neneedle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer 2003; 99: 285-292;

10. Early DS, Acosta RD, Jue T. et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013; 77: 839-843

11. Madhoun MF, Wani SB, Rastogi A. et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a metaanalysis. Endosc 2013; 45: 86-92

12. Iglesias-Garcia J, Poley JW, Bruno M. et al. Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 2011; 73: 1189-1196

13. Bang JY, Ramesh J, Trevino J, et al. Objective assessment of an algorithmic approach to EUS-guided FNA and interventions. Gastrointest Endosc 2013; 77: 739-744

14. Hucl T, Wee E, Anuradha S, et al. Feasibility and ef ciency of a new 22G core needle: a prospective comparison study. Endoscopy 2013; 45: 792-798

15. Tamerisa R, Irisawa A, Bhutani M. Endoscopic ultrasound in the diagnosis, staging, and management of gastrointestinal and adjacent malignancies. Med Clin North Am 2005; 89(1):139-58

16. Gao L, Parker KJ, Lerner RM, Levinson SF: Imaging of the elastic properties of tissue-a review. Ultrasound Med Biol 1996; 22(8):959-977;

17. Ophir J, Cespedes EI, Garra BS, Ponnekanti Y, Huang Y, Maklad N: Elastography: ultrasoinic imaging of tissue strain and elastic modulus in vivo. Eur J Ultrasound 1996; 3(1):49-70.

18. Giovannini M, Thomas B, Erwan B. et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol 2009; 15: 1587-1593

19. Mei M, Ni J, Liu D. et al. EUS elastography for diagnosis of solid pancreatic masses: a meta-analysis. Gastrointest Endosc 2013; 77: 578-589

20. De Jong K, Nio CY, Hermans JJ et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 2010; 8: 806-811

21. Jaïs B, Rebours V, Myung-Hwan K et al. Pancreatic serous cystadenoma related mortality is nil. Results of a multinational study under the auspices of the International Association of Pancreatology and the European Pancreatic Club. Gastroenterology 2014; 147: 137-138

22. Nakai Y, Isayama H, Shinoura S et al. Confocal laser endomicroscopy in gastrointestinal and pancreatobiliary diseases. Dig Endosc 2014; 26: 86-94

23. Konda VJ, Meining A, et al. A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. Endoscopy 2013; 45: 1006-1013

24. Napoléon B, Lemaistre A-I, Pujol B et al. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy 2015; 47: 26