Clin Endosc.  2019 Sep;52(5):479-485. 10.5946/ce.2018.163.

Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer

• Fujii Y
• Matsumoto
• Kato H
• Saragai Y
• Takada S
• Mizukawa S
• Muro S
• Uchida D
• Tomoda T
• Horiguchi
• Tanaka N
• Okada H

• KMID: 2464670
• DOI: http://doi.org/10.5946/ce.2018.163

Abstract

BACKGROUND/AIMS
This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance.
METHODS
In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels.
RESULTS
The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0-742] µm vs. 2,833 [1,076-5,694] µm, p=0.012) and arteries (623 [0-854] µm vs. 3,097 [1,396-6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed.
CONCLUSIONS
Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

Keyword

Endoscopic ultrasonography; Pancreatic cancer; Pathological distance; Staging; Vascular invasion

MeSH Terms

Arteries
Diagnosis
Endosonography*
Humans
Pancreatic Neoplasms*
Retrospective Studies
Sensitivity and Specificity
Veins

Figure

• 

  Fig. 1. Classification of endoscopic ultrasonography findings into four types in accordance with the relationship between tumors and major vessels. (A) Type 1: clear invasion, encasement of vessel by tumor. (B) Type 2: a tumor that contacts a vessel with loss of hyperechoic vessel layer. (C) Type 3: a tumor that contacts a vessel without loss of hyperechoic vessel layer. (D) Type 4: clear non-invasion, existence of distance between a tumor and a vessel. SMA, superior mesenteric artery; SMV, superior mesenteric vein; SPA, splenic artery.

• 

  Fig. 2. Box plots of distances between pancreatic cancers and pathologically evaluated vessels. Box plots of the distances from the evaluated major veins (A) and major arteries (B) to pancreatic cancers in cases of type 2 and type 3 endoscopic ultrasonography (EUS) findings with no vascular invasion. The distances of the cases with type 2 EUS finding were significantly shorter than those of cases with type 3 EUS finding in both, the veins and arteries.

• 

  Fig. 3. False-positive case of pancreatic cancer in transition of head and body, with a size of 55 mm. (A) This case was diagnosed as type 2. The pancreatic tumor (arrowhead) contacting the superior mesenteric vein (SMV: arrow) with the loss of the hyperechoic vessel layer, as observed by endoscopic ultrasonography. (B) Computed tomography image showing pancreatic tumor (arrowhead) contact SMV (arrow). (C) Pathological evaluation showing a distance of 742 µm between the tumor and SMV (hematoxylin-eosin stain, ×20). (D) No invasion to vessel was verified using Elastica van Gieson staining (×40).

• 

  Fig. 4. False-positive case of a pancreatic cancer in tail with a size of 45 mm. (A) This case was diagnosed as type 2. The pancreatic tumor (arrowhead) contacting the splenic artery (SPA: arrow), with the loss of the hyperechoic vessel layer, as observed by endoscopic ultrasonography. (B) Computed tomography image showing the pancreatic tumor (arrowhead) in contact with the SPA (arrow). (C) Pathological evaluation showing a distance of 0 μm between the tumor and SPA (hematoxylin-eosin staining, ×20). (D) Although proliferation of the tumor cells surrounding the SPA was observed, no invasion to vessel was verified in Elastica van Gieson staining (×40).

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