Contrast-enhanced endoscopic ultrasound for diagnosis of pancreatic malignancy-a visual aid or a distraction?

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Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is the gold standard for diagnosis of pancreatic malignancy. This commentary discusses the findings and limitations of a study by Dietrich and colleagues that examined the operative characteristics of contrast-enhanced EUS (CE-EUS) in patients with a solitary, solid, pancreatic mass of less than 4 cm in diameter. The authors compared the vascularity of adenocarcinomas with that of neuroendocrine tumors and other lesions of the pancreas. The finding of decreased vascularity on CE-EUS had a sensitivity of 92% and a specificity of 100% for the differentiation of adenocarcinomas from neuroendocrine tumors. It seems unlikely that CE-EUS will replace EUS-FNA for the diagnosis of pancreatic malignancy, but CE-EUS might have a role in differentiating adenocarcinomas from neuroendocrine tumors. It might be possible to use CE-EUS to assist in confirming the diagnosis of neuroendocrine tumors and perhaps in directing EUS-FNA.

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