Localization of endocrine tumors of the pancreas with endoscopic ultrasonography

Article Abstract:

The pancreas is, in a sense, two glands in one. Much of the pancreas is an exocrine gland that secretes digestive enzymes into the digestive tract. However, scattered within the pancreas are the islets of Langerhans, which constitute islands of endocrine tissue that secrete hormones, such as insulin and glucagon. Cancers of the endocrine pancreas often reveal their presence first by secreting copious amounts of these hormones. Pancreatic tumors secreting the hormone gastrin may also occur within the body of the pancreas. Once the presence of such tumors is suspected on the basis of blood tests, imaging techniques must be used to determine the location of tumors within the pancreas. CT scans and magnetic resonance imaging, as well as abdominal ultrasonography, are generally unsatisfactory for detecting tumors that are smaller than 2 centimeters (0.7 inches) in size. A study was conducted to evaluate the usefulness of endoscopic ultrasonography in 13 patients suspected of having pancreatic endocrine tumors. In endoscopic ultrasonography, the ultrasound sensor is lowered down the esophagus into the stomach; the fiberoptic endoscope can then be used to visually guide the ultrasound sensor into place. The pancreas lies next to the stomach and the duodenum, and ultrasound images can be recorded from these locations. After the sensor is in place, reflected ultrasonic sound waves are used to record the image of the pancreas. This imaging method detected tumors in 10 of the 13 patients; in 5 patients more than one tumor was observed. Eight patients were treated surgically; the ultrasound diagnosis was confirmed in these cases. In one case, the presumed tumor was found to be benign lymph nodes, and in another case, a tumor was found despite apparently negative findings on the ultrasound imaging. However, in both cases, re-examination of the ultrasound images revealed that the images were, indeed, lymph nodes in one case and a tumor in the other; it was the interpretation of the images that was faulty. The technique of endoscopic ultrasonography has proved capable of detecting small tumors between 0.5 and 2.0 centimeters in size. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Pancreatic cancer, Pancreatic tumors, Endoscopic ultrasonography

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Preoperative staging of esophageal cancer: comparison of endoscopic US and dynamic CT

Article Abstract:

Cancer of the esophagus is a highly deadly, but rare type of cancer in the US. Unfortunately, it is usually not diagnosed until it has progressed to the latter stages of disease and surgery is the only treatment that offers much hope for a cure. Accurate evaluation and staging of esophageal cancer is important both in determining who might benefit from surgical treatment and in determining how extensive the surgery should be. This study compared the accuracy of endoscopic ultrasonography (US), an imaging technique that uses a high-frequency transducer fitted to a flexible optical instrument, and computed tomography (CT), a scanning X-ray technique that uses a computer to create images, in staging esophageal cancer. Endoscopic US was performed on 50 patients with esophageal cancer for preoperative evaluation and CT of the chest and abdomen was performed on 42 of the 50 patients. Imaging findings were compared with findings at surgery. Surgical findings on tumor growth confirmed the findings using US in 46 of 50 patients. In the 42 patients that underwent both US and CT, surgical findings on tumor growth confirmed US findings in 40 patients (96 percent) and CT findings in 25 patients (60 percent). US findings did not cause any significant understaging or overstaging of tumor growth, but CT results tended to suggest the tumors were slightly less advanced than they actually were found to be. In the 42 patients examined with both US and CT, surgical results confirmed US findings on lymph node involvement in 37 of 42 patients (88 percent) and CT findings in 31 of 42 patients (74 percent). CT was more accurate than US in staging distant metastases. In overall tumor staging, US alone was accurate in 25 of 42 patients (60 percent), CT alone was accurate in 27 of 42 patients (64 percent), and the combined use of US and CT was accurate in 36 of 42 patients (86 percent). These results indicated that US could be very useful in staging esophageal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Esophageal cancer

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Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT

Article Abstract:

Gastric, or stomach, cancer accounts for a small portion of the newly diagnosed cases of cancer in the US each year. Despite advances that allow stomach cancer to be detected in its early stages, many patients are not diagnosed until the cancer is in its latter stages. The mortality associated with this type of cancer remains very high. Surgical treatment offers the best hope for a cure. Accurate staging of the cancer and identification of affected tissues is important both in deciding who might benefit from surgery and in planning the surgery. Computed tomography (CT) and magnetic resonance (MR) imaging are two diagnostic imaging techniques used to evaluate gastric cancer prior to surgery. Both are limited in their abilities to accurately stage depth of tumor invasion and regional lymph node involvement. This study compared a relatively new diagnostic imaging procedure, endoscopic ultrasonography (US), with CT for their ability in staging gastric cancer. US was performed prior to surgery on 50 patients suffering from gastric cancer. CT was performed on 33 of the 50 patients. Imaging results were compared with findings at surgery. US results on tumor depth were confirmed by surgical findings in 46 of the 50 patients (92 percent) and in 30 of the 33 patients (91 percent) who also underwent CT examination. CT results on tumor depth were confirmed with findings at surgery in 14 of 33 patients (42 percent). For regional lymph node involvement, findings at surgery confirmed US results in 25 of 33 patients (76 percent) and confirmed results in 16 of 33 patients (48 percent). On overall cancer staging, surgical findings supported US results in 24 of 33 patients and supported CT results in 15 of 33 patients. When US and CT results were combined, accurate staging was obtained in 24 of 33 patients. The results indicated that endoscopic US was significantly better than CT in evaluating and staging gastric cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Identification and classification, Stomach cancer

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