Vol 7, No 2 (2011)
Review paper
Published online: 2011-06-22
Enlarged pancreatic head and other ambiguous findings on pancreatic imaging — how to rule out malignancy?
Onkol. Prak. Klin 2011;7(2):66-72.
Abstract
The problem of ambiguous findings on pancreatic imaging is increasingly important in clinical practice
and closely related to the huge number of imaging tests being performed in everyday clinical practice.
The most common ambiguous finding is a focal or diffuse enlargement (fullness, prominence) of the
pancreas without a discrete mass. Although the enlargement represents normal pancreas or benign
pancreatic disease in most cases, there is still a considerable risk of malignancy. Results from four
retrospective studies conducted in the United States indicate that among patients who underwent endoscopic
ultrasonography (EUS) to clarify ambiguous findings on computed tomography or magnetic
resonance imaging, 13.5% had pancreatic malignancy, 38% had benign pancreatic disease, and the remaining 48.5% had normal pancreas. These results indicate that ambiguous findings on pancreatic
imaging cannot be ignored and need to be clarified. The very high negative predictive value of EUS in
patients with a suspicion of pancreatic cancer and the capability to perform EUS-guided fine needle
aspiration from focal lesions, makes EUS the perfect tool in such cases. However, a prospective study
on this topic is badly needed because all of the available data are from retrospective studies.
Onkol. Prak. Klin. 2011; 7, 2: 66–72
Onkol. Prak. Klin. 2011; 7, 2: 66–72
Keywords: pancreatic cancerchronic pancreatitispancreatic imagingcomputed tomographyendoscopic ultrasonography