Endoscopic Ultrasound in Differentiation of Solid Pancreatic Head Lesions: A Single-Center Experience

Background: Precise characterization of pancreatic head lesions remains a challenge even with all the radiological advancement. Pancreatic adenocarcinoma is the most common malignant lesion, but many other malignant and benign pathology can masquerade with similar clinical and radiological features. This study designed to see the role of endoscopic ultrasound (EUS) in such cases.

Methods: This is a retrospective analysis of prospectively maintained databases in a tertiary care center of north India. Patients with suspicious solid mass lesion in pancreatic head in CT-scan/MRI who underwent EUS-FNB in last 3 (2020–2022) years were analyzed. Those who have at least 6 months of F/U or F/U until surgery or death were included. Different EUS characteristics were compared to look for predictors of malignant head lesions.

Results: A total of 92 patients identified, among which 39 patients included in final analysis. Twenty-four (61.5%) patients had pancreatic adenocarcinoma, 1 (2.6%) neuro-endocrine cancer (NEC), 11 (28.2%) inflammatory head mass, 2 (5.1%) autoimmune pancreatitis (AIP), and 1 had pancreatic tuberculosis. History of acute pancreatitis in recent past significantly favored benign pathology. Increased pancreatic duct (PD) diameter (5.2 ± 2.5 mm vs. 3.3 ± 1 mm; p = 0.01) and negative duct penetrating sign (22 (88%) vs. 7 (50%); p = 0.03) predicted malignancy. In EUS elastography, both qualitative (color pattern) (p = 0.01) and quantitative (strain ratio) (p = 0.02) parameters found to be significant predictor of malignant lesion.

Conclusion: This study highlights the importance of EUS and EUS elastography in differentiation of solid pancreatic head lesions.

Table 1 Diagnosis of pancreatic head mass

Diagnosis	Numbers (%)
Malignant (adeno-carcinoma)	24 (61.5%)
Inflammatory	11 (28.2%)
Auto-immune pancreatitis	2 (5.1%)
Tuberculosis	1 (2.6%)
Malignant (neuro-endocrine cancer)	1 (2.6%)

Table 2 EUS characteristics according to nature of head mass

	Malignant lesion (25)	Benign lesion (14)	p-Value
Dilated CBD	19 (76%)	9 (64.3%)	0.43
Dilated PD	19 (76%)	8 (57.1%)	0.22
Double duct sign	14 (56%)	6 (42.9%)	0.43
CBD diameter (mm)	12.8 ± 4.8	10.9 ± 3.5	0.19
PD diameter (mm)	5.2 ± 2.5	3.3 ± 1	0.01
Max diameter of lesion (mm)	32.2 ± 12	31.4 ± 3.2	0.75
Duct penetration	3 (12%)	7 (50%)	0.03
Surrounding vascular encasement	5 (20%)	0	0.14
Significant peripancreatic LAP	9 (36%)	1 (7.1%)	0.1
Calcification with in the lesion	2 (8%)	2 (14.3%)	0.6
Echogenicity	Hypoechoic: 16 (64%)Heteroechoic: 9 (36%)	Hypoechoic: 5 (35.7%)Heteroechoic: 9 (64.3%)	0.09
Elastography	Heterogenous; predominantly blue: 20 (80%)Heterogenous; predominantly green: 5 (20%)	Heterogenous; predominantly blue: 3 (21.4%)Heterogenous; predominantly green: 11 (78.6%)	0.01
Strain ratio	26 ± 7.2 (n = 13)	14.8 ± 10.2 (n = 6)	0.02

Publication History

Article published online:
22 April 2024