Laparoscopic ultrasound-guided biopsy in upper gastrointestinal tract cancer patients

Laparoscopic and Percutaneous Core Needle Biopsy Plays a Central Role for the Diagnosis of Autoimmune Pancreatitis in a Single-Center Study From Denmark

OBJECTIVES

The aims of this study were to describe the diagnosis of autoimmune pancreatitis (AIP) in Denmark and to test the usefulness of the International Consensus Diagnostic Criteria (ICDC) on a geographically well-defined cohort.

METHODS

All patients diagnosed with AIP at Odense University Hospital from 2007 to 2013 were included (n = 30; mean follow-up, 26.2 months). Data from laparoscopic or percutaneous ultrasound-guided core needle biopsy (CNB), resection specimens, endoscopic ultrasound (EUS), EUS-guided CNB, computed tomography, serum immunoglobulin G4 (IgG4), and pancreatography were retrospectively analyzed according to ICDC.

RESULTS

Twenty patients were diagnosed with type 1, 8 with type 2, and 2 with not otherwise specified AIP. Twenty-eight patients (93%) could correctly be classified when ICDC were retrospectively applied. Serum IgG4 was elevated in 44% of type 1 and 0% of type 2. Other organ involvement was observed in 40% of type 1 and 13% of type 2, but inflammatory bowel disease only in type 2 (P = 0.001). One patient had IgG4-related chronic perisplenitis as a hitherto undescribed manifestation of IgG4-related disease. Nineteen (91%) of 21 biopsied patients had diagnostic CNB features of AIP. Computed tomography, EUS, and pancreatography showed features highly suggestive or supportive of AIP in 68%, 72%, and 71%, respectively.

CONCLUSIONS

Laparoscopic or percutaneous ultrasound-guided CNB had the highest sensitivity for AIP. The ICDC could retrospectively correctly diagnose 93% of the patients.

The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions

Intraoperative ultrasonography (IOUS) has been widely utilized in hepatic surgery both as a diagnostic technique and in the course of treatment. Since IOUS involves direct-contact imaging of the target organ, it can provide high spatial resolution without interference from the surrounding structures. Therefore, IOUS may improve the detection, characterization, localization, and local staging of hepatic tumors. IOUS is also a real-time imaging modality capable of providing interactive information and valuable guidance in a range of procedures. Recently, contrast-enhanced IOUS, IOUS elastography, and IOUS-guided hepatic surgery have attracted increasing interest and are expected to lead to the broader implementation of IOUS. Herein, we review the various applications of IOUS in the diagnosis and management of focal hepatic lesions.

Applications of intraoperative ultrasound in the treatment of complicated cases of acute and chronic pancreatitis and pancreatic cancer - own experience

Both acute and chronic inflammation of the pancreas often lead to complications that nowadays can be resolved using endoscopic and surgical procedures. In many cases, intraoperative ultrasound examination (IOUS) enables correct assessment of the extent of the lesion, and allows for safe surgery, while also shortening its length.

AIM OF THE RESEARCH

At the authors' clinic, intraoperative ultrasound is performed in daily practice. In this paper, we try to share our experiences in the application of this particular imaging technique.

RESEARCH SAMPLE AND METHODOLOGY

Intraoperative examination conducted by a surgeon who has assessed the patient prior to surgery, which enabled the surgeon to verify the initial diagnosis. The material presented in this paper includes 145 IOUS procedures performed during laparotomy due to lesions of the pancreas, 57 of which were carried out in cases of inflammatory process.

RESULTS AND CONCLUSIONS

IOUS is a reliable examination tool in the evaluation of acute inflammatory lesions in the pancreas, especially during the surgery of chronic, symptomatic inflammation of the organ. The procedure allows for a correct determination of the necessary scope of the planned surgery. The examination allows for the differentiation between cystic lesions and tumors of cystic nature, dictates the correct strategy for draining, as well as validates the indications for the lesion's surgical removal. IOUS also allows the estimation of place and scope of drainage procedures in cases of overpressure in the pancreatic ducts caused by calcification of the parenchyma or choledocholitiasis in chronic pancreatitis. In pancreatic cancer, IOUS provides a verification of the local extent of tumor-like lesions, allowing for the assessment of pancreatic and lymph nodes metastasis, and indicating the presence of distant and local metastases, including the liver. IOUS significantly improves the effectiveness of intraoperative BAC aspiration or drainage of fluid reservoirs.

Novel imaging strategies for upper gastrointestinal tract cancers

Accurate pretherapeutic imaging is the cornerstone of all cancer treatment. Unfortunately, modern imaging modalities have several unsolved problems and limitations. The differentiation between inflammation and cancer infiltration, false positive and false negative findings as well as lack of confirming biopsies in suspected metastases may have serious negative consequences in cancer patients. This review describes some of these problems and challenges the use of conventional imaging by suggesting new combined strategies that include selective use of confirming biopsies and complementary methods to detect microscopic cancer dissemination.

Standards of the Polish Ultrasound Society - update. Pancreas examination

Ultrasound examination of the pancreas constitutes an integral part of the abdominal ultrasound. It is mostly indicated to diagnose pain in the epigastrium, discomfort and jaundice as well as to monitor the patients with acute pancreatitis. The assessment of this organ in an ultrasound examination may be problematic due to its anatomical location and the fact that it might be covered by gastric and duodenal contents as well as due to a number of possible pathological changes, including inflammation and benign or malignant neoplasms, which require differentiation. The basis for establishing a correct diagnosis is the knowledge of the examination technique, correct pancreas structure and images of individual pathologies. This paper presents the standards of ultrasound examination published in 2011 and updated with the current knowledge. The following are discussed: preparation of the patient for the examination, abnormal lesions in the pancreas, acute pancreatitis, chronic pancreatitis, cystic lesions (benign and malignant cysts) and solid focal lesions. Ultrasound is also used to guide the drainage of fluid cisterns, abscesses and cysts. The prime role in the diagnosis and treatment of selected diseases of the upper gastrointestinal tract and parenchymal organs of the abdomen belongs to endosonography of the upper gastrointestinal tract, with the possibility to conduct a fine needle aspiration biopsy, and intraoperative or laparoscopic ultrasound.