Role of ultrasound guided fine needle biopsy, EUS and serum CA19-9 level in diagnosis of pancreatic masses

Pancreatic Cancer is a very aggressive tumor with an extremely poor prognosis. Early diagnosis, accurate preoperative staging and better adjuvant treatment remain a challenge. Abdominal ultrasound, abdominal CT, EUS and ERCP are common tools used for imaging of pancreatic cancer. Fine needle aspiration has made significant contribution to the diagnosis of cancer pancreas. The aim of the present work was to evaluate the role of ultrasound guided fine needle aspiration cytology [FNAC] in the diagnosis of pancreatic masses and in the differentiation of cancer pancreas from benign lesions. In addition to that, the level of serum CA 19-was measured to assess its accuracy in differentiating cancerous from benign lesions. This cross sectional study included forty patients with pancreatic lesions. They were subjected to full clinical examination, laboratory tests [including serum level CA 19- 9], abdominal ultrasound, percutaneous sonar guided FNAC of pancreatic lesions, endosonography and surgical interference [was done to 32 patients]. Thirty three patients proved to have pancreatic malignancy while seven patients proved to have pancreatitis. Ultrasonography [US] showed a sensitivity of 70%, specificity of 86% and accuracy of 73% for malignancy detection. Adding CAI9-9 to ultrasound raised the sensitivity to 94%, specificity remained 86% and accuracy to 93%. Adding FNAC to US raised the sensitivity to 85%, specificity remained 86% and accuracy to 91%. EUS showed a sensitivity of 90%, specificity of 100% and accuracy of 91%. Adding CA to EUS showed a sensitivity of 94%, specificity of 100% and accuracy of 91%. Adding FNAC to EUS showed a sensitivity of 97%, specificity of 86% and accuracy of 97%. The combination of EUS, serum CAI9-9 level and sonar guided fine needle aspiration showed an accuracy of 97% in the diagnosis of pancreatic lesions. These investigatory tools are cheap and available and thus may be an excellent alternative to EUS guided fine needle aspiration which is expensive and available in only a few centres

Role of [201]TI-[99m]TC.HIDA subtraction liver scan in detection and specification of focal hepatic lesions

Focal hepatic lesion is a common problem accidentally discovered on imaging studies as abdominal ultrasonography, computed tomography and magnetic resonance imaging that must be characterized. The aim of this prospective study is to verify, the efficacy of [201]Tl-[99m]Tc.HIDA subtraction scan in detection and specification of such lesions. Seventy five patients, divided into two groups according to their definitive diagnosis, were the subject of the this work. Group 1: included 41 patients with benign focal hepatic lesions. Group 2 : included 34 patients with malignant focal hepatic lesions. All cases were diagnosed by sonography and /or tissue biopsy through true-cut needle biopsy. All of them were subjected to [201]Tl-[99m]Tc.HIDA subtraction liver scan that was interpreted both qualitatively and quantitatively. Correct diagnosis was achieved in about 80.5% and 82.4% of group 1 and 2 cases respectively using abdominal ultrasonography whereas [201]Tl-[99m]Tc.HIDA subtraction scan achieved correct diagnosis in 100% of group 2 patients. All malignant lesions appeared hot, whereas benign lesions showed no abnormality in subtraction images respectively. Moreover, [201]Tl-[99m]Tc.HIDA subtraction quantitative analysis failed to discriminate between primary and secondary hepatic focal lesions or different histopathological types or grades [P > 0.05]. [201]Tl-[99m]Tc-HIDA subtraction scan is recommended in any patient with hepatic focal lesion suspected sonographically being non-invasive, simple, easy and efficient method that can differentiate between benign and malignant focal hepatic lesions

Abnormal iron metabolism in non alcoholic steatohepatitis

Non-alcoholic steatohepatitis [NASH] is a form of liver disease resembling alcoholic liver disease in a patient who did not consume significant amount of alcohol. Our study is concerned with the relation between NASH and iron level in serum and liver tissue. 44 patients with NASH proved by liver biopsy were the subjects of our study. The investigations done to all of them included: fasting and post prandial blood glucose, hepatitis markers, lipid profile, liver function tests, serum iron, total iron binding capacity [TIBC], serum ferritin, prothrombin time and concentration, abdominal ultrasonography, ultrasonography guided liver biopsy and histopathological examination of the specimen. Our results showed elevation of the serum levels of iron, total iron biding capacity, serum ferritin and total iron score in 84% of our NASH patients. There was no significant difference in the studied iron parameters in different grades of steatosis and in different grades of activity while there was significant difference in different stages of fibrosis. Thus we might conclude that in addition to diabetes mellitus, lipid abnormalities and obesity, increased iron stores may play important role in the development of NASH and this may be through increased oxidative stress that ultimately lead to fibrosis and iron reduction might be of benefit in the treatment of this disease