Second-generation endoscopic ultrasound elastography in the differential diagnosis of solid pancreatic masses. Pancreatic cancer vs. inflammatory mass in chronic pancreatitis.

Endoscopic ultrasonography (EUS) is considered one of the most accurate methods for the diagnosis and staging of pancreatic tumors. EUS-guided fine-needle aspiration (FNA) allows to increase the diagnostic accuracy of EUS in this setting; however, it is technically demanding (a pathologist is also essential) and is furthermore associated with small, but not insignificant morbidity. EUS pancreatic elastography, by analyzing tissue stiffness, arises as a new and very useful tool for the differential diagnosis of solid pancreatic masses. Elastography provides specific patterns supporting the benign or malignant nature of the disease. However, there is a handicap related to the subjective interpretation of images. Second-generation elastography has been recently developed, and allows a quantitative analysis of tissue stiffness. It is based on the determination of a strain ratio (obtained after comparing the strain value of the mass to a strain value from a control area in the region under study). We present two cases reflecting the usefulness of second-generation elastography in the differential diagnosis between pancreatic adenocarcinoma and an inflammatory mass in the context of chronic pancreatitis. We found significant differences between both masses in the strain ratio values (25.46% in the pancreatic adenocarcinoma vs. 2.35% in the inflammatory mass). Second-generation elastography is a very useful tool for the differential diagnosis of solid pancreatic masses.

Elastografía ecoendoscópica de segunda generación en el diagnóstico diferencial de las lesiones sólidas pancreáticas. Cáncer de páncreas vs. masa inflamatoria en pancreatitis crónica / Second-generation endoscopic ultrasound elastography in the differential diagnosis of solid pancreatic masses. Pancreatic cancer vs. inflammatory mass in chronic pancreatitis

La ultrasonografía endoscópica (USE) es la técnica más eficazpara el diagnóstico y estadiaje local de los tumores pancreáticos.La asociación de la punción guiada por USE ha permitido aumentarla rentabilidad diagnóstica, si bien es muy explorador dependiente(sin obviar el papel fundamental del patólogo) y no se encuentraexenta de complicaciones. En este contexto la elastografíapancreática emerge como una técnica de gran utilidad que permiteevaluar la dureza de los tejidos, mostrando una elevada eficaciadiagnóstica en el diagnóstico diferencial de los tumores pancreáticos.La elastografía muestra patrones muy específicos que apoyanla naturaleza maligna o benigna de las lesiones. Sin embargo existeel hándicap de la subjetividad de la interpretación de las imágenes.Recientemente se ha desarrollado la elastografía de 2ª generaciónque permite realizar un análisis cuantitativo de la elasticidadde los tejidos. Se basa en la determinación de un coeficiente deelasticidad. Nosotros presentamos dos casos que reflejan la utilidadde la elastografía de segunda generación en el diagnóstico diferencialde las lesiones sólidas pancreáticas, en concreto en la diferenciaciónentre un adenocarcinoma de páncreas y una masainflamatoria en el contexto de una pancreatitis crónica. Se apreciacómo existen diferencias significativas entre ambas lesiones en elcoeficiente de elasticidad (25,46 en el adenocarcinoma de páncreasvs. 2,35 en la masa inflamatoria). Probablemente la elastografíade segunda generación sea una herramienta útil en el diagnósticodiferencial de las lesiones sólidas pancreáticas(AU)

Endoscopic ultrasonography (EUS) is considered one of themost accurate methods for the diagnosis and staging of pancreatictumors. EUS-guided fine-needle aspiration (FNA) allows to increasethe diagnostic accuracy of EUS in this setting; however, itis technically demanding (a pathologist is also essential) and isfurthermore associated with small, but not insignificant morbidity.EUS pancreatic elastography, by analyzing tissue stiffness,arises as a new and very useful tool for the differential diagnosisof solid pancreatic masses. Elastography provides specific patternssupporting the benign or malignant nature of the disease.However, there is a handicap related to the subjective interpretationof images. Second-generation elastography has been recentlydeveloped, and allows a quantitative analysis of tissue stiffness.It is based on the determination of a strain ratio (obtained aftercomparing the strain value of the mass to a strain value from acontrol area in the region under study). We present two cases reflectingthe usefulness of second-generation elastography in thedifferential diagnosis between pancreatic adenocarcinoma and aninflammatory mass in the context of chronic pancreatitis. Wefound significant differences between both masses in the strainratio values (25.46% in the pancreatic adenocarcinoma vs.2.35% in the inflammatory mass). Second-generation elastographyis a very useful tool for the differential diagnosis of solid pancreaticmasses(AU)

Pancreatic fusocellular sarcoma. The importance of endoscopic ultrasound-guided fine needle aspiration in the differential diagnosis of solid pancreatic tumors.

In the presence of a pancreatic tumor, the main diagnostic problem is to determine the benign o malignant nature of the lesion, and then to evaluate its resectability. A preoperative biopsy was usually rejected based on the fact that negative results do not exclude malignancy, that such biopsy may hamper the possibility of curative surgery because of potential seeding along the biopsy s trajectory, that surgical morbidity and mortality are low, and also because of the high diagnostic sensitivity of the various imaging techniques. Biopsy for solid pancreatic tumors was limited to irresectable tumors, and isolated cases with suspicion of tuberculosis, lymphoma or neuroendocrine tumors. Nowadays the performance of a pancreatic biopsy is becoming essential for the correct management of solid lesions, and is useful not only to establish malignancy, but also for a better knowledge of all kind of pathologies and, thus, for better therapeutic management. In this context, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) has proven a safe technique with a low rate of complications and a diagnostic accuracy superior to other procedures, this being considered the method of choice for the study of solid pancreatic lesions. An illustrative example is the case we report in this article -a patient diagnosed of a solid, locally advanced-stage pancreatic tumor with imaging techniques (abdominal ultrasounds and EUS) under EUS-guided FNA; the procedure could establish a final diagnosis of pancreatic fusocellular sarcoma.

Sarcoma fusocelular de páncreas: importancia de la PAAF guiada por ultrasonografía endoscópica en el diagnóstico diferencial de los tumores sólidos pancreáticos / Pancreatic fusocellular sarcoma. The importance of endoscopic ultrasound-guided fine needle aspiration in the differential diagnosis of solid pancreatic tumors

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Afectación bilateral del tendón de Aquiles por tratamiento con levofloxacino / Bilateral Achiles tendon disorders secondary to levofloxacin

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