EUS for pancreatic cystic neoplasms: The roadmap to the future is much more than just a few shades of gray
Journal Title: Asian Pacific Journal of Tropical Medicine - Year 2016, Vol 9, Issue 12
Abstract
Pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or endoscopic therapy as well as avoiding unnecessary surgery in cysts with no malignant potential. Tumor markers such as KRAS and GNAS hold promise, but which molecular marker or a combination of markers is most useful and cost effective remains to be seen. Advanced imaging with confocal laser endomicroscopy can serve as an optical biopsy and play a part in the diagnostic algorithm. Microforceps aided biopsy of pancreatic cyst wall and tumor contents hold great promise as they allow direct tissue acquisition. Much progress has been made in the role of EUS guided evaluation of pancreatic cystic neoplasms over the last several years, and with the advances enumerated above, the future is more than just a few shades of gray. Future studies should include prospective multi-arm trials of microforceps biopsy versus conventional EUS-FNA and use of biochemical and molecular markers, confocal laser endomicroscopy or a combination thereof to determine best approach to pancreatic cystic neoplasms. In Osler's words, ‘Medicine is a science of uncertainty and an art of probability’. Incorporation of advanced imaging and molecular markers into a new diagnostic algorithm with subsequent validation through retrospective and prospective studies has the potential to increase diagnostic accuracy and guide optimal management of patients and improve outcomes.
Authors and Affiliations
Manoop S. Bhutani
Keywords
Related Articles
- EP ID EP281548
- DOI 10.1016/j.apjtm.2016.11.003
- Views 87
- Downloads 0
Resistance status of main malaria vector, Anopheles stephensi Liston (Diptera: Culicidae) to insecticides in a malaria Endemic Area, Southern Iran
To evaluate the susceptibility of Anopheles stephensi (An. stephensi) Liston, the main malaria vector in southern Iran, to WHO recommended insecticides. Methods: Larvae of An. stephensi were collected from three differen...
Melaleuca quinquenervia (Cav.) S.T. Blake (Myrtales: Myrtaceae): Natural alternative for mosquito control
Objective: To evaluate an essential oil with larvicide, adulticide and growth inhibitory activity against Aedes aegypti, Aedes albopictus and Culex quinquefasciatus mosquitoes, of medical importance. Methods: Standardize...
Protective effect of antioxidant on renal damage caused by doxorubicin chemotherapy in mice with hepatic cancer
Objectives: To investigate the protective effects and mechanism of antioxidant TBHQ on renal damage caused by doxorubicin chemotherapy in mice with hepatic cancer. Methods: Cell H22 of mice with hepatic cancer which was...
Epidemiology of polio virus infection in Pakistan and possible risk factors for its transmission
End Polio Pakistan program still has to overcome many hurdles; unfortunately on 8th February 2016 first polio case of the year has surfaced in Karachi. It seems that battle against polio demands little bit more convictio...
Therapeutic role of Ricinus communis L. and its bioactive compounds in disease prevention and treatment
Ricinus communis L. (R. communis), commonly known as castor oil plant, is used as a traditional natural remedy or folkloric herb for the control and treatment of a wide range of diseases around the globe. Various studies...