Enlarged pancreatic head and other ambiguous findings on pancreatic imaging — how to rule out malignancy?

Abstract

The problem of ambiguous findings on pancreatic imaging is increasingly important in clinical practice and closely related to the huge number of imaging tests being performed in everyday clinical practice. The most common ambiguous finding is a focal or diffuse enlargement (fullness, prominence) of the pancreas without a discrete mass. Although the enlargement represents normal pancreas or benign pancreatic disease in most cases, there is still a considerable risk of malignancy. Results from four retrospective studies conducted in the United States indicate that among patients who underwent endoscopic ultrasonography (EUS) to clarify ambiguous findings on computed tomography or magnetic resonance imaging, 13.5% had pancreatic malignancy, 38% had benign pancreatic disease, and the remaining 48.5% had normal pancreas. These results indicate that ambiguous findings on pancreatic imaging cannot be ignored and need to be clarified. The very high negative predictive value of EUS in patients with a suspicion of pancreatic cancer and the capability to perform EUS-guided fine needle aspiration from focal lesions, makes EUS the perfect tool in such cases. However, a prospective study on this topic is badly needed because all of the available data are from retrospective studies.
Onkol. Prak. Klin. 2011; 7, 2: 66–72