Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
Endoscopic ultrasound elastography (Fig. 1) + Contrast enhanced harmonic EUS (CE-EUS) (Fig. 2, Movie 1) + EUS-fine needle biopsy (FNB) (Fig. 3). Malignant pancreatic tumors are typically stiff hypoenhanced lesions.
For contrast-enhanced EUS, a peripheral rim (visible during microbubble trace imaging mode) with central hypoenhancement in the arterial and venous phase is suggestive of a pancreatic metastasis. In patients with a personal history of a colorectal cancer this indicates the need to use a histological needle biopsy followed by immunohistochemistry (IHC) analysis, performed in order to rule out pancreatic metastasis.
Palazo M., Role of contrast harmonic endoscopic ultrasonography in other pancreatic solid lesions: Neuroendocrine tumors, autoimmune pancreatitis and metastases. Endoscopic Ultrasound, 2016, Volume 5, Issue 6 [p. 373-376]