REVIEW   

Minerva Gastroenterologica e Dietologica 2020 March;66(1):70-81

DOI: 10.23736/S1121-421X.20.02646-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Differential diagnosis of solid pancreatic masses

Julio IGLESIAS-GARCIA ✉, Daniel de la IGLESIA-GARCIA, José M. OLMOS-MARTINEZ, José LARIÑO-NOIA, J. Enrique DOMINGUEZ-MUÑOZ

Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

Solid pancreatic lesions include mainly adenocarcinoma, neuroendocrine tumors pancreatic cystic neoplasms with solid component, solid pseudopapillary tumor, pancreatoblastoma, pancreatic lymphoma, and pancreatic metastasis. The most frequent pancreatic lesion is the adenocarcinoma, representing between 70% and 95% of all solid pancreatic neoplasm. The diagnosis of these lesions can be a challenge and currently, there are different imaging techniques such as CT scan, EUS and MRI with high sensitivity and specificity. The most widely used technique for the initial evaluation is the CT scan with a sensitivity between 76% and 92% for the diagnosis of pancreatic cancer. The EUS has a sensitivity for the detection of pancreatic lesions of around 98% and is accepted to be the most sensitive technique for the detection of small pancreatic tumors (<2 cm). The MRI, with a very high soft-tissue contrast resolution, provides an accuracy in the detection and staging of adenocarcinoma of 90-100%. A multimodality approach is usually necessary in patients with clinical suspicion of pancreatic lesion. The EUS is required for the local evaluation of the relation of the lesion with vessels and for tissue acquisition and the CT scan and/or MRI is usually required for the local and distance staging in case of pancreatic cancer. The purpose of this review is to provide an overview of solid pancreatic lesions and the role of the different imaging techniques in their evaluation.

KEY WORDS: Pancreatic neoplasms; Diagnostic imaging; Endosonography; X-ray computed tomography; Magnetic resonance imaging