Frühdiagnose des Pankreaskarzinoms – Die Rolle von Endosonografie und Sonografie

Zusammenfassung

Pankreaskarzinome sind im Vergleich zu anderen Tumorarten relativ selten, die Prognose ist aber weiterhin schlecht, da die Tumoren meist in einem fortgeschrittenen Stadium diagnostiziert werden. Eine Frühdiagnostik wäre für das Überleben sinnvoll, ein generelles Screening ist für die Allgemeinbevölkerung aufgrund der niedrigen Prävalenz nicht möglich. Ein Screening ist nur für spezielle Risikogruppen mit einem hohen/erhöhten Karzinomrisiko (Keimbahnmutationen, familiäres Pankreaskarzinom, muzinöse zystische Pankreastumoren) etabliert. Weitere Risikokonstellationen (Pankreatitis, Diabetes mellitus, Zigaretten- und Alkoholabusus) sollten jedoch beachtet werden, um frühe Neoplasien nicht zu übersehen. Bedeutung kommt insbesondere der transabdominellen Ultraschalluntersuchung als weit verbreitetem erstem Untersuchungsverfahren zu. Damit können bereits erste Verdachtsmomente mit hoher Sensitivität beschrieben und der Tumorverdacht kann durch Einsatz von Ultraschallkontrastmittel erhärtet werden. Die Endosonografie hat in der weiteren Diagnostik eine herausragende Bedeutung. Durch zusätzliche Verfahren mit Einsatz von Ultraschallkontrastmittel, Elastografie und Feinnadelpunktion ist in der Regel eine definitive Klärung mit hoher Sensitivität und Spezifität möglich mit dem Ziel, die bislang schlechte Prognose des Pankreaskarzinoms weiter zu verbessern.

Abstract

Pancreatic neoplasms are less common tumors and have a poor prognosis when advanced. Early diagnosis would be beneficial for survival, but screening of the whole population cannot be justified with a satisfying benefit-effort correlation. Subgroups of patients with a higher than average risk are those with germ-like mutations, familial cancers risks, and mucinous cystadenomas that would benefit from surveillance programs. Other risk groups, like patients with pancreatitis, new onset diabetes, and heavy smokers, should be considered as well. Transabdominal ultrasonography is of great advantage as a first-line imaging method because of its easy access. The accuracy for adenocarcinoma diagnosis is nearly 90% while using CEUS. Endosonography is of extraordinary importance in the diagnostic approach of pancreatic tumors because of high sensitivity and specificity while using advanced imaging techniques like CEUS, elastography, and fine needle biopsy. Screening by means of EUS is also possible in high-risk situations, and a favourable cost-benefit ratio must be shown by future data.

Schlüsselwörter

Bauchspeicheldrüsenkrebs - Früherkennung - endoskopischer Ultraschall - transabdominaler Ultraschall - Personen mit hohem Risiko - familiärer Krebs - kontrastverstärkter Ultraschall - Elastografie - endoskopische Feinnadelbiopsie

Keywords

pancreatic cancer - early detection - endoscopic ultrasound - transabdominal ultrasound - high risk individuals - familiar cancer - contrast enhanced ultrasound - elastography - endoscopic fine needle biopsy

Publication History

Received: 05 March 2021

Accepted after revision: 16 May 2021

Article published online:
09 July 2021

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