Ultrasonography in pancreatic carcinoma

Pancreatic tumors are the fourth cause of death in Occident: the 8-year-sur vival rate is less than 5% because of diagnostic difficulties, low clinical expression at early stage, and complexity of the surgical treatment. The r ole of ultrasound (US) is in early diagnosis, because also in early cancer there could be lymphatic spread or peritoneal involvement. There are multiple modalities to study the pancreas with US: abdominal US, "contact" US (endosonography and intra-operative or laparoscopic US). The f irst is not invasive, cheap but limited by extrinsic and intrinsic factors, the latter are respectively characterized by high cost, and need of endosc opic specialists for endosonography, the complementarity to laparoscopy or surgery for the laparoscopic/intraoperative US. Abdominal US is the first d iagnostic step for the pancreas, but it is not affordable in 15-25% of pati ents, because of meteorism. in all the other cases, it represents the pancr eas with a good contrast between the normal parenchyma and tumoral tissues. Abdominal US, together with biopsy, can define the resectability. Ecoendoscopy is actually dedicated to small tumors staging, but recent stud ies demonstrate the same results achieved by spiral TC. Laparoscopic US is a second step imaging in patients already selected for s urgery. The first finality in US evaluation of tumor masses is early diagnosis of p ancreatic cancer; it can give to some of these patients the opportunity of undergoing to surgical treatment. This could be achieved by a proper use of the moltitude of ultrasonic abdominal explorations that are requested in d aily practice. US, together with CT and MR, can define the resectability of the tumor, wit h further supplementar evaluation by mean of laparoscopic US. Intraoperative US is now indicated for planning and guiding the surgeon in resection of the pancreatic cancer.