(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA.

AGEL Research and Training Institute 796 04 Prostejov Czech Republic

Department of Internal Medicine 2 Gastroenterology and Geriatrics Faculty of Medicine and Dentistry Palacký University Olomouc and University Hospital Olomouc 775 15 Olomouc Czech Republic

Department of Radiology and Nuclear Medicine University Hospital Brno and Masaryk University Brno 625 00 Brno Czech Republic

Department of Radiology Faculty of Medicine University Hospital Olomouc Dentistry Palacký University Olomouc 779 00 Olomouc Czech Republic

Department of Radiology Vitkovice Hospital 703 00 Ostrava Vitkovice Czech Republic

Faculty of Medicine and Dentistry Palacký University Olomouc 775 15 Olomouc Czech Republic

Institute of Endocrinology 116 94 Prague Czech Republic

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Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2018;68:394–424. doi: 10.3322/caac.21492. PubMed DOI

Lovecek M., Janatova M., Skalicky P., Zemanek T., Havlik R., Ehrmann J., Strouhal O., Zemankova P., Lhotova K., Borecka M., et al. Genetic Analysis of Subsequent Second Primary Malignant Neoplasms in Long-Term Pancreatic Cancer Survivors Suggests New Potential Hereditary Genetic Alterations. Cancer Manag. Res. 2019;11:599–609. doi: 10.2147/CMAR.S185352. PubMed DOI PMC

Toft J., Hadden W.J., Laurence J.M., Lam V., Yuen L., Janssen A., Pleass H. Imaging Modalities in the Diagnosis of Pancreatic Adenocarcinoma: A Systematic Review and Meta-Analysis of Sensitivity, Specificity and Diagnostic Accuracy. Eur. J. Radiol. 2017;92:17–23. doi: 10.1016/j.ejrad.2017.04.009. PubMed DOI

Yamao K., Takenaka M., Ishikawa R., Okamoto A., Yamazaki T., Nakai A., Omoto S., Kamata K., Minaga K., Matsumoto I., et al. Partial Pancreatic Parenchymal Atrophy Is a New Specific Finding to Diagnose Small Pancreatic Cancer (≤10 Mm) Including Carcinoma in Situ: Comparison with Localized Benign Main Pancreatic Duct Stenosis Patients. Diagnostics. 2020;10:445. doi: 10.3390/diagnostics10070445. PubMed DOI PMC

Zhang L., Sanagapalli S., Stoita A. Challenges in Diagnosis of Pancreatic Cancer. World J. Gastroenterol. 2018;24:2047–2060. doi: 10.3748/wjg.v24.i19.2047. PubMed DOI PMC

Haeno H., Gonen M., Davis M.B., Herman J.M., Iacobuzio-Donahue C.A., Michor F. Computational Modeling of Pancreatic Cancer Reveals Kinetics of Metastasis Suggesting Optimum Treatment Strategies. Cell. 2012;148:362–375. doi: 10.1016/j.cell.2011.11.060. PubMed DOI PMC

Blouhos K., Boulas K.A., Tsalis K., Hatzigeorgiadis A. The Isoattenuating Pancreatic Adenocarcinoma: Review of the Literature and Critical Analysis. Surg. Oncol. 2015;24:322–328. doi: 10.1016/j.suronc.2015.09.006. PubMed DOI

Kim J.H., Park S.H., Yu E.S., Kim M.-H., Kim J., Byun J.H., Lee S.S., Hwang H.J., Hwang J.-Y., Lee S.S., et al. Visually Isoattenuating Pancreatic Adenocarcinoma at Dynamic-Enhanced CT: Frequency, Clinical and Pathologic Characteristics, and Diagnosis at Imaging Examinations. Radiology. 2010;257:87–96. doi: 10.1148/radiol.10100015. PubMed DOI

Ishigami K., Yoshimitsu K., Irie H., Tajima T., Asayama Y., Nishie A., Hirakawa M., Ushijima Y., Okamoto D., Nagata S., et al. Diagnostic Value of the Delayed Phase Image for Iso-Attenuating Pancreatic Carcinomas in the Pancreatic Parenchymal Phase on Multidetector Computed Tomography. Eur. J. Radiol. 2009;69:139–146. doi: 10.1016/j.ejrad.2007.09.012. PubMed DOI

Yoon S.H., Lee J.M., Cho J.Y., Lee K.B., Kim J.E., Moon S.K., Kim S.J., Baek J.H., Kim S.H., Kim S.H., et al. Small (≤20 Mm) Pancreatic Adenocarcinomas: Analysis of Enhancement Patterns and Secondary Signs with Multiphasic Multidetector CT. Radiology. 2011;259:442–452. doi: 10.1148/radiol.11101133. PubMed DOI

Puli S.R., Bechtold M.L., Buxbaum J.L., Eloubeidi M.A. How Good Is Endoscopic Ultrasound–Guided Fine-Needle Aspiration in Diagnosing the Correct Etiology for a Solid Pancreatic Mass?: A Meta-Analysis and Systematic Review. Pancreas. 2013;42:20–26. doi: 10.1097/MPA.0b013e3182546e79. PubMed DOI

Dumonceau J.-M., Polkowski M., Larghi A., Vilmann P., Giovannini M., Frossard J.-L., Heresbach D., Pujol B., Fernández-Esparrach G., Vazquez-Sequeiros E., et al. Indications, Results, and Clinical Impact of Endoscopic Ultrasound (EUS)-Guided Sampling in Gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2011;43:897–912. doi: 10.1055/s-0030-1256754. PubMed DOI

Hartwig W., Werner J., Jäger D., Debus J., Büchler M.W. Improvement of Surgical Results for Pancreatic Cancer. Lancet Oncol. 2013;14:e476–e485. doi: 10.1016/S1470-2045(13)70172-4. PubMed DOI

Kliment M., Urban O., Cegan M., Fojtik P., Falt P., Dvorackova J., Lovecek M., Straka M., Jaluvka F. Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Masses: The Utility and Impact on Management of Patients. Scand. J. Gastroenterol. 2010;45:1372–1379. doi: 10.3109/00365521.2010.503966. PubMed DOI

Tamada T., Ito K., Kanomata N., Sone T., Kanki A., Higaki A., Hayashida M., Yamamoto A. Pancreatic Adenocarcinomas without Secondary Signs on Multiphasic Multidetector CT: Association with Clinical and Histopathologic Features. Eur. Radiol. 2016;26:646–655. doi: 10.1007/s00330-015-3880-3. PubMed DOI

Aslan S., Nural M.S., Camlidag I., Danaci M. Efficacy of Perfusion CT in Differentiating of Pancreatic Ductal Adenocarcinoma from Mass-Forming Chronic Pancreatitis and Characterization of Isoattenuating Pancreatic Lesions. Abdom. Radiol. 2019;44:593–603. doi: 10.1007/s00261-018-1776-9. PubMed DOI

Prokesch R.W., Chow L.C., Beaulieu C.F., Bammer R., Jeffrey R.B. Isoattenuating Pancreatic Adenocarcinoma at Multi–Detector Row CT: Secondary Signs. Radiology. 2002;224:764–768. doi: 10.1148/radiol.2243011284. PubMed DOI

Illés D., Terzin V., Holzinger G., Kosár K., Róka R., Zsóri G., Ábrahám G., Czakó L. New-Onset Type 2 Diabetes Mellitus—A High-Risk Group Suitable for the Screening of Pancreatic Cancer? Pancreatology. 2016;16:266–271. doi: 10.1016/j.pan.2015.12.005. PubMed DOI

Kanno A., Masamune A., Hanada K., Kikuyama M., Kitano M. Advances in Early Detection of Pancreatic Cancer. Diagnostics. 2019;9:18. doi: 10.3390/diagnostics9010018. PubMed DOI PMC

Wang W., Shpaner A., Krishna S.G., Ross W.A., Bhutani M.S., Tamm E.P., Raju G.S., Xiao L., Wolff R.A., Fleming J.B., et al. Use of EUS-FNA in Diagnosing Pancreatic Neoplasm without a Definitive Mass on CT. Gastrointest. Endosc. 2013;78:73–80. doi: 10.1016/j.gie.2013.01.040. PubMed DOI

Kohoutová D., Bureš J., Zar S., Urban O. Carcinoma of Pancreatobiliary Origin. Gastroenterol. Res. Pract. 2020;2020:1–2. doi: 10.1155/2020/4323687. PubMed DOI PMC

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