Page 1 of 2: Best diagnosis of pancreatic cancer (head) is by

dr_nickash · Credits: 6577 My Scrapbook

Best diagnosis of pancreatic cancer (head) is by
a) Ultrasound
b) ERCP
c) PTC

shivesh · Credits: 2026 My Scrapbook

the best investigation is contrast enhanced helical ct scan followed by ercp were in we can find a constricted portion of the duct near the neoplasm and incase gall bladder duct is involved too then double duct sign can also be seen.
among the options the ercp is best.

vijayandhare · Credits: 77713 My Scrapbook My Reading List 262569 Books

true.
ercp.
but the best option in endoscopic ultrasound.

manipalguy · Credits: 15905 My Scrapbook

i will also go for ercp... with this we can take a biopsy too!!!

indianprince · Credits: 503 My Scrapbook

Depends on the question put up.
If "The best choice" includes both ERCP and endoscopic ultrasound then ERCP is better because 85 % are duct cell carcinomas from genu of the duct.
However, the correct SEQUENCE of investigations is --
1. Contrast enhanced spiral CT for initial diagnosis
2. ERCP for tissue diagnosis and possible endo-stenting.

It should be noted that a CECT spiral may be twice as expensive as the endoUSG but it is
1. more accurate
2. both are non invasive
3. both dont give us tissue biopsy.
so prefer CECT over endo USG

cheers

VIJAYANDHARE · Credits: 77713 My Scrapbook My Reading List 262569 Books

I THINK INDIANPRINCE IS WRONG.

HAVE U SEEN HOW ENDOSCOPIC ULTRASOUND DONE?

I HAVE SEEN

AND TO CORRECT U, BIOPSY CAN BE TAKEN WITH ENDOSCOPIC ULTRASOUND

CECT CAN-NOT NECESSARILY CONFUSE US WITH CHRONIC PANCREATITIS/CA. GROTHS LESS THAN 1CM DIFFICULT TO DETECT WITH CT

EUS CAN DETECT METASTAIC/MALIGNANT GROWTH AS SMALL AS 3MM AND DEPEN UPON PROBE FREQUENCY WHICH IS USUALLY 7.5 TO 12 MHZ GIVE IDEA IN 6CM VICINITY.

MALIGNANT GROWTH IS ECHOPOOR ON EUS.

COMMENTS!!!!

vijayandhare · Credits: 77713 My Scrapbook My Reading List 262569 Books

THOSE WHO HAVENT SEEN HOW EUS WORKS IN REALITY PLS VISIT WEBSITE.

Only RxPG members can see links here! Register or Sign In!

indianprince · Credits: 503 My Scrapbook

DEAR MEMBERS,

COMMENTS AS REQUESTED ARE BEING PROVIDED

1. ENDO USG IS "USELESS" FOR STAGING PANCREATIC CANCERS COZ OTHER ORGANS ARE NOT SCANNED AND ENDO USG IS KNOWN TO BE GOOD ONLY FOR THE PRIMARY GROWTH DELINEATION. AND SO OUR VERY PURPOSE OF INVESTIGATIONS IS DEFEATED.

2. I WILL ADD THAT ENDO USG IS KNOWN TO BE GOOD ONLY FOR LEEVL -1 LYMPH NODES AND HAS POOR (VERY POOR) DISCRIMINATION BETWEEN BENIGN AND MALIGNANT LYMPH NODES AT TIMES. THERE ARE A SCORE OF CAUSES FOR DETECTION OF AN ECHOPOOR LESION ON ENDOUSG APART FROM MALIGNANCY. YES IT CAN DETECT 3 mm MALIGNANCY BUT ONLY IF WITHIN A FEW cm FROM THE LUMEN---NO MORE (AS ACCEPTED IN THE LAST POST)

2. AS FAR AS BIOPSY IS CONCERNED, TRUE, A NEEDLE CAN BE ADVANCED INTO THE PANCREAS (ACTUALLY ANYWHERE !!) UNDER ENDO-USG GUIDANCE, BUT A BIOPSY FROM ERCP IS LESS INVASIVE TO TISSUE PLANES AS COMPARED TO ENDO-USG AND SO HAS FAR LESSER CHANCES OF TUMOR DISSEMINATION (refer to the diagram shown in the website referred to in the last post)

3. By the way,

the original questoin never mentioned endo-usg -it only said USg and so, the answer to THAT question can only be ERCP

Happy studying

vijayandhare · Credits: 77713 My Scrapbook My Reading List 262569 Books

comments provided are away from the issue.\

issue is diagnosis of primary, not staging.so comment 1 is useless.

comment 2 , again same thing.
endousg is better than ct for detecting malignancy .
so point again is diagnosis isof primary not spread or mets

comment 3 (given no. 2 by prince again)-thank god prince agreed , biopsy can be taken. i surprise how prince make confident statement without confirming things.

i think ur book study is good but u r not aware of practical things done/interpreted

indianprince · Credits: 503 My Scrapbook

Read L& B (relevant page) and satisfy urself. No more comments.

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