Xiao Yu (alias), a 28 year old, suffered from repeated pancreatitis in two years, for which she had to terminate pregnancy twice and a local hospital gave a diagnosis of pancreatic pseudocyst (PPC). Then she came to PUMCH, where first-time needle biopsy failed to find out the cause. The hospital organized a multi-disciplinary consultation, which led to an ultrasound contrast, and then to a 5mm suspicious enhanced region at the edge of the lesion. Ultrasound Medicine had a fine needle aspiration of this region and the pathological result was solid pseudopapillary tumor, a rare low malignancy tumor. Then the patient received a successful operation, now free of the condition and able to prepare for pregnancy without worry and care.
In the past five years, Ultrasound Medicine, together with other departments of the hospital, used contrast-enhanced ultrasound combined with fine needle aspiration to improve biopsy of tumor of pancreas. It thus improved diagnosis by precise intervention, and pushed the diagnosis rate to world advanced level. The project won the third prize of PUMCH 2018 Medical Achievement Award.
Pancreatic tumor diagnosis has been a clinical difficulty due to its obscure symptoms and wide varieties. Percutaneous biopsy is the first option for pathological result, but the success rate depends on lesion location, size, instrument, operator’s experience and other factors.
The introducing of ultrasound contrast made possible imaging of lesion haemodynamics, so doctors could not only know the lesion, but also locate it precisely, thus providing condition for individualized biopsy plans. Looking back at the 72 cases completed in 2014, the hospital found that ultrasound contrast had an accuracy rate of more than 90% on the diagnosis of pancreatic ductal adenocarcinoma (PDAC), obviously higher than that of conventional ultrasound. The finding was consistent with multi-center research results in Europe, proving that ultrasound contrast is more sensitive and specific than conventional ultrasound.
A fine needle, with a diameter of no more than 0.7mm, can reach regions inaccessible to conventional core needle due to the depth of lesion and surrounding vessels. It is of wider application, fewer complications like bleeding and easier operation. The hospital followed for an average of two years 173 aspiration cases between January 2014 and April 2017, and proved that fine needle can almost reach the same diagnosis with that of core needle.
In ultrasound contrast combined with ultrasound-guided percutaneous aspiration biopsy, doctors, according to suspicious regions pointed out in ultrasound contrast, can effectively tell inflammatory from necrosis regions, and accurately guide the fine needle through path, thus boosting the overall diagnosis efficiency. It is particularly effective on patients like Xiao Yu, who had had negative aspiration results. The new technique has been promoted in clinical practice. In the recent two years, the hospital completed more than 200 cases of pancreatic biopsy, had precise interventional diagnosis of both tumors (PDAC, rare pancreatic tumors) and non-tumor lesions (inflammatory), with a diagnosis rate reaching world advanced level.
After five years’ study, Ultrasound Medicine established standardized operation procedures of the new technique, and established diagnosis standards on various pancreatic lesions (chiefly pancreatic cancer) that are individualized, scientific and accurate. The Pancreatic Ultrasound Standards compiled by the department was published in May 2018.
According to Professor Lv Ke from the department, the team, supported by the National Natural Science Foundation, is researching into imaging genomics of pancreatic diseases to look for better treatments.