Cancer medicine · 2026
Pancreatic Metastasis of Clear Cell Renal Cell Carcinoma: Challenges in Percutaneous Biopsy and Contrast-Enhanced Ultrasound Imaging Features.
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Gui Yang, Yan Xiaoyi, Lv Ke, Zhang Zhiyang, Tan Li, Dai Menghua, Chang Xiaoyan, Chen Xueqi, Jia Wanying, Wang Weibin, Jiang Yuxin
Аннотация
OBJECTIVES: The objective of this study is to investigate the value of conventional ultrasound, contrast-enhanced ultrasound (CEUS) and percutaneous ultrasound-guided biopsy in the diagnosis of pancreatic metastases from clear cell renal cell carcinoma (ccRCC).
METHODS: A retrospective database search was conducted to identify all pancreatic lesions performed CEUS and final diagnosed as metastasis from ccRCC at our institution from September 2017 to June 2024. All enrolled patients were considered unsuitable for endoscopic ultrasound (EUS)-guided tissue acquisition, had failed EUS-guided biopsy, or required an alternative diagnostic approach. A total of 23 patients were enrolled in this study. Demographics, clinical features, ultrasound and CEUS findings, biopsy procedures, and results were collected and reviewed.
RESULTS: Of the enrolled patients, metachronous metastasis was 100%. The median interval time from tumor-nephrectomy to the emergence of the pancreatic metastasis was 121.0 months (range: 46.0-276.0 months). Ultrasonography revealed rounded, well-defined, homogeneous hypoechogenic lesions in all the patients. Color Doppler flow image findings displayed plenty of blood flow signals around and inside the pancreatic lesions in 87.0% of patients. 22 patients (95.7%) exhibited rapid hyper-enhancement in the arterial phase of CEUS and 1 patient (4.3%) showed iso-enhancement. In the venous phase, 15 cases showed sustained hyper-enhancement and 8 cases showed iso-enhancement. In the biopsy procedure, ultrasound-guided core needle biopsy demonstrated higher diagnostic yield than fine needle aspiration (75.0% vs. 46.7%). The biopsy diagnosis was positive in 13 patients (65.0%) in general.
CONCLUSIONS: Metastatic tumors of the pancreas can occur after a prolonged period from ccRCC diagnoses, thus long-term follow-up is necessary. The features of the lesion by conventional ultrasound and CEUS were specific, which are valuable for diagnosis. In patients who are unsuitable for EUS-guided tissue acquisition or have experienced unsuccessful EUS-guided sampling, CEUS combined with percutaneous ultrasound-guided biopsy may serve as a valuable complementary second-line diagnostic approach and facilitate accurate diagnosis.
METHODS: A retrospective database search was conducted to identify all pancreatic lesions performed CEUS and final diagnosed as metastasis from ccRCC at our institution from September 2017 to June 2024. All enrolled patients were considered unsuitable for endoscopic ultrasound (EUS)-guided tissue acquisition, had failed EUS-guided biopsy, or required an alternative diagnostic approach. A total of 23 patients were enrolled in this study. Demographics, clinical features, ultrasound and CEUS findings, biopsy procedures, and results were collected and reviewed.
RESULTS: Of the enrolled patients, metachronous metastasis was 100%. The median interval time from tumor-nephrectomy to the emergence of the pancreatic metastasis was 121.0 months (range: 46.0-276.0 months). Ultrasonography revealed rounded, well-defined, homogeneous hypoechogenic lesions in all the patients. Color Doppler flow image findings displayed plenty of blood flow signals around and inside the pancreatic lesions in 87.0% of patients. 22 patients (95.7%) exhibited rapid hyper-enhancement in the arterial phase of CEUS and 1 patient (4.3%) showed iso-enhancement. In the venous phase, 15 cases showed sustained hyper-enhancement and 8 cases showed iso-enhancement. In the biopsy procedure, ultrasound-guided core needle biopsy demonstrated higher diagnostic yield than fine needle aspiration (75.0% vs. 46.7%). The biopsy diagnosis was positive in 13 patients (65.0%) in general.
CONCLUSIONS: Metastatic tumors of the pancreas can occur after a prolonged period from ccRCC diagnoses, thus long-term follow-up is necessary. The features of the lesion by conventional ultrasound and CEUS were specific, which are valuable for diagnosis. In patients who are unsuitable for EUS-guided tissue acquisition or have experienced unsuccessful EUS-guided sampling, CEUS combined with percutaneous ultrasound-guided biopsy may serve as a valuable complementary second-line diagnostic approach and facilitate accurate diagnosis.