Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 44: Our Endosonographer Frequently Detects Vague Hypoechoic Pancreatic Lesions, But Does Not Perform Fine Needle Aspiration—He Recommends Follow Up Eus In 3 Months. How Many Follow Up Exams Are Needed? Are Fine Needle Aspirations Unsafe? (continued)

Jason B. Samarasena, MD; Kenneth J. Chang, MD, FACG, FASGE

First, it is important to describe what a vague hypoechoic lesion of the pancreas means to an endosonographer (Figure 44-1). Any lesion that is large, well circumscribed, cystic, or distorts surrounding structures (main or side branch ducts, vessels, etc) does not fall into this category. The differential diagnosis of a vague hypoechoic lesion of the pancreas includes normal changes, chronic pancreatitis (including focal), lobularity (normal parenchyma surrounded by fibrous bands), and, much less likely, a neuroendocrine tumor, lymphoma, metastatic tumor, or early cancer. The 2 main factors…