To detect a 4 mm nodule in the pancreas, the investigation of your choice would be?: (A) PET scan, (B) Endoscopic USG, (C) CECT, (D) MRI
Answer is B. In detection and staging of small tumors EUS (Endoscopic ultrasound) is reliable. EUS is used in the detection of tumors smaller than 2 cm. EUS has a high sensitivity and specificity for pancreatic cancer, with an overall staging accuracy higher than 80%. The possibility of performing EUS-guided FNA significantly improves both diagnostic and staging capability of EUS Contrast enhanced CT is generally accepted as first line of investigation for suspected pancreatic cancer. MRI appears to be more valuable for staging the extent and spread of pancreatic carcinoma than for tumor detection of lesions smaller than 2 cm. PET scan is usually reserved, to confirm malignancy, to differentiate between carcinoma and a focal nodular pancreatitis and to recognize distant metastasis. In general, the sensitivity of PET is high in the detection of lesions more than a centimeter in diameter.