Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach  Marcia Irene Canto, Michael Goggins, Charles J. Yeo, Constance Griffin, Jennifer E. Axilbund, Kieran Brune, Syed Z. Ali, Sanjay Jagannath, Gloria M. Petersen, Elliot K. Fishman, Steven Piantadosi, Francis M. Giardiello, Ralph H. Hruban  Clinical Gastroenterology and Hepatology  Volume 2, Issue 7, Pages 606-621 (July 2004) DOI: 10.1016/S1542-3565(04)00244-7

Figure 1 Study flow chart. Clinical Gastroenterology and Hepatology 2004 2, 606-621DOI: (10.1016/S1542-3565(04)00244-7)

Figure 2 Endoscopic ultrasound image (7.5 MHz) of hypoechoic malignant-appearing mass (A) in the head of the pancreas of patient 1 from a (B) family with 7 affected members in 3 generations. Patient 1 (upward arrow) is a nonsmoker with a prior history of breast cancer who developed pancreatic cancer at age 45. Clinical Gastroenterology and Hepatology 2004 2, 606-621DOI: (10.1016/S1542-3565(04)00244-7)

Figure 3 (A) Dual-phase abdominal CT scan image from patient 5 showing a small enhancing lesion in the pancreatic tail (arrow), misdiagnosed to be an islet cell tumor. (B) EUS image of the same lesion in the tail (left-pointing arrow) and normal main pancreatic duct (upward-pointing arrow). (C) ERCP image of pancreatic duct in the body and tail from the same patient showing tortuosity of the main duct and a saccular deformity of a branch duct (arrow). Clinical Gastroenterology and Hepatology 2004 2, 606-621DOI: (10.1016/S1542-3565(04)00244-7)

Figure 4 (A) H & E stain of section from a distal pancreatectomy specimen of patient 6 showing an example of a pancreatic intraepithelial neoplastic lesion (PanIN 2). Note the transition from normal pancreatic ducts (arrow) with normal cuboidal epithelium to an enlarged pancreatic duct distended with papillary mucinous, low-columnar epithelium. There is also very mild associated chronic inflammation and scarring in the adjacent pancreas. (B) Higher-power magnification (40×) of the PanIN in Figure 2A showing nuclear enlargement, pleomorphism, and nucleoli. Clinical Gastroenterology and Hepatology 2004 2, 606-621DOI: (10.1016/S1542-3565(04)00244-7)

Figure 5 Dif-quik stain of random pancreatic fine-needle aspirate from patient 7 (magnification, 200×) showing ductal cells with enlarged nuclei and pleomorphism, interpreted to be markedly atypical and suspicious for adenocarcinoma. Clinical Gastroenterology and Hepatology 2004 2, 606-621DOI: (10.1016/S1542-3565(04)00244-7)