BACKGROUND: The relative accuracy of helical CT and EUS for defining the local resectability of peripapillary malignancies is undefined. METHODS: Fifty-one patients with a peripapillary malignancy and no metastatic disease were prospectively evaluated with helical CT and EUS. Imaging results were compared with surgical staging, and a tumor was defined as resectable when there was no macroscopic or microscopic residual tumor. RESULTS: Nine patients had surgically confirmed locally unresectable disease, which was accurately predicted by EUS in 6 patients (sensitivity 67%) and by helical CT in 3 patients (sensitivity 33%; p = 0.35). When only patients with complete EUS examinations were included, the sensitivities of EUS and helical CT for vascular invasion were 100% and 33% (p = 0.06), respectively. When all patients not undergoing surgery because of imaging evidence of locally unresectable disease were included, the sensitivities were 100% and 62.5% (p = 0.02), respectively. One of 15 patients with a tumor amenable to surgical resection was labeled as unresectable by EUS but subsequently had a local recurrence of the tumor. The specificities of EUS (93%) and helical CT (100%) were similar. CONCLUSION: EUS is more sensitive than helical CT for detecting vascular invasion by peripapillary malignancies and should be added to staging protocols, particularly when findings on helical CT are equivocal.
BACKGROUND: The relative accuracy of helical CT and EUS for defining the local resectability of peripapillary malignancies is undefined. METHODS: Fifty-one patients with a peripapillary malignancy and no metastatic disease were prospectively evaluated with helical CT and EUS. Imaging results were compared with surgical staging, and a tumor was defined as resectable when there was no macroscopic or microscopic residual tumor. RESULTS: Nine patients had surgically confirmed locally unresectable disease, which was accurately predicted by EUS in 6 patients (sensitivity 67%) and by helical CT in 3 patients (sensitivity 33%; p = 0.35). When only patients with complete EUS examinations were included, the sensitivities of EUS and helical CT for vascular invasion were 100% and 33% (p = 0.06), respectively. When all patients not undergoing surgery because of imaging evidence of locally unresectable disease were included, the sensitivities were 100% and 62.5% (p = 0.02), respectively. One of 15 patients with a tumor amenable to surgical resection was labeled as unresectable by EUS but subsequently had a local recurrence of the tumor. The specificities of EUS (93%) and helical CT (100%) were similar. CONCLUSION: EUS is more sensitive than helical CT for detecting vascular invasion by peripapillary malignancies and should be added to staging protocols, particularly when findings on helical CT are equivocal.
Authors: Nicolas C Buchs; Michael Chilcott; Pierre-Alexandre Poletti; Leo H Buhler; Philippe Morel Journal: World J Gastroenterol Date: 2010-02-21 Impact factor: 5.742
Authors: Frances Tse; Jeffrey S Barkun; Joseph Romagnuolo; Gad Friedman; Jeffrey D Bornstein; Alan N Barkun Journal: HPB (Oxford) Date: 2006 Impact factor: 3.647
Authors: B N J Thomson; R W Parks; D N Redhead; F K S Welsh; K K Madhavan; S J Wigmore; O J Garden Journal: Br J Cancer Date: 2006-01-30 Impact factor: 7.640