BACKGROUND: The optimal approach for detecting small pancreatic tumors is uncertain. We compared multidetector CT (MDCT) with follow-up endoscopic ultrasonography (EUS) without or with fine-needle aspiration (EUS-FNA) for diagnosing pancreatic cancer. METHODS: Patients with suspicion of pancreatic cancer who underwent dual-phase MDCT and follow-up EUS were retrospectively reviewed. This consisted of scoring MDCT scans independently by three radiologists on a 1-5 scale of certainty, determining whether a stent was present, scoring EUS reports regarding presence of a mass and analyzing EUS-FNA results. RESULTS: A total of 117 patients underwent MDCT and EUS. ROC values for MDCT were 0.85, 0.87, and 0.91. There was no significant difference in the accuracy of EUS and MDCT. Follow-up EUS (99%) was significantly more sensitive than MDCT (89% and 93%), as interpreted by two radiologists. Follow-up EUS was statistically significantly more sensitive than MDCT (96% vs. 70%) for one radiologist for tumors < 2 cm. Specificity of EUS was 50%, and sensitivity of EUS-FNA was 82%. Negative predictive value of EUS-FNA was significantly less in patients with (21%) than without (70%) biliary stents. CONCLUSIONS: Follow-up EUS improves lesion detection over MDCT alone. Close follow-up/repeat biopsy should be considered if FNA is negative, but EUS is positive.
BACKGROUND: The optimal approach for detecting small pancreatic tumors is uncertain. We compared multidetector CT (MDCT) with follow-up endoscopic ultrasonography (EUS) without or with fine-needle aspiration (EUS-FNA) for diagnosing pancreatic cancer. METHODS:Patients with suspicion of pancreatic cancer who underwent dual-phase MDCT and follow-up EUS were retrospectively reviewed. This consisted of scoring MDCT scans independently by three radiologists on a 1-5 scale of certainty, determining whether a stent was present, scoring EUS reports regarding presence of a mass and analyzing EUS-FNA results. RESULTS: A total of 117 patients underwent MDCT and EUS. ROC values for MDCT were 0.85, 0.87, and 0.91. There was no significant difference in the accuracy of EUS and MDCT. Follow-up EUS (99%) was significantly more sensitive than MDCT (89% and 93%), as interpreted by two radiologists. Follow-up EUS was statistically significantly more sensitive than MDCT (96% vs. 70%) for one radiologist for tumors < 2 cm. Specificity of EUS was 50%, and sensitivity of EUS-FNA was 82%. Negative predictive value of EUS-FNA was significantly less in patients with (21%) than without (70%) biliary stents. CONCLUSIONS: Follow-up EUS improves lesion detection over MDCT alone. Close follow-up/repeat biopsy should be considered if FNA is negative, but EUS is positive.
Authors: Somashekar G Krishna; Bhavana B Rao; Emmanuel Ugbarugba; Zarine K Shah; Alecia Blaszczak; Alice Hinton; Darwin L Conwell; Phil A Hart Journal: Surg Endosc Date: 2017-04-04 Impact factor: 4.584
Authors: Dushyant V Sahani; Pietro A Bonaffini; Onofrio A Catalano; Alexander R Guimaraes; Michael A Blake Journal: Radiographics Date: 2012 Jul-Aug Impact factor: 5.333
Authors: Zhongkui Li; Zhe Chang; Lucia J Chiao; Ya'an Kang; Qianghua Xia; Cihui Zhu; Jason B Fleming; Douglas B Evans; Paul J Chiao Journal: Cancer Res Date: 2009-09-22 Impact factor: 12.701
Authors: Alan R Penheiter; Sibel Erdogan; Stephen J Murphy; Steven N Hart; Joema Felipe Lima; Fariborz Rakhshan Rohakhtar; Daniel R O'Brien; William R Bamlet; Ryan E Wuertz; Thomas C Smyrk; Fergus J Couch; George Vasmatzis; Claire E Bender; Stephanie K Carlson Journal: Biomed Res Int Date: 2015-05-27 Impact factor: 3.411