BACKGROUND: Incidental findings of an enlarged head of pancreas (HOP) or dilated pancreatic duct (PD) with or without a dilated common bile duct (CBD) on CT or magnetic resonance imaging (MRI), in patients without obstructive jaundice, raise suspicion for a pancreatic neoplasm, but their clinical significance has not been established. OBJECTIVE: To determine the prevalence of pancreatic neoplasm in this patient group. DESIGN: Retrospective analysis of a prospective database. SETTING: Tertiary-care university hospital. PATIENTS: Patients without obstructive jaundice at initial presentation, who underwent EUS and/or EUS-guided FNA (EUS-FNA) for an abnormal CT and/or MRI with an enlarged HOP (n = 67) or a PD with or without a dilated CBD (n = 43). The final diagnosis was based on definitive cytology, surgical pathology, and clinical follow-up. INTERVENTIONS: An EUS examination was performed by using a radial echoendoscopy followed by a linear echoendoscopy, if a focal pancreatic lesion was identified. Fine-needle aspirates were stained with Diff-Quik and Papanicolaou's methods, and were immediately assessed by an attending cytopathologist. MAIN OUTCOME MEASUREMENTS: (1) The prevalence of pancreatic neoplasms and (2) performance characteristics of EUS-FNA for identifying malignant neoplasm, in this patient group. RESULTS: In 110 study patients, the final diagnosis included adenocarcinoma (n = 7), pancreatic intraepithelial neoplasia (n = 1), neuroendocrine tumor (n = 1), tumor metastasis (n = 1), and benign cyst (n = 3). Thirty-two patients had EUS evidence of chronic pancreatitis, and, in the remaining 65 patients, the pancreas was normal. The accuracy of EUS and EUS-FNA for diagnosing pancreatic neoplasm in these patients was 99.1%, with 88.8% sensitivity, 100% specificity, 99% negative predicative value, and 100% positive predictive value. LIMITATION: A retrospective design and surgical confirmation in only a small number of study patients. CONCLUSION: A pancreatic neoplasm is seen in a clinically significant number of patients with "enlarged HOP" or "dilated PD with or without a dilated CBD" but without obstructive jaundice. EUS-FNA seems highly accurate for diagnosing pancreatic neoplasm in these patients.
BACKGROUND: Incidental findings of an enlarged head of pancreas (HOP) or dilated pancreatic duct (PD) with or without a dilated common bile duct (CBD) on CT or magnetic resonance imaging (MRI), in patients without obstructive jaundice, raise suspicion for a pancreatic neoplasm, but their clinical significance has not been established. OBJECTIVE: To determine the prevalence of pancreatic neoplasm in this patient group. DESIGN: Retrospective analysis of a prospective database. SETTING: Tertiary-care university hospital. PATIENTS: Patients without obstructive jaundice at initial presentation, who underwent EUS and/or EUS-guided FNA (EUS-FNA) for an abnormal CT and/or MRI with an enlarged HOP (n = 67) or a PD with or without a dilated CBD (n = 43). The final diagnosis was based on definitive cytology, surgical pathology, and clinical follow-up. INTERVENTIONS: An EUS examination was performed by using a radial echoendoscopy followed by a linear echoendoscopy, if a focal pancreatic lesion was identified. Fine-needle aspirates were stained with Diff-Quik and Papanicolaou's methods, and were immediately assessed by an attending cytopathologist. MAIN OUTCOME MEASUREMENTS: (1) The prevalence of pancreatic neoplasms and (2) performance characteristics of EUS-FNA for identifying malignant neoplasm, in this patient group. RESULTS: In 110 study patients, the final diagnosis included adenocarcinoma (n = 7), pancreatic intraepithelial neoplasia (n = 1), neuroendocrine tumor (n = 1), tumor metastasis (n = 1), and benign cyst (n = 3). Thirty-two patients had EUS evidence of chronic pancreatitis, and, in the remaining 65 patients, the pancreas was normal. The accuracy of EUS and EUS-FNA for diagnosing pancreatic neoplasm in these patients was 99.1%, with 88.8% sensitivity, 100% specificity, 99% negative predicative value, and 100% positive predictive value. LIMITATION: A retrospective design and surgical confirmation in only a small number of study patients. CONCLUSION: A pancreatic neoplasm is seen in a clinically significant number of patients with "enlarged HOP" or "dilated PD with or without a dilated CBD" but without obstructive jaundice. EUS-FNA seems highly accurate for diagnosing pancreatic neoplasm in these patients.
Authors: Tommaso Maria Manzia; Luca Toti; Ilaria Lenci; Magdy Attia; Laura Tariciotti; Simon R Bramhall; John A C Buckels; Darius F Mirza Journal: Ann R Coll Surg Engl Date: 2010-05 Impact factor: 1.891
Authors: Alexander W Jahng; Sonya Reicher; David Chung; Donna Varela; Rahul Chhablani; Anil Dev; Binh Pham; Jose Nieto; Rose J Venegas; Samuel W French; Bruce E Stabile; Viktor E Eysselein Journal: World J Gastrointest Endosc Date: 2010-11-16
Authors: S Hébert-Magee; S Bae; S Varadarajulu; J Ramesh; A R Frost; M A Eloubeidi; I A Eltoum Journal: Cytopathology Date: 2013-06 Impact factor: 2.073