BACKGROUND: Diagnosis of pancreatic neoplasm is challenging in patients with inconclusive findings on pancreatic multidetector row CT (MDCT). OBJECTIVE: To determine the diagnostic accuracy and to identify predictors of pancreatic neoplasm by EUS with FNA in this setting. DESIGN: Retrospective chart review during the study period of January 2002 to December 2010. SETTING: Tertiary referral center. PATIENTS: Of the 1046 patients who underwent pancreatic EUS, 116 patients were selected because their clinical presentation was suspicious for pancreatic malignancy, but their MDCT findings were inconclusive. INTERVENTION: EUS with FNA. MAIN OUTCOME MEASUREMENTS: Diagnostic yield of malignancy and significance of clinical variables. RESULTS: When surgical pathology or subsequent clinical course was used as the criterion standard, EUS with FNA had a sensitivity, specificity, positive predictive value, and accuracy of 87.3%, 98.3%, 98.5%, and 92.1%, respectively, in diagnosing a pancreatic neoplasm that was indeterminate on MDCT. Factors significantly associated with EUS detection of pancreatic ductal adenocarcinoma were total bilirubin level greater than 2 mg/dL (P < .001), CT finding of pancreatic duct dilation (P < .001), bile duct stricture (P < .001), and tumor size 1.5 cm or larger detected by EUS (P = .004). Among them, pancreatic duct dilation on CT (odds ratio 4.10; 95% confidence interval, 1.52-11.05), and tumor size 1.5 cm or larger detected by EUS (odds ratio 8.46; 95% confidence interval, 2.02-35.45) were independent risk factors. LIMITATIONS: Retrospective design and patient referral bias. CONCLUSIONS: When MDCT is indeterminate, EUS is a highly sensitive and accurate modality for the detection of pancreatic neoplasm, especially when the tumor is smaller than 2.0 cm.
BACKGROUND: Diagnosis of pancreatic neoplasm is challenging in patients with inconclusive findings on pancreatic multidetector row CT (MDCT). OBJECTIVE: To determine the diagnostic accuracy and to identify predictors of pancreatic neoplasm by EUS with FNA in this setting. DESIGN: Retrospective chart review during the study period of January 2002 to December 2010. SETTING: Tertiary referral center. PATIENTS: Of the 1046 patients who underwent pancreatic EUS, 116 patients were selected because their clinical presentation was suspicious for pancreatic malignancy, but their MDCT findings were inconclusive. INTERVENTION: EUS with FNA. MAIN OUTCOME MEASUREMENTS: Diagnostic yield of malignancy and significance of clinical variables. RESULTS: When surgical pathology or subsequent clinical course was used as the criterion standard, EUS with FNA had a sensitivity, specificity, positive predictive value, and accuracy of 87.3%, 98.3%, 98.5%, and 92.1%, respectively, in diagnosing a pancreatic neoplasm that was indeterminate on MDCT. Factors significantly associated with EUS detection of pancreatic ductal adenocarcinoma were total bilirubin level greater than 2 mg/dL (P < .001), CT finding of pancreatic duct dilation (P < .001), bile duct stricture (P < .001), and tumor size 1.5 cm or larger detected by EUS (P = .004). Among them, pancreatic duct dilation on CT (odds ratio 4.10; 95% confidence interval, 1.52-11.05), and tumor size 1.5 cm or larger detected by EUS (odds ratio 8.46; 95% confidence interval, 2.02-35.45) were independent risk factors. LIMITATIONS: Retrospective design and patient referral bias. CONCLUSIONS: When MDCT is indeterminate, EUS is a highly sensitive and accurate modality for the detection of pancreatic neoplasm, especially when the tumor is smaller than 2.0 cm.
Authors: Leticia Perondi Luz; Mohammad Ali Al-Haddad; Michael Sai Lai Sey; John M DeWitt Journal: World J Gastroenterol Date: 2014-06-28 Impact factor: 5.742
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: Ajaykumar C Morani; Abdelrahman K Hanafy; Nisha S Ramani; Venkata S Katabathina; Sireesha Yedururi; Anil K Dasyam; Srinivasa R Prasad Journal: Radiol Imaging Cancer Date: 2020-03-13
Authors: Clifton G Fulmer; Kyung Park; Thomas Dilcher; Mai Ho; Susanna Mirabelli; Susan Alperstein; Erika M Hissong; Meredith Pittman; Momin Siddiqui; Jonas J Heymann; Rhonda K Yantiss; Alain C Borczuk; Helen Fernandes; Carlie Sigel; Wei Song; Juan Miguel Mosquera; Rema Rao Journal: Cancer Cytopathol Date: 2020-06-29 Impact factor: 4.264