Faculty Collaboration Database

Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer. Abdom Imaging 2007;32(5):660-7

Date

08/23/2007

Pubmed ID

17712589

DOI

10.1007/s00261-007-9298-x

Scopus ID

2-s2.0-35348888366 (requires institutional sign-in at Scopus site)   66 Citations

Abstract

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.

Author List

Tamm EP, Loyer EM, Faria SC, Evans DB, Wolff RA, Charnsangavej C

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Diagnosis, Differential
Diagnostic Imaging
Female
Follow-Up Studies
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Pancreatic Neoplasms
ROC Curve
Radiology
Retrospective Studies
Tomography, X-Ray Computed