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Title: Endoscopic Ultrasound Highly Accurate in Diagnosing Pancreatic Neoplasms
URL: http://www.pslgroup.com/dg/22A0D2.htm
Doctor's Guide
August 27, 2008

OAK BROOK, Ill -- August 27, 2008 -- Endoscopic ultrasound (EUS) and EUS with fine needle aspiration (FNA) are 99.1% accurate in diagnosing pancreatic neoplasms in patients who were referred because of computed tomography (CT) and/or magnetic resonance imaging (MRI) findings of enlargement of head of pancreas (HOP) or dilation of the pancreatic duct (PD), according to a study in the August issue of Gastrointestinal Endoscopy.

"Often, patients with these radiologic findings are referred for EUS in lieu of waiting for repeated imaging," said lead author Banke Agarwal, MD, Saint Louis University School of Medicine, St. Louis, Missouri.

"Our study looked to determine the performance characteristics of EUS and/or EUS with FNA in diagnosing a pancreatic tumour in this patient population.

"We found that EUS and/or an EUS-FNA for diagnosing a pancreatic neoplasm was 99.1% accurate with 88.8% sensitivity and 100% specificity."

The study was a retrospective analysis of 110 patients (mean age 60.3 y), from a prospectively maintained database of patients who underwent an EUS and/or EUS-FNA at St. Louis University Hospital between March 2002 and March 2006.

All patients were suspected of having pancreatic cancer based on an abnormal CT and/or MRI and were reported as having an enlarged HOP or dilation of the PD (with or without a dilated common bile duct).

An EUS examination was initially performed by using a radial echoendoscope. Whenever a suspicious mass was identified on radial EUS, an FNA was performed using a linear echoendoscope.

Fine needle aspirates were submitted for cytology and biochemical analysis. A final diagnosis was based on definitive cytology, surgical pathology, or clinical follow-up of 12 months or more (median follow-up, 16 mo).

Researchers found that 6% of patients referred because of an enlarged HOP on a CT and/or an MRI and 11.5% of patients referred for a dilated PD had a pancreatic neoplasm.

The diagnostic accuracy of an EUS and/or EUS-FNA in these patients for diagnosing a pancreatic neoplasm was 99.1%. Furthermore, no patient with enlarged HOP, but without a mass at EUS, went on to develop cancer.

In conclusion, researchers found that a pancreatic neoplasm is present in a clinically significant number of patients with an enlarged HOP or dilated PD detected on a CT and/or MRI performed for evaluation of nonspecific symptoms, such as abdominal pain or weight loss.

They also observed that an EUS and/or EUS-FNA are highly accurate for the diagnosis of pancreatic neoplasm in these patients. Based on these data, researchers recommend that an EUS and/or EUS-FNA be considered as the logical next test in the evaluation of patients with such imaging findings.

SOURCE: American Society for Gastrointestinal Endoscopy

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