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Endoscopic Ultrasound Highly Effective in Assessing Ambiguous Radiographic Findings of the Pancreas

By MedImaging International staff writers
Posted on 22 Sep 2008
Researchers reported that endoscopic ultrasound (EUS) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are 99.1% accurate in diagnosing pancreatic neoplasms in patients who were referred for endoscopic ultrasound (EUS) because of computed tomography (CT) and/or magnetic resonance imaging (MRI) reports of two common, although somewhat ambiguous findings--enlargement of head of pancreas (HOP) or dilation of the pancreatic duct (PD).

The study conducted by researchers from St. Louis University School of Medicine (St. Louis, MO, USA), appeared in the August 2008 issue of the journal Gastrointestinal Endoscopy (GIE).

Occasionally, patients who are asymptomatic or who have nonspecific symptoms, such as weight loss and abdominal pain, have slight abnormal or incidental findings on CT and/or MRI that raise suspicion for pancreatic cancer. These modalities have relatively low specificity (ability to definitively discern between various diagnoses) in this setting. Perhaps due to a concern of missing early, small pancreatic tumors, clinicians who perform EUS are increasingly referred patients with subtle CT or MRI findings such as "enlarged pancreatic head” or "dilation of the pancreatic duct (widening of the main duct coursing through the pancreas).”

Endoscopic ultrasound and EUS-FNA have become a valuable tool in the diagnostic evaluation of patients with suspected pancreatic cancer. This technique allows for detection and possible needle biopsy of small pancreatic tumors even before they can be visualized as a subtle mass with CT or MRI.

"Often, patients with these radiologic findings are referred for EUS in lieu of waiting for repeated imaging. Our study looked to determine the performance characteristics of EUS and/or EUS with FNA in diagnosing a pancreatic tumor in this patient population,” said study lead author Banke Agarwal, M.D., from Saint Louis University School of Medicine. "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.”

Endoscopic ultrasound consists of a flexible endoscope that has a small ultrasound device built into the end. The ultrasound component generates sound waves that create visual images of the digestive tract that extend beyond the inner surface lining. EUS can be used to evaluate an abnormality below the surface such as a growth that was detected at a prior endoscopy or by X-ray. EUS can also be used to diagnose diseases of the pancreas, bile duct, and gallbladder when other tests are inconclusive, and can be used to determine the stage of tumors. Tissue samples, using a fine needle aspiration technique (FNA), can be obtained in real time with EUS guidance should an abnormality be seen.

This study was a retrospective analysis of 110 patients, mean age 60.3 years, 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 for suspected pancreatic cancer based on an abnormal CT and/or MRI who 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 was 16 months).

Researchers found that 6% of patients referred because of an enlarged HOP on a CT and/or an MRI scan 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, the researchers demonstrated 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 scan 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 valid next test in the evaluation of patients with such imaging findings.

Related Links:
St. Louis University School of Medicine

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86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
87 (71.048736572266): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720434 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1
88 (36.954879760742): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720434 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1
89 (35.04753112793): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`
90 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1
91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1
92 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1
93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
94 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
96 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1
97 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1
98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1
101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1
102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1
103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1
104 (145.91217041016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
105 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
106 (79.154968261719): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720434 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1
107 (80.108642578125): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720434 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1
108 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
109 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
110 (52.213668823242): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294720434 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1
111 (527.14347839355): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294720434 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1
112 (675.91667175293): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1
113 (434.87548828125): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1
114 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
115 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
116 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
117 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
118 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
119 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
120 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
121 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
122 (395.05958557129): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`
123 (!!!!! 21559.953689575): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7
124 (624.17984008789): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720434 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720434 AND type='deeppockets_item' AND published='1' LIMIT 1
125 (!!!!! 7391.2143707275): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3
126 (77.962875366211): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3
127 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1
128 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1
129 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1
130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1
131 (283.95652770996): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1
132 (37.193298339844): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1
133 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1
134 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1
135 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1
136 (323.05717468262): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1
137 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=214
138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=214
139 (593.90068054199): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3
140 (969.17152404785): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3
141 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
142 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
143 (!!!!! 12316.942214966): TRUNCATE TABLE jos_trademed_module
144 (128.03077697754): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720434 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1
145 (80.108642578125): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294720434 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1
146 (638.96179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1
147 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1
148 (133.03756713867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
149 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
150 (!!!!! 1705.1696777344): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6
151 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
152 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
153 (72.956085205078): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294720434 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294720434 AND type='deeppockets_item' AND published='1' LIMIT 1
154 (64.13459777832): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)
155 (39.100646972656): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)
156 (66.041946411133): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1
157 (372.88665771484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
158 (138.99803161621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294720434 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294720434 AND published='1' LIMIT 1
159 (73.909759521484): select jos_twitters.link from jos_twitters where cat=10
160 (49.114227294922): select jos_facebook.link from jos_facebook where cat=10
161 (46.014785766602): select jos_google_plus.link from jos_google_plus where cat=10
162 (46.014785766602): select jos_linkedin.link from jos_linkedin where cat=10