| EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. | |
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MedLine Citation:
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PMID: 18423464 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Banke Agarwal; Naveen B Krishna; Jennifer L Labundy; Rizwan Safdar; Ece I Akduman |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2008-04-18 |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 68 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-07-28 Completed Date: 2008-09-30 Revised Date: 2010-05-03 |
Medline Journal Info:
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Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States |
Other Details:
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Languages: eng Pagination: 237-42; quiz 334, 335 Citation Subset: IM |
Affiliation:
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Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenocarcinoma
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diagnosis*,
epidemiology Age Distribution Aged Biopsy, Fine-Needle / methods* Cohort Studies Common Bile Duct / pathology, ultrasonography Diagnostic Imaging / methods* Endosonography / methods* Female Humans Immunohistochemistry Incidence Magnetic Resonance Imaging / methods Male Middle Aged Pancreatic Ducts / pathology, ultrasonography Pancreatic Neoplasms / diagnosis*, epidemiology Pancreatitis / diagnosis, epidemiology Prognosis Retrospective Studies Risk Factors Sensitivity and Specificity Sex Distribution Survival Analysis Tomography, X-Ray Computed / methods |
| Comments/Corrections | |
Comment In:
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Endoscopy. 2010 Jan;42(1):68-72
[PMID:
20066593
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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