|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.|
|PMID: 18423464 Owner: NLM Status: MEDLINE|
|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.|
|Banke Agarwal; Naveen B Krishna; Jennifer L Labundy; Rizwan Safdar; Ece I Akduman|
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|Type: Comparative Study; Journal Article Date: 2008-04-18|
|Title: Gastrointestinal endoscopy Volume: 68 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2008 Aug|
|Created Date: 2008-07-28 Completed Date: 2008-09-30 Revised Date: 2010-05-03|
Medline Journal Info:
|Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: United States|
|Languages: eng Pagination: 237-42; quiz 334, 335 Citation Subset: IM|
|Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Biopsy, Fine-Needle / methods*
Common Bile Duct / pathology, ultrasonography
Diagnostic Imaging / methods*
Endosonography / methods*
Magnetic Resonance Imaging / methods
Pancreatic Ducts / pathology, ultrasonography
Pancreatic Neoplasms / diagnosis*, epidemiology
Pancreatitis / diagnosis, epidemiology
Sensitivity and Specificity
Tomography, X-Ray Computed / methods
|Endoscopy. 2010 Jan;42(1):68-72
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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