Document Detail

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.
MedLine Citation:
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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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-04-18
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  68     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2008 Aug 
Date Detail:
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    
Other Details:
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.
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MeSH Terms
Adenocarcinoma / diagnosis*,  epidemiology
Age Distribution
Biopsy, Fine-Needle / methods*
Cohort Studies
Common Bile Duct / pathology,  ultrasonography
Diagnostic Imaging / methods*
Endosonography / methods*
Magnetic Resonance Imaging / methods
Middle Aged
Pancreatic Ducts / pathology,  ultrasonography
Pancreatic Neoplasms / diagnosis*,  epidemiology
Pancreatitis / diagnosis,  epidemiology
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Sex Distribution
Survival Analysis
Tomography, X-Ray Computed / methods
Comment In:
Endoscopy. 2010 Jan;42(1):68-72   [PMID:  20066593 ]

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