| Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. | |
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MedLine Citation:
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PMID: 21067747 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Accurate preoperative diagnosis and staging of cholangiocarcinoma (CCA) remain difficult. OBJECTIVE: To evaluate the utility of EUS in the diagnosis and preoperative evaluation of CCA. DESIGN: Observational study of prospectively collected data. SETTING: Single tertiary referral hospital in Indianapolis, Indiana. PATIENTS: Consecutive patients with CCA from January 2003 through October 2009. INTERVENTIONS: EUS and EUS-guided FNA (EUS-FNA). MAIN OUTCOME MEASUREMENTS: Sensitivity of EUS for the detection of a tumor and prediction of unresectability compared with CT and magnetic resonance imaging (MRI); sensitivity of EUS-FNA to provide tissue diagnosis, by using surgical pathology as a reference standard. RESULTS: A total of 228 patients with biliary strictures undergoing EUS were identified. Of these, 81 (mean age 70 years, 45 men) had CCA. Fifty-one patients (63%) had distal and 30 (37%) had proximal CCA. For those with available imaging, tumor detection was superior with EUS compared with triphasic CT (76 of 81 [94%] vs 23 of 75 [30%], respectively; P < .001). MRI identified the tumor in 11 of 26 patients (42%; P = .07 vs EUS). EUS identified CCA in all 51 (100%) distal and 25 (83%) of 30 proximal tumors (P < .01). EUS-FNA (median, 5 passes; range, 1-12 passes) was performed in 74 patients (91%). The overall sensitivity of EUS-FNA for the diagnosis of CCA was 73% (95% confidence interval, 62%-82%) and was significantly higher in distal compared with proximal CCA (81% vs 59%, respectively; P = .04). Fifteen tumors were definitely unresectable. EUS correctly identified unresectability in 8 of 15 and correctly identified the 38 of 39 patients with resectable tumors (53% sensitivity and 97% specificity for unresectability). CT and/or MRI failed to detect unresectability in 6 of these 8 patients. LIMITATION: Single-center study. CONCLUSION: EUS and EUS-FNA are sensitive for the diagnosis of CCA and very specific in predicting unresectability. The sensitivity of EUS-FNA is significantly higher in distal than in proximal CCA. |
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Authors:
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Mehdi Mohamadnejad; John M DeWitt; Stuart Sherman; Julia K LeBlanc; Henry A Pitt; Michael G House; Kelly J Jones; Evan L Fogel; Lee McHenry; James L Watkins; Gregory A Cote; Glen A Lehman; Mohammad A Al-Haddad |
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Publication Detail:
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Type: Journal Article Date: 2010-11-09 |
Journal Detail:
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Title: Gastrointestinal endoscopy Volume: 73 ISSN: 1097-6779 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-27 Completed Date: - Revised Date: - |
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: 71-8 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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