Original ArticlesEUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma☆,☆☆
Section snippets
Patients and methods
Between August 1996 and January 1999, 35 patients thought to have resectable pancreatic adenocarcinomas were evaluated by CT, EUS, and PET. This represents approximately 50% of the patients with potentially resectable pancreatic adenocarcinoma seen at our institution during this period. Patients with obvious unresectable disease were frequently not evaluated with all imaging techniques. All patients presented with either abdominal pain or jaundice and had an abnormal abdominal CT of the
Detection of pancreatic carcinoma
Pancreatic adenocarcinoma was diagnosed in 31 of 35 patients. Chronic pancreatitis was diagnosed in the other four patients. The sensitivities of EUS and of PET for detection of pancreatic adenocarcinoma were similar at 93% (29 of 31) and 87% (27 of 31), respectively. Helical CT had a sensitivity of 53% (16 of 31), inferior to both EUS and PET (p < 0.05). If criteria for a positive scan were expanded to include pancreatic head enlargement, CT sensitivity rose to 70%, still inferior to EUS (p <
Discussion
Helical CT is tremendously helpful when there is a suspicion of pancreatic malignancy. It can demonstrate a pancreatic mass, abnormalities of the pancreatic and biliary ducts, metastatic disease, and vascular involvement. However CT is insensitive for some of these purposes. We found EUS and PET scanning to have superior sensitivity compared with helical CT for identification of pancreatic cancer. With only four cases of benign disease, it is not possible to comment on specificity and overall
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Reprint requests: Howard R. Mertz, MD, 1501 TVC, Vanderbilt University Medical Center, Nashville, TN 37232-5340.
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Gastrointest Endosc 2000;52:367–71.