Elsevier

Gastrointestinal Endoscopy

Volume 52, Issue 3, September 2000, Pages 367-371
Gastrointestinal Endoscopy

Original Articles
EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma,☆☆

Presented at the annual meeting of the American Society for Gastrointestinal Endoscopy, Orlando, Florida, May 18, 1999.
https://doi.org/10.1067/mge.2000.107727Get rights and content

Abstract

Background: Preoperative diagnosis of pancreatic adenocarcinoma can be difficult. Computed tomography (CT) is the standard, noninvasive imaging method for evaluation of suspected pancreatic adenocarcinoma, but it has limited sensitivity for diagnosis, local staging, and metastases. Endoscopic ultrasound (EUS) and fluoro-deoxyglucose/positron emission tomography (FDG-PET) are imaging methods that may improve diagnostic accuracy. Methods: Thirty-five patients with presumed resectable pancreatic adenocarcinoma were prospectively evaluated with helical CT, EUS, and FDG-PET. Results: Sensitivity for the detection of pancreatic cancer was higher for EUS (93%) and FDG-PET (87%) than for CT (53%). EUS was more sensitive than CT for local vascular invasion of the portal and superior mesenteric veins. EUS diagnosis of vascular invasion was associated with poor outcome after surgery. EUS-guided, fine-needle aspiration allowed tissue diagnosis in 14 of 21 attempts (67%). FDG-PET diagnosed 7 of 9 cases of proven metastatic disease, 4 of which were missed by CT. Two of three metastatic liver lesions suspected by CT were indeterminate for metastases. FDG-PET confirmed metastases. Conclusions: EUS and PET improve diagnostic capability in pancreatic adenocarcinoma. EUS is useful in determining local vascular invasion and obtaining tissue diagnosis. FDG-PET is useful in identifying metastatic disease. Both techniques are more sensitive than helical CT for identification of the primary tumor. (Gastrointest Endosc 2000;52:367–71).

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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  • Cited by (0)

    Reprint requests: Howard R. Mertz, MD, 1501 TVC, Vanderbilt University Medical Center, Nashville, TN 37232-5340.

    ☆☆

    Gastrointest Endosc 2000;52:367–71.

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