Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography.
BACKGROUND
We evaluated the usefulness of endoscopic ultrasonography for detecting pancreatobiliary carcinoma and assessing portal venous invasion by carcinoma.


METHODS
Seventy-three patients with pancreatic carcinoma (54 patients) or bile duct carcinoma (19 patients) underwent endoscopic ultrasonography, transabdominal ultrasonography, computed tomography (CT), and angiography. All patients underwent tumor resection and histological examination for portal venous invasion. Results of endoscopic ultrasonography were compared with those of other imaging modalities.


RESULTS
Histopathology revealed portal venous invasion in 20 patients. Endoscopic ultrasonography was significantly more sensitive (96%) than ultrasonography (81%), CT (86%), and angiography (59%) in detecting carcinomas. On endoscopic ultrasonography, loss of the echogenic vessel-parenchymal sonographic interface or a tumor within the vessel lumen indicated portal venous invasion. For diagnosing portal venous invasion, endoscopic ultrasonography was more sensitive (95%) and accurate (93%) than ultrasonography (55% and 67%), CT (65% and 74%), and angiography (75% and 79%), respectively.


CONCLUSIONS
Endoscopic ultrasonography is the most accurate tool for detecting pancreatobiliary carcinomas and assessing portal venous invasion.
Sugiyama
M
M
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Hagi
H
H
Atomi
Y
Y
Saito
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D004386:Duodenum / Q000000981:diagnostic imaging / Q000473:pathology; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000473:pathology; D011172:Portography; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed