title: Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer.
abstract: BACKGROUND
  Accurate preoperative detection and staging of pancreatic cancer may identify patients with locoregional disease that is amenable to surgical resection.
  
  
  OBJECTIVE
  To compare endoscopic ultrasonography and multidetector computed tomography (CT) for the detection, staging, and resectability of known or suspected locoregional pancreatic cancer.
  
  
  METHODS
  Prospective, observational, cohort study.
  
  
  METHODS
  Single, tertiary referral hospital in Indianapolis, Indiana.
  
  
  METHODS
  120 participants with known or suspected locoregional pancreatic cancer.
  
  
  METHODS
  Endoscopic ultrasonography followed by multidetector CT was performed in all patients. Patients with known or suspected pancreatic cancer deemed potentially resectable by 1 or both tests were considered for surgery.
  
  
  METHODS
  Detection, staging, and resectability of pancreatic cancer. Surgically resected pancreatic cancer with negative microscopic histologic margins was considered resectable.
  
  
  RESULTS
  Of 120 patients enrolled, 104 (87%) underwent endoscopic ultrasonography and CT. Of the 80 patients with pancreatic cancer, 27 (34%) were managed nonoperatively, and 53 (66%) treated surgically had resectable (n = 25) or unresectable (n = 28) cancer. For the 80 patients with cancer, the sensitivity of endoscopic ultrasonography (98% [95% CI, 91% to 100%]) for detecting a pancreatic mass was greater than that of CT (86% [CI, 77% to 93%]; P = 0.012). For the 53 surgical patients, endoscopic ultrasonography was superior to CT for tumor staging accuracy (67% vs. 41%; P < 0.001) but equivalent for nodal staging accuracy (44% vs. 47%; P > 0.2). Of the 25 resectable pancreatic tumors in patients recommended for surgery, endoscopic ultrasonography and CT correctly identified 88% and 92%, respectively, as resectable. Of the 28 unresectable pancreatic tumors in patients recommended for surgery, endoscopic ultrasonography and CT correctly identified 68% and 64%, respectively, as unresectable.
  
  
  CONCLUSIONS
  Radiologists who read the scans and endosonographers were not blinded to previous radiographic information. Because of the modest sample size, CIs of the sensitivity estimates were sometimes wide.
  
  
  CONCLUSIONS
  Compared with multidetector CT, endoscopic ultrasonography is superior for tumor detection and staging but similar for nodal staging and resectability of preoperatively suspected nonmetastatic pancreatic cancer.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, Roudebush Veterans Affairs Medical Center, and Regenstrief Institute, Inc., Indianapolis, Indiana 46202-5121, USA. jodewitt@iupui.edu
authors.forename: John
authors.initials: J
authors.lastname: DeWitt
authors.forename: Benedict
authors.initials: B
authors.lastname: Devereaux
authors.forename: Melissa
authors.initials: M
authors.lastname: Chriswell
authors.forename: Kathleen
authors.initials: K
authors.lastname: McGreevy
authors.forename: Thomas
authors.initials: T
authors.lastname: Howard
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.forename: Donato
authors.initials: D
authors.lastname: Ciaccia
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: Dean
authors.initials: D
authors.lastname: Maglinte
authors.forename: Kenyon
authors.initials: K
authors.lastname: Kopecky
authors.forename: Julia
authors.initials: J
authors.lastname: LeBlanc
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: James
authors.initials: J
authors.lastname: Madura
authors.forename: Alex
authors.initials: A
authors.lastname: Aisen
authors.forename: Harvey
authors.initials: H
authors.lastname: Cramer
authors.forename: Oscar
authors.initials: O
authors.lastname: Cummings
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed