EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates.
BACKGROUND
Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses.


METHODS
All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor.


RESULTS
30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered.


CONCLUSIONS
EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.
Aslanian
Harry
H
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Salem
Ronald
R
Lee
Jeffrey
J
Andersen
Dana
D
Robert
Marie
M
Topazian
Mark
M
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010173:Palpation; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000469:parasitology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology; D014743:Videotape Recording