title: A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions.
abstract: BACKGROUND
  Diagnosing pancreatic cancer by EUS-FNA is a potentially appealing alternative to percutaneous biopsy.
  
  
  OBJECTIVE
  To compare EUS-FNA with CT or US-guided FNA for diagnosing pancreatic cancer.
  
  
  METHODS
  Single center, prospective, randomized, cross-over.
  
  
  METHODS
  Duke University Medical Center.
  
  
  METHODS
  Eighty-four patients referred with suspicious solid pancreatic mass lesions randomized to CT/US-FNA (n = 43) or EUS-FNA (n = 41).
  
  
  METHODS
  Patients underwent an imaging procedure/FNA. If cytology was nondiagnostic, cross over to the other modality was offered. Final outcome was determined by clinical follow-up every 6 months for 2 years and/or surgical pathology for patients with negative FNA.
  
  
  METHODS
  Sensitivity and accuracy of EUS-FNA versus CT/US-FNA for pancreatic cancer.
  
  
  RESULTS
  There were 16 true positive (TP) by CT/US-FNA and 21 TP by EUS-FNA. Sixteen of the 20 CT/US-FNA negative patients crossed over to EUS-FNA; 12 underwent FNA, 4 had no mass at EUS. Seven of the 12 had positive EUS-FNA. Eight EUS-FNA negative crossed over to CT/US; 4 had no mass at CT/US, 3 remained true negative throughout follow-up, 1 had chronic pancreatitis at surgery. The sensitivity of CT/US-FNA and EUS-FNA for detecting malignancy was 62% and 84%, respectively. A comparison of the accuracy for CT/US-FNA and EUS-FNA was not statistically significant (P = .074, chi(2)).
  
  
  CONCLUSIONS
  Failure to meet target enrollment resulted in an inability to demonstrate a statistically significant difference between the 2 modalities.
  
  
  CONCLUSIONS
  EUS-FNA is numerically (though not quite statistically) superior to CT/US-FNA for the diagnosis of pancreatic malignancy.
authors.affiliation: Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307, USA.
authors.forename: John David
authors.initials: JD
authors.lastname: Horwhat
authors.forename: Erik K
authors.initials: EK
authors.lastname: Paulson
authors.forename: Kevin
authors.initials: K
authors.lastname: McGrath
authors.forename: M Stanley
authors.initials: MS
authors.lastname: Branch
authors.forename: John
authors.initials: J
authors.lastname: Baillie
authors.forename: Douglas
authors.initials: D
authors.lastname: Tyler
authors.forename: Theodore
authors.initials: T
authors.lastname: Pappas
authors.forename: Robert
authors.initials: R
authors.lastname: Enns
authors.forename: Gail
authors.initials: G
authors.lastname: Robuck
authors.forename: Helen
authors.initials: H
authors.lastname: Stiffler
authors.forename: Paul
authors.initials: P
authors.lastname: Jowell
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000379:methods*; D018592:Cross-Over Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed