Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer.
BACKGROUND
The optimal approach for detecting small pancreatic tumors is uncertain. We compared multidetector CT (MDCT) with follow-up endoscopic ultrasonography (EUS) without or with fine-needle aspiration (EUS-FNA) for diagnosing pancreatic cancer.


METHODS
Patients with suspicion of pancreatic cancer who underwent dual-phase MDCT and follow-up EUS were retrospectively reviewed. This consisted of scoring MDCT scans independently by three radiologists on a 1-5 scale of certainty, determining whether a stent was present, scoring EUS reports regarding presence of a mass and analyzing EUS-FNA results.


RESULTS
A total of 117 patients underwent MDCT and EUS. ROC values for MDCT were 0.85, 0.87, and 0.91. There was no significant difference in the accuracy of EUS and MDCT. Follow-up EUS (99%) was significantly more sensitive than MDCT (89% and 93%), as interpreted by two radiologists. Follow-up EUS was statistically significantly more sensitive than MDCT (96% vs. 70%) for one radiologist for tumors < 2 cm. Specificity of EUS was 50%, and sensitivity of EUS-FNA was 82%. Negative predictive value of EUS-FNA was significantly less in patients with (21%) than without (70%) biliary stents.


CONCLUSIONS
Follow-up EUS improves lesion detection over MDCT alone. Close follow-up/repeat biopsy should be considered if FNA is negative, but EUS is positive.
Tamm
Eric P
EP
Department of Diagnostic Radiology, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. etamm@di.mdacc.tmc.edu
Loyer
Evelyne M
EM
Faria
Silvana C
SC
Evans
Douglas B
DB
Wolff
Robert A
RA
Charnsangavej
Chusilp
C
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D012372:ROC Curve; D011871:Radiology / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*