Radial endoscopic ultrasonography in the preoperative staging of pancreatic cancer.
BACKGROUND
Endoscopic ultrasonography (EUS) is a diagnostic method that aims to detect and stage tumors of the pancreas more accurately. It has a high predictive role regarding tumor resectability.


OBJECTIVE
The present paper aims to assess the diagnostic accuracy of radial EUS in the staging of pancreatic cancer as well as the role of EUS to predict tumor resectability.


METHODS
30 patients (22 males, 8 females, mean age 61 +/- 12 years) with pancreatic masses staged by both radial EUS and surgery (17 patients with intraoperative exploration and 13 with pathological examination of surgical specimens) and with histologically proved adenocarcinoma were included in the study. Surgical examination was indicated in patients with pancreatic masses evidenced by imaging methods other than EUS, without distant metastases proved preoperatively, and without taking into consideration the staging obtained by EUS. Resectability criteria for pancreatic tumors as assessed by EUS were invasion of superior mesenteric artery or invasion of celiac trunk.


RESULTS
The accuracy of EUS T staging was 86.6%, that of N staging was 93.3% while that of the vascular invasion was 80%. The accuracy of EUS for predicting tumor stage had a direct impact on the assessment of tumor resectability (83.3%, CI 95%: 81.5- 85.2). It had a sensitivity of 100%, specificity of 75%, PPV of 91.6% and NPV of 100%.


CONCLUSIONS
The radial EUS of the pancreas is an accurate method for tumor staging. For establishing tumor resectability, association with other imaging methods is advisable for arterial assessment.
Seicean
Andrada
A
3rd Medical Clinic, Croitorilor Str., 19-21 400162 Cluj-Napoca, Romania. andradaseicean@yahoo.com
Badea
Radu
R
Mocan
Teodora
T
Iancu
Cornel
C
Pop
Teodora
T
Seicean
Radu
R
Mo Scedil Teanu
Ofelia
O
B Abreve L Abreve
Ovidiu
O
Pascu
Oliviu
O
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019160:Endosonography; D006801:Humans; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D012680:Sensitivity and Specificity