Endoscopic ultrasound versus CT scan for detection of the metastases to the liver: results of a prospective comparative study.
BACKGROUND
Computed tomography (CT) scan is a standard test for the detection of the liver metastases; however, metastases are often missed on the CT scan.


OBJECTIVE
To compare the accuracy of the endoscopic ultrasound (EUS)/endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with CT scan for detection of the liver metastases.


METHODS
Prospective study.


METHODS
Subjects with newly diagnosed tumors of the lung, pancreas, biliary tree, esophagus, stomach, and colon were enrolled.


METHODS
A CT scan and EUS examination of the liver was performed. EUS-FNA was performed on noncystic liver lesions.


RESULTS
One hundred thirty-two cases were enrolled. The presence of liver metastasis was established in 26 cases. The diagnostic accuracy of EUS/EUS-FNA and CT scan was 98% and 92%, respectively (P=0.0578). In comparison to CT scan, EUS detected significantly higher number of metastatic lesions in the liver (40 vs.19; P=0.008). CT scan detected lesions in liver that were too small to be characterized in 8 cases (malignant-3; benign-5). Of these, EUS-FNA correctly characterized the lesion to be malignant in 3/3 cases and benign in 4/5 cases. No complications were observed as a result of EUS-FNA.


CONCLUSIONS
Endoscopist was not blinded to the findings of the CT scan.


CONCLUSIONS
In comparison with the CT scan, there was trend in favor of EUS/EUS-FNA for the superior diagnostic accuracy. EUS was distinctly superior to the CT scan in detecting the number of metastatic lesions. EUS-FNA was also useful to identify the nature of lesions that were too small to be characterized on the CT scan.
Singh
Pankaj
P
Division of *Gastroenterology and Hepatology, Central Texas Veterans Health Care System, Texas A&MUniversity College Station, TX, USA. pankaj.singh@med.va.gov
Mukhopadhyay
Phalguni
P
Bhatt
Bankim
B
Patel
Tushar
T
Kiss
Alex
A
Gupta
Rahul
R
Bhat
Sanjay
S
Erickson
Richard A
RA
D000368:Aged; D044963:Biopsy, Fine-Needle; D004067:Digestive System Neoplasms / Q000473:pathology*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*