title: Endoscopic ultrasound versus CT scan for detection of the metastases to the liver: results of a prospective comparative study.
abstract: 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.
authors.affiliation: Division of *Gastroenterology and Hepatology, Central Texas Veterans Health Care System, Texas A&MUniversity College Station, TX, USA. pankaj.singh@med.va.gov
authors.forename: Pankaj
authors.initials: P
authors.lastname: Singh
authors.forename: Phalguni
authors.initials: P
authors.lastname: Mukhopadhyay
authors.forename: Bankim
authors.initials: B
authors.lastname: Bhatt
authors.forename: Tushar
authors.initials: T
authors.lastname: Patel
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhat
authors.forename: Richard A
authors.initials: RA
authors.lastname: Erickson
mesh_terms: 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*