title: Role of endoscopic ultrasonography in patients suspected of pancreatic cancer with negative helical MDCT scan.
abstract: BACKGROUND
  In some patients suspected of pancreatic cancer, no mass can be detected by multidetector computed tomography (MDCT) scan as the cause of biliary obstruction.
  
  
  METHODS
  All patients suspected of pancreatic cancer between January 2007 and 2009 with a negative MDCT were identified from a database.
  
  
  RESULTS
  MDCT was performed for suspected pancreatic cancer in 290 patients, and in 258 a pancreatic mass was found. MDCT failed to establish a diagnosis in 32 patients (11%). In 23 patients (74%) with complete endoscopic ultrasonography (EUS), the cause of the obstruction was correctly diagnosed. A mass in the pancreatic head was found in 15 patients; 13 patients had a malignant tumor, and 2 patients a benign cause of obstruction. Further, EUS diagnosed 3 patients with a superficial adenoma of the papilla and 8 patients with a benign cause of the obstruction. In 5 patients EUS could not detect the cause of obstruction but finally a pancreatic malignancy was diagnosed. The positive predictive value of EUS was 86% and the negative predictive value 63%. Accuracy of MDCT and EUS decreased in the presence of pancreatitis or a biliary endoprosthesis.
  
  
  CONCLUSIONS
  In patients suspected of pancreatic cancer in whom MDCT fails to demonstrate the cause of obstructive jaundice, EUS identifies 74% of the underlying diseases correctly.
authors.affiliation: Department of Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
authors.forename: Eva B
authors.initials: EB
authors.lastname: Deerenberg
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: John J
authors.initials: JJ
authors.lastname: Hermans
authors.forename: Sjam
authors.initials: S
authors.lastname: Ganesh
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.forename: Casper H J
authors.initials: CH
authors.lastname: van Eijck
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging*; D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000209:etiology; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies