title: Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT.
abstract: BACKGROUND
  Diagnosis of pancreatic neoplasm is challenging in patients with inconclusive findings on pancreatic multidetector row CT (MDCT).
  
  
  OBJECTIVE
  To determine the diagnostic accuracy and to identify predictors of pancreatic neoplasm by EUS with FNA in this setting.
  
  
  METHODS
  Retrospective chart review during the study period of January 2002 to December 2010.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Of the 1046 patients who underwent pancreatic EUS, 116 patients were selected because their clinical presentation was suspicious for pancreatic malignancy, but their MDCT findings were inconclusive.
  
  
  METHODS
  EUS with FNA.
  
  
  METHODS
  Diagnostic yield of malignancy and significance of clinical variables.
  
  
  RESULTS
  When surgical pathology or subsequent clinical course was used as the criterion standard, EUS with FNA had a sensitivity, specificity, positive predictive value, and accuracy of 87.3%, 98.3%, 98.5%, and 92.1%, respectively, in diagnosing a pancreatic neoplasm that was indeterminate on MDCT. Factors significantly associated with EUS detection of pancreatic ductal adenocarcinoma were total bilirubin level greater than 2 mg/dL (P < .001), CT finding of pancreatic duct dilation (P < .001), bile duct stricture (P < .001), and tumor size 1.5 cm or larger detected by EUS (P = .004). Among them, pancreatic duct dilation on CT (odds ratio 4.10; 95% confidence interval, 1.52-11.05), and tumor size 1.5 cm or larger detected by EUS (odds ratio 8.46; 95% confidence interval, 2.02-35.45) were independent risk factors.
  
  
  CONCLUSIONS
  Retrospective design and patient referral bias.
  
  
  CONCLUSIONS
  When MDCT is indeterminate, EUS is a highly sensitive and accurate modality for the detection of pancreatic neoplasm, especially when the tumor is smaller than 2.0 cm.
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Alexander
authors.initials: A
authors.lastname: Shpaner
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Eric P
authors.initials: EP
authors.lastname: Tamm
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D010180:Pancreatectomy / Q000379:methods / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome