title: The role of routine preoperative EUS when performed after contrast enhanced CT in the diagnostic work-up in patients suspected of pancreatic or periampullary cancer.
abstract: BACKGROUND
  In patients suspected of pancreatic or periampullary cancer, abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic modality. A supplementary endoscopic ultrasonography (EUS) is often performed, although there is only limited evidence of its additional diagnostic value. The aim of the study is to evaluate the additional diagnostic value of EUS over CT in deciding on exploratory laparotomy in patients suspected of pancreatic or periampullary cancer.
  
  
  METHODS
  We retrospectively analyzed 86 consecutive patients who routinely underwent CT and EUS before exploratory laparotomy with or without pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma between 2007 and 2010. Primary outcomes were visibility of a mass, resectability on CT/EUS and resection with curative intent.
  
  
  RESULTS
  A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 (16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these patients. A malignant lesion was histological proven in 11/12 (92%) of these patients. Overall, resectability was accurately predicted by CT and EUS in 90% (77/86) and 84% (72/86), respectively.
  
  
  CONCLUSIONS
  In patients with a visible mass on CT, suspected for pancreatic or periampullary cancer, EUS has no additional diagnostic value, does not influence the decision to perform laparotomy and should therefore not be performed routinely. In patients without a visible mass on CT, EUS is useful to confirm the presence of a tumor.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands. Electronic address: kasia_cieslak@hotmail.com.
authors.forename: Kasia P
authors.initials: KP
authors.lastname: Cieslak
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.affiliation: Department of Radiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Maarten S
authors.initials: MS
authors.lastname: van Leeuwen
authors.affiliation: Department of Pathology, University Medical Center Utrecht, The Netherlands.
authors.forename: Fibo J
authors.initials: FJ
authors.lastname: ten Kate
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: CT; EUS; Pancreatic and periampullary cancer; Preoperative diagnostic assessment