title: Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: a tertiary oncology center experience.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma (PDAC), pancreatic neuroendocrine tumors (pNET), and metastatic lesions (pMET) are the most common neoplastic solid pancreatic lesions (SPLs). Early diagnosis enables prompt treatment.
  
  
  OBJECTIVE
  To identify factors differentiating PDAC from non-PDAC lesions and assess the accuracy of EUS-guided FNA.
  
  
  METHODS
  Retrospective tertiary center.
  
  
  METHODS
  Consecutive patients referred for EUS evaluation of SPLs from 2004 to 2011.
  
  
  METHODS
  Pretest (preceding EUS-guided FNA [EUS-FNA]) predictors of PDAC among neoplastic SPLs and accuracy of EUS-FNA.
  
  
  RESULTS
  A total of 1333 EUS scans with 1108 EUS-FNAs were performed for pancreatic lesions. Of the 672 patients with neoplastic SPLs, 528 had PDAC and 144 non-PDAC. The sensitivity, specificity, positive predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 97.3%, 99.3%, 99.8%, and 97.8%, respectively. Years of EUS experience significantly correlated with fewer needle passes (Rs = -0.18, P < .001). Controlling for all potential confounders, multivariable regression analysis demonstrated that patients with PDAC compared with pNETs and pMETs were older (odds ratio [OR] 4.42; 95% confidence interval [CI], 2.1-9.5; P < .001), had weight loss (OR 3.0; 95% CI, 1.6-5.4; P < .001), hyperbilirubinemia (OR 3.7; 95% CI, 1.8-7.5; P < .001), elevated CA19-9 (OR 6.9; 95% CI, 2.4-20.3; P < .01), evidence of arterial invasion (OR 6.5; 95% CI, 2.7-15.4; P < .001), and PD dilation (OR 3.3; 95% CI, 1.8-5.9; P < .001).
  
  
  CONCLUSIONS
  Retrospective design, single center.
  
  
  CONCLUSIONS
  When evaluating neoplastic SPLs, demographic, clinical, laboratory, and imaging characteristics can reliably discern and suggest PDAC. In addition, EUS-FNA is exceedingly sensitive and specific for PDAC.
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, Ohio, USA.
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, Ohio, USA.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Bhattacharya
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Harshad
authors.initials: H
authors.lastname: Ladha
authors.affiliation: Department of Biostatistics, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Porter
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Amanpal
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies