title: Diagnostic Performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) Based on Histopathology.
abstract: OBJECTIVE
  Studies correlating endoscopic ultrasound (EUS) with histopathology for chronic pancreatitis (CP) are limited by small sample size, and/or inclusion of many patients without CP, limiting applicability to patients with painful CP. The aim of this study was to assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP).
  
  
  METHODS
  Adult patients undergoing total pancreatectomy and islet autotransplantation (TPIAT) for NCCP, between 2008 and 2013, with EUS <1 year before surgery. Histology from resected pancreas at the time of TPIAT (from head, body, and tail) was graded by a GI pathologist blinded to the EUS features. A fibrosis score (FS) ≥2 was abnormal, and FS≥6 was considered severe fibrosis. A multivariate regression analysis for the EUS features predicting fibrosis, after taking age, sex, smoking, and body mass index into consideration, was performed. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation co-efficient (r) was calculated.
  
  
  RESULTS
  68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61%), specificity (75%), and accuracy (63%). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP.
  
  
  CONCLUSIONS
  Correlation between standard EUS features and histopathology is poor in NCCP. MPD irregularity is an independent predictor for NCCP.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Guru
authors.initials: G
authors.lastname: Trikudanathan
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Vega-Peralta
authors.affiliation: Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Malli
authors.affiliation: Division of Gastroenterology, St Louis University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Munigala
authors.affiliation: Department of Pathology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Yusheng
authors.initials: Y
authors.lastname: Han
authors.affiliation: The Schulze Diabetes Institute, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Melena
authors.initials: M
authors.lastname: Bellin
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Usman
authors.initials: U
authors.lastname: Barlass
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Ty
authors.initials: T
authors.lastname: Dunn
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pruett
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Beilman
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Arain
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Stuart K
authors.initials: SK
authors.lastname: Amateau
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Mallery
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Freeman
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Attam
mesh_terms: D000328:Adult; D019160:Endosonography; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D012680:Sensitivity and Specificity