title: Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma.
abstract: Endoscopic ultrasound (EUS) is used for pancreatic adenocarcinoma staging and obtaining a tissue diagnosis. The objective was to determine patterns of preoperative EUS and the impact on downstream treatment.
  
  
  
  The Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database was used to identify patients with pancreatic adenocarcinoma. The staging period was the first staging procedure within 6 months of surgery until surgery. Logistic regression was used to determine factors associated with preoperative EUS. The main outcome was EUS in the staging period, with secondary outcomes including number of staging tests and time to surgery.
  
  
  
  2782 patients were included, 56% were treated at an academic hospital (n = 1563). 1204 patients underwent EUS (43.3%). The factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and a NCI or academic hospital (all p < 0.0001). EUS was associated with a longer time to surgery (17.8 days; p < 0.0001), and a higher number of staging tests (40 tests/100 patients; p < 0.0001).
  
  
  
  Factors most associated with receipt of EUS are geographic, temporal, and institutional, rather than clinical/disease factors. EUS is associated with a longer time to surgery and more preoperative testing, and additional study is needed to determine if EUS is overused.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Schmocker
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Vanness
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Havlena
authors.affiliation: Department of Medicine, Division of Oncology, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Noelle K
authors.initials: NK
authors.lastname: LoConte
authors.affiliation: Department of Medicine, Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Weiss
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, USA. Electronic address: winslow@surgery.wisc.edu.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D016017:Odds Ratio; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors; D061665:Time-to-Treatment; D014481:United States