Background: The aims of this study were to assess the role of endoscopic ultrasound (EUS) in the evaluation of adenocarcinoma of the head of the pancreas in cases of diagnostic dilemma and to determine the strength of agreement between perceived pre-operative stage as determined by computerised tomography (CT) and EUS and histopathological stage. Methods: Patients undergoing pancreatic EUS were identified from a computerised radiology database. The strengths of agreement between the radiological and histopathological stages were determined by the weighted kappa (Kw) statistic. Results: Fifty-eight patients were identified. Of 37 patients with a pancreatic head mass on prior imaging, 32 had a diagnosis of adenocarcinoma confirmed by EUS, as did 11 of 21 patients with suspicious pancreatic head lesions. Twenty-five of 43 patients were deemed to have resectable carcinomas, and 2 patients had resectable mucinous lesions. In comparing CT and EUS in the 25 patients undergoing resection, the Kw for T and N stages was 0.250 (p = 0.05) and –0.080 (p = 0.288), respectively, for CT, compared with 0.738 (p = 0.0001) and 0.606 (p = 0.0001), respectively, for EUS. Conclusions: EUS was effective in assessing the resectability of pancreatic head adenocarcinomas. Furthermore, EUS held a significant 3-fold advantage over CT with regard to T stage and an even higher significant advantage with regard to N stage.

Keywords:
Pancreatic cancer, Endoscopic ultrasound, Computed tomography, Staging
1.
Wood HE, Gupta S, Kang JY, Quinn MJ, Maxwell JD, Mudan S, Majeed A: Pancreatic cancer in England and Wales 1975–2000: patterns and trends in incidence, survival and mortality. Aliment Pharmacol Ther 2006;23:1205–1214.
2.
Wagner M, Redaelli C, Leitz M, Seiler CA, Friess H, Büchler MW: Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594.
3.
Cameron JL, Riall TS, Coleman J, Belcher KA: One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15.
4.
Cress RD, Yin D, Clarke L, Bold R, Holly EA: Survival among patients with adenocarcinoma of the pancreas: a population-based study (United States). Cancer Causes Control 2006;7;403–409.
5.
Pancreatic Section of the British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Royal College of Pathologists, Special Interest Group for Gastro-Intestinal Radiology: Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 2005;54(suppl 1):1–16.
6.
Puli SR, Singh S, Hagedorn CH, Reddy J, Olyaee M: Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc 2007;65:788–797.
7.
DeWitt J, Deveraux BM, Lehman GA, Sherman S, Imperiale TF: Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol 2006;4:717–725.
8.
Klapman JB, Chang KJ, Lee JG, Nguyen P: Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 2005;100:2658–2661.
9.
Manzia TM, Toti L, Lenci I, Attia M, Tariciotti L, Bramhall SR, et al: Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration. Ann R Coll Surg Engl 2010;92:295–301.
10.
Taylor AM, Roberts SA, Manson JM: Experience with laparoscopic ultrasonography for defining tumour resectability in carcinoma of the pancreatic head and periampullary region. Br J Surg 2001;88:1077–1083.
11.
Ho JM, Eysselein VE, Stabile BE: The value of endoscopic ultrasonography in predicting resectability and margins of periampullary tumors. Am Surg 2008;74:1026–1029.
12.
Altman DG: Practical Statistics for Medical Research. London, Chapman & Hall, 1991.
13.
Buscail L, Faure P, Bournet B, Selves J, Escourrou J: Interventional endoscopic ultrasound in pancreatic diseases. Pancreatology 2006;6:7–16.
14.
García JI, Noia JL, Muñoz JED: Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. Rev Esp Enferm Dig 2009;101:631–638.
15.
Mansfield SD, Scott J, Oppong K, Richardson DL, Sen G, Jaques BC, et al: Comparison of multislice computed tomography and endoscopic ultrasonography with operative and histological findings in suspected pancreatic and periampullary malignancy. Br J Surg 2008;95:1512–1520.
16.
Itoi T, Itokawa F, Sofuni A, Nakamura K, Tsuchida A, Yamao K, et al: Puncture of solid pancreatic tumors guided by endoscopic ultrasonography: a pilot study series comparing Trucut and 19-gague and 22-gague aspiration needles. Endoscopy 2005;37:362–366.
17.
Shah SM, Ribeiro A, Levi J, Jorda M, Rocha-Lima C, Sleeman D, et al: EUS-guided fine needle aspiration with and without biopsy of pancreatic masses. JOP 2008;10:422–430.
18.
Katz MHG, Pisters PWT, Evans DB, Sun CC, Lee JE, Fleming JB, et al: Borderline resectable pancreatic cancer: the importance of this emerging state of disease. J Am Coll Surg 2008;206:833–848.
19.
McClaine RJ, Lowy AM, Sussman JJ, Schmulewitz N, Grisell DL, Ahmad SA: Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer. HPB (Oxford) 2010;12:73–79.
20.
Stokes JB, Nolan NJ, Stelow EB, Walters DM, Weiss GR, de Lange EE, et al: Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol 2011;18:619–627.
21.
Patel M, Hoffe S, Malafa M, Hodul P, Klapman J, Centeno B, et al: Neoadjuvant GTX chemotherapy and IMRT-based chemoradiation for borderline resectable pancreatic cancer. J Surg Oncol 2011;104:155–161.
22.
Virtue MA, Mallery S, Li R, Sielaff TD: Clinical utility of endoscopic ultrasound in solid pancreatic mass lesions deemed resectable by computer tomography. JOP 2008;9:167–171.
23.
De la Fuente SG, Ceppa EP, Reddy SK, Clary BM, Tyler DS, Pappas TN: Incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA). J Gastrointest Surg 2010;14:1139–1142.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.