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Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer

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Abstract

Background

The optimal approach for detecting small pancreatic tumors is uncertain. We compared multidetector CT (MDCT) with follow-up endoscopic ultrasonography (EUS) without or with fine-needle aspiration (EUS-FNA) for diagnosing pancreatic cancer.

Methods

Patients with suspicion of pancreatic cancer who underwent dual-phase MDCT and follow-up EUS were retrospectively reviewed. This consisted of scoring MDCT scans independently by three radiologists on a 1–5 scale of certainty, determining whether a stent was present, scoring EUS reports regarding presence of a mass and analyzing EUS-FNA results.

Results

A total of 117 patients underwent MDCT and EUS. ROC values for MDCT were 0.85, 0.87, and 0.91. There was no significant difference in the accuracy of EUS and MDCT. Follow-up EUS (99%) was significantly more sensitive than MDCT (89% and 93%), as interpreted by two radiologists. Follow-up EUS was statistically significantly more sensitive than MDCT (96% vs. 70%) for one radiologist for tumors < 2 cm. Specificity of EUS was 50%, and sensitivity of EUS-FNA was 82%. Negative predictive value of EUS-FNA was significantly less in patients with (21%) than without (70%) biliary stents.

Conclusions

Follow-up EUS improves lesion detection over MDCT alone. Close follow-up/repeat biopsy should be considered if FNA is negative, but EUS is positive.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Eric P. Tamm, Evelyne M. Loyer, Silvana C. Faria & Chusilp Charnsangavej

  2. Department of Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Douglas B. Evans

  3. Oncologic Medicine, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Robert A. Wolff

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  1. Eric P. Tamm
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  2. Evelyne M. Loyer
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  3. Silvana C. Faria
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  4. Douglas B. Evans
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  5. Robert A. Wolff
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  6. Chusilp Charnsangavej
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Correspondence to Eric P. Tamm.

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Tamm, E.P., Loyer, E.M., Faria, S.C. et al. Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer. Abdom Imaging 32, 660–667 (2007). https://doi.org/10.1007/s00261-007-9298-x

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