Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Endoscopic ultrasound highly accurate in evaluating ambiguous radiographic findings of the pancreas

01.09.2008
Researchers from St. Louis University School of Medicine in Missouri report that EUS and EUS-FNA is 99.1 percent accurate in diagnosing pancreatic neoplasms (abnormal growths or tumors) in patients who were referred for endoscopic ultrasound (EUS) because of CT and/or MRI reports of two common, though somewhat ambiguous findings - enlargement of head of pancreas (HOP) or dilation of the pancreatic duct (PD).

The study appears in the August issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Occasionally, patients who are asymptomatic or who have nonspecific symptoms, such as weight loss and abdominal pain, have subtle abnormal or incidental findings on CT and/or MRI that raise suspicion for pancreatic cancer. These tests have relatively low specificity (ability to definitively discern between various diagnoses) in this setting. Perhaps due to a concern of missing early, small pancreatic cancers, physicians who perform EUS are increasingly referred patients with subtle CT or MRI findings such as ''enlarged pancreatic head" or ''dilation of the pancreatic duct (widening of the main duct coursing through the pancreas)."

Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) have become a valuable tool in the diagnostic evaluation of patients with suspected pancreatic cancer. This technique allows for detection and possible needle biopsy of small pancreatic tumors even before they can be visualized as a discrete mass with CT or MRI. According to the American Cancer Society, deaths from pancreatic cancer in 2008 are estimated to be approximately 34,000.

"Often, patients with these radiologic findings are referred for EUS in lieu of waiting for repeated imaging. Our study looked to determine the performance characteristics of EUS and/or EUS with FNA in diagnosing a pancreatic tumor in this patient population," said study lead author Banke Agarwal, MD, Saint Louis University School of Medicine. "We found that EUS and/or an EUS-FNA for diagnosing a pancreatic neoplasm was 99.1 percent accurate with 88.8 percent sensitivity and 100 percent specificity."

Endoscopic ultrasound consists of a flexible endoscope which has a small ultrasound device built into the end. The ultrasound component produces sound waves that create visual images of the digestive tract which extend beyond the inner surface lining. EUS can be used to evaluate an abnormality below the surface such as a growth that was detected at a prior endoscopy or by X-ray. EUS can also be used to diagnose diseases of the pancreas, bile duct, and gallbladder when other tests are inconclusive, and can be used to determine the stage of cancers. Tissue samples, using a fine needle aspiration technique (FNA), can be obtained in real time with EUS guidance should an abnormality be seen.

Patients and Methods

This study was a retrospective analysis of 110 patients, mean age 60.3 years, from a prospectively maintained database of patients who underwent an EUS and/or EUS-FNA at St. Louis University Hospital between March 2002 and March 2006 for suspected pancreatic cancer based on an abnormal CT and/or MRI who were reported as having an enlarged HOP or dilation of the PD (with or without a dilated common bile duct). An EUS examination was initially performed by using a radial echoendoscope. Whenever a suspicious "mass" was identified on radial EUS, an FNA was performed using a linear echoendoscope. Fine needle aspirates were submitted for cytology and biochemical analysis. A final diagnosis was based on definitive cytology, surgical pathology or clinical follow up of 12 months or more (median follow up was 16 months).

Results

Researchers found that 6 percent of patients referred because of an enlarged HOP on a CT and/or an MRI and 11.5 percent of patients referred for a dilated PD had a pancreatic neoplasm. The diagnostic accuracy of an EUS and/or EUS-FNA in these patients for diagnosing a pancreatic neoplasm was 99.1 percent. Furthermore, no patient with enlarged HOP, but without a mass at EUS, went on to develop cancer.

In conclusion, researchers found that a pancreatic neoplasm is present in a clinically significant number of patients with an ''enlarged HOP'' or "dilated PD" detected on a CT and/or MRI performed for evaluation of nonspecific symptoms, such as abdominal pain or weight loss. They also observed that an EUS and/or EUS-FNA are highly accurate for the diagnosis of pancreatic neoplasm in these patients. Based on these data, researchers recommend that an EUS and/or EUS-FNA be considered as the logical next test in the evaluation of patients with such imaging findings.

Anne Brownsey | EurekAlert!
Further information:
http://www.asge.org
http://www.screen4coloncancer.org

More articles from Studies and Analyses:

nachricht The Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

nachricht A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Quantum optical sensor for the first time tested in space – with a laser system from Berlin

For the first time ever, a cloud of ultra-cold atoms has been successfully created in space on board of a sounding rocket. The MAIUS mission demonstrates that quantum optical sensors can be operated even in harsh environments like space – a prerequi-site for finding answers to the most challenging questions of fundamental physics and an important innovation driver for everyday applications.

According to Albert Einstein's Equivalence Principle, all bodies are accelerated at the same rate by the Earth's gravity, regardless of their properties. This...

Im Focus: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

New technology for mass-production of complex molded composite components

23.01.2017 | Process Engineering

Quantum optical sensor for the first time tested in space – with a laser system from Berlin

23.01.2017 | Physics and Astronomy

The interactome of infected neural cells reveals new therapeutic targets for Zika

23.01.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>