EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct

Agarwal, Banke; Krishna, Naveen B.; LaBundy, Jennifer; Safdar, Rizwan; Akduman, Ece Isin

doi:10.1016/j.gie.2008.01.026

Cited by 67 publications

(59 citation statements)

References 15 publications

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“…In this study, routine cytology had sensitivity of 41%, which is much lower than previously reported (usual range 70% to 90% [2][3][4][5][6][7][8][9][10][11][12][13][14] ). This was due to higher prevalence of indeterminate cytology at 46%, versus 4% to 26% reported in other studies [2][3][4][5][6][7][8][9][10][11][12][13][14] . The discrepancy is possibly due to instances of differing cytologic criteria having been applied to different patient populations.…”

Section: Discussioncontrasting

confidence: 72%

“…The overall 5-year survival rate is less than 5%, although early detection and curative resection can improve the survival rate to 20% [1] . Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has high specificity for malignancy in a solid pancreatic lesion, but sensitivity varies from 70% to 90% [2][3][4][5][6][7][8][9][10][11][12][13][14] . This is due to suboptimal sampling and cases of indeterminate cytology.…”

Section: Introductionmentioning

confidence: 99%

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Staining for p53 and Ki-67 increases the sensitivity of EUS-FNA to detect pancreatic malignancy

Jahng

Reicher²,

Chung³

et al. 2010

WJGE

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AIM:To investigate whether tumor marker staining can improve the sensitivity of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to diagnose pancreatic malignancy. METHODS:Patients who underwent EUS-FNA were retrospectively identified. Each EUS-FNA specimen was evaluated by routine cytology and stained for tumor markers p53, Ki-67, carcinoembryonic antigen (CEA) and CA19-9. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (PLR and NLR) were calculated in order to evaluate the performance of each test to detect malignancy. RESULTS:Sixty-one specimens had complete sets of stains, yielding 49 and 12 specimens from pancreatic adenocarcinomas and benign pancreatic lesions due to pancreatitis, respectively. Cytology alone had sensitivity and specificity of 41% and 100% to detect malignancy, respectively. In 46% of the specimens, routine cytology alone was deemed indeterminate. The addition of either p53 or Ki-67 increased the sensitivity to 51% and 53%, respectively, with perfect specificity, PPV and PLR (100%, 100% and infinite). Both stains in combination increased the sensitivity to 57%. While additional staining with CEA and CA19-9 further increased the sensitivity to 86%, the specificity, PPV and PLR were significantly reduced (at minimum 42%, 84% and 1, respectively). Markers in all combinations performed poorly as a negative test (NPV 26% to 47%, and NLR 0.27 and 0.70). CONCLUSION: Immunohistochemical staining for p53and Ki-67 can improve the sensitivity of EUS-FNA to diagnose pancreatic adenocarcinoma.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Staining for p53 and Ki-67 increases the sensitivity of EUS-FNA to detect pancreatic malignancy

Jahng

Reicher²,

Chung³

et al. 2010

WJGE

View full text Add to dashboard Cite

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“…Agarwal et al 13 reported that some patients with a dilated pancreatic duct had an underlying malignancy. We found that 6% of patients had a pancreatic mass, 5% had an intraductal papillary mucinous neoplasm and 2% had ampullary tumors.…”

Section: Discussionmentioning

confidence: 99%

“…We found that 6% of patients had a pancreatic mass, 5% had an intraductal papillary mucinous neoplasm and 2% had ampullary tumors. Agarwal et al 13 reported 11.5% of patients with a dilated PD had an underlying pancreatic malignancy and that 33.3% of patients with a dilated PD with an abrupt cutoff had a pancreatic malignancy. EUS has already been shown to be very effective in diagnosing pancreatic adenocarcinoma and pancreatic cystic neoplasms.…”

Section: Discussionmentioning

confidence: 99%

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Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Carriere¹,

Conway²,

Evans³

et al. 2012

jig

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Background:Patients with dilated common bile duct (CBD) (>7mm) and/or pancreatic duct (PD) on abdominal imaging are often referred for endoscopic ultrasound (EUS). In many cases, the EUS shows no obvious etiology for the dilated ducts. Objective: Find clinical factors that may predict which patients are more likely to have positive findings on EUS to explain the etiologies for the dilated ducts. Design: Retrospective database analysis. Setting: Tertiary-care university hospital. Patients: Patients referred for EUS for dilated CBD and/or PD from January 2004 to February 2010 were included in this study. Only patients without an obvious etiology for the dilated ducts on abdominal imaging were included. Interventions: An EUS was performed by using either a radial echoendoscope or a linear endoscope to evaluate the common bile duct and/or the pancreatic duct. When appropriate fine needle aspiration of the mass or cyst was performed. Main Outcome Measurements: The characteristics of patients who had positive findings on EUS to explain the etiology of their dilated PD and/or CBD. Results: A total of 140 patients were included in the study with a mean age of 64 years, 51 (36%) male and 115 (82%) white. The majority of our patients had a presenting symptom of abdominal pain 105 (75%). 49 (36%) had elevated AST or ALT, 25 (8%) had an elevated bilirubin and 13 (23%) had an elevated lipase. EUS findings explained the dilated ducts in 54 (39%) of our patients, most common diagnoses included: CBD stone in 11 (8%), non-calcific chronic pancreatitis in 9 (6%), pancreatic mass in 8 (6%), IPMN in 7 (5%). On bivarate analysis patients who were older (p = 0.006), male (p = 0.001), had elevated LFTs (p = <0.001), had elevated lipase (p = 0.021) or had dilated CBD and PD (p = 0.007) were more likely to have an etiology for their dilated duct(s) discovered on EUS. Limitations: A retrospective study with a small number of patients. Conclusion: Older patients, males and those patients presenting with concurrent elevations in the AST/ALT and/or lipase were more likely to have an underlying etiology discovered on EUS. Furthermore, EUS may detect an undiagnosed pancreatic malignancy in patients presenting with unexplained duct dilation.

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Imaging modalities for characterising focal pancreatic lesions

Best

Rawji

Pereira

et al. 2017

Cochrane Database of Systematic Reviews

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EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct

Cited by 67 publications

References 15 publications

Staining for p53 and Ki-67 increases the sensitivity of EUS-FNA to detect pancreatic malignancy

Staining for p53 and Ki-67 increases the sensitivity of EUS-FNA to detect pancreatic malignancy

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

Imaging modalities for characterising focal pancreatic lesions

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