Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT.

BACKGROUND

Diagnosis of pancreatic neoplasm is challenging in patients with inconclusive findings on pancreatic multidetector row CT (MDCT).

OBJECTIVE

To determine the diagnostic accuracy and to identify predictors of pancreatic neoplasm by EUS with FNA in this setting.

DESIGN

Retrospective chart review during the study period of January 2002 to December 2010.

SETTING

Tertiary referral center.

PATIENTS: Of the 1046 patients who underwent pancreatic EUS, 116 patients were selected because their clinical presentation was suspicious for pancreatic malignancy, but their MDCT findings were inconclusive.

INTERVENTION: EUS with FNA.

MAIN OUTCOME MEASUREMENTS: Diagnostic yield of malignancy and significance of clinical variables.

RESULTS

When surgical pathology or subsequent clinical course was used as the criterion standard, EUS with FNA had a sensitivity, specificity, positive predictive value, and accuracy of 87.3%, 98.3%, 98.5%, and 92.1%, respectively, in diagnosing a pancreatic neoplasm that was indeterminate on MDCT. Factors significantly associated with EUS detection of pancreatic ductal adenocarcinoma were total bilirubin level greater than 2 mg/dL (P < .001), CT finding of pancreatic duct dilation (P < .001), bile duct stricture (P < .001), and tumor size 1.5 cm or larger detected by EUS (P = .004). Among them, pancreatic duct dilation on CT (odds ratio 4.10; 95% confidence interval, 1.52-11.05), and tumor size 1.5 cm or larger detected by EUS (odds ratio 8.46; 95% confidence interval, 2.02-35.45) were independent risk factors.

LIMITATIONS: Retrospective design and patient referral bias.

CONCLUSIONS

When MDCT is indeterminate, EUS is a highly sensitive and accurate modality for the detection of pancreatic neoplasm, especially when the tumor is smaller than 2.0 cm.