Role of endoscopic ultrasound in staging and vascular assessment of pancreatic cancer

Abstract

Background: computed tomography (CT) of the abdomen with contrast is the gold standard method for the evaluation of pancreatic cancer concerning staging and vascular assessment. however, not all patients can be evaluated by contrast-enhanced CT abdomen as those with an allergy to the contrast agent, pregnancy, and renal impairment, in addition to hazards of radiation and non-availability of tissue sampling in CECT abdomen .so this study was designed to evaluate the diagnostic ability of Endoscopic Ultrasound for staging and vascular assessment of pancreatic cancer in comparison to CT abdomen with contrast. Method: fifty patients with cancer pancreas were evaluated by CECT and EUS as regard staging and vascular invasion. The vascular assessment was done by dividing the EUS findings into three types by the relationship between tumors and major vessels, type 1, clear invasion, encasement of the vessel by a tumor or tumor that contacts a vessel wall more than 180o; type2, Abutment, a tumor that contacts a vessel wall but less than 180o and type 3, clear non-invasion, the existence of distance between a tumor and a vessel. We regarded type 1 and type 2 as signs of vascular invasion and type 3 as a sign of vascular non-invasion, these findings were compared with the findings of the CECT abdomen. The endoscopist was blind to the CT result before the EUS examination. Result: as regards staging of pancreatic cancer EUS showed sensitivity, specificity, and accuracy of 100% for all. and as regard vascular invasion EUS showed sensitivity, specificity, and accuracy of 100%,95.93%, and 96% respectively for venous invasion and 95.65%,100%, and 99.5% for arterial invasion. Conclusion: EUS can evaluate staging and vascular invasion of pancreatic cancer with very high sensitivity, specificity, and accuracy to the extent it can replace CT in evaluation, with the superiority of EUS due to tissue sampling.