Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma

Howard, Thomas J.; Chin, Anthony C.; Streib, Erik W.; Kopecky, Kenyon K.; Wiebke, Eric A.

doi:10.1016/s0002-9610(97)00132-3

Cited by 108 publications

(75 citation statements)

References 23 publications

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“…Several reports have described that this modality can be used to diagnose early pancreatic cancers that cannot be recognized by CT (20)(21)(22)(23)(24)(25)(26). We suggest that EUS should be selected to diagnose pancreatic cancer at an early stage in patients with acute pancreatitis.…”

Section: Discussionmentioning

confidence: 94%

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

2015

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Objective The aims of this study were to assess the incidence of pancreatic cancer and the contributing factors for the diagnosis of tumors in patients with acute pancreatitis and to gain insight into how patients with acute pancreatitis should be followed up. Methods Using the electronic medical database of Shizuoka General Hospital, 177 patients admitted for acute pancreatitis in the past 6 years were evaluated retrospectively for pancreatic cancer. Results Twelve patients (6.8%) were newly diagnosed with pancreatic cancer. During the first hospitalization, 5 patients (41.7%) with a detected pancreatic mass underwent surgical treatment: the final tumor stages were IA, IIA, and IIB in 1, 2, and 2 patients, respectively. In 7 patients (58.3%) without a detected pancreatic mass at the first admission, a pancreatic mass was recognized on follow-up computed tomography (CT) in 2 patients with main pancreatic duct (MPD) dilatation, and 1 patient with recurrent acute pancreatitis. The tumor stages were IA, IIA, and IA, respectively. Among the remaining 4 patients without follow-up, the tumor stage was IV. The patient gender, age, MPD dilatation, tumor marker, and serum amylase level were not significantly associated with pancreatic cancer. The detection of a pancreatic mass on CT led to the diagnosis of pancreatic cancer. Conclusion Acute pancreatitis should be considered as a possible diagnostic indicator of pancreatic cancer. Various factors associated with acute pancreatitis and pancreatic cancer were not predictive of a diagnosis of pancreatic cancer. Only the detection of a pancreatic mass led to the early diagnosis of pancreatic cancer. Patients hospitalized for acute pancreatitis should be followed up with a diagnostic imaging modality.

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Section: Discussionmentioning

confidence: 94%

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

2015

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“…Twenty-two papers (10%) matched the selection criteria while the remainder (197, 90%) were excluded [2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . Seventeen articles were prospective [2,[4][5][6][9][10][11][12][13][14][15]18,[20][21][22][23][24] and five retrospective [7,8,16,17,19] . In all studies radiological findings where compared with both intraoperative findings and final histopathological analysis that were considered gold-standards of comparison.…”

Section: Resultsmentioning

confidence: 99%

“…The sensitivity of EUS for diagnosing the primary tumour has been reported in thirteen studies (Table 2) [4,6,7,[9][10][11][12][13]15,16,18,19,22] and the range varied between 92% and 100% [9,10,15,16,22] . The overall sensitivity estimated by the sum of the total true positives / total number of patients was 97% (474/488) (Table 6) [4,6,7,[9][10][11][12][13]15,16,18,19,22] .…”

Section: Tumour Diagnosis: Eusmentioning

confidence: 96%

“…Rivadeneira DE [16] Midwinter MJ [13] Shoup M [19] Maluf-Filho F [11] Cannon ME [5] Mukai H [15] Mukai H [15] Schwarz M [18] Skordilis P [20] Mansfield SD [12] Chen CH [6] Tomazic A [21] Chen CH [7] Brugge WR [4] Ho JM [8] Howard TJ [9] Tio TL [2] Zhang QL [23] Zhang QL [23] Rosch T [17] Mitake M [14] Kubo H [10] Yasuda K [22] Tierney WM [24] Recruitment period 1996-2000 1996-1998 1996-1998 1997-1999 1994-1997 1984-1991 1984-1991 1996-1997 1993-2000 2002-2004 1996-1999 -1998-2006 1996-2007 1993-1996 1987-1988 1989-1992 1989-1992 1991-1995 1985-1988 1988-1997 1982-1987 1996-1999 Type of study [15] and Zhang [23] present results for ampullary cancers and common bile duct cancers separated, for this reason they are reported in two separated rows each. Table 2 Tumour detection rate.…”

Section: Studymentioning

confidence: 99%

“…Yasuda K [22] Mukai H (Ampullary) [15] Mukai H (CBD) [15] Tio TL [2] Kubo H [10] Zhang QL (Ampullary [23] Zhang QL (CBD) [23] Brugge WR [4] Howard TJ [9] Skordilis P [20] Cannon ME [5] Schwarz M [18] Midwinter MJ [13] Shoup M [19] Chen CH [6] Rivadeneira DE [16] Maluf-Filho F [11] Chen CH [7] Mansfield SD [12] Yasuda K [22] Mukai H (Ampullary) [15] Mukai H (CBD) [15] Brugge WR [4] Howard T [9] Schwarz M [18] Midwinter MJ [13] Shoup M [19] Chen CH (2001) [6] Rivadeneira DE [16] Maluf-Filho F [11] Chen CH [7] Mansfield SD [12] Imaging …”

Section: Studymentioning

confidence: 99%

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The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

Saad

Gravante

Andrew

et al. 2015

Journal of Gastroenterology and Hepatology Research

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Periampullary carcinoma has a better prognosis than pancreatic adenocarcinoma. Hence accurate pre -operative staging is essential for avoiding surgical exploration for unresectable tumours. At the same time, operable cases should not be denied curative surgery based on false positive imaging. Hence it is essential that the imaging should have a high positive predictive value. This article makes a case for the utility of EUS in the accurate diagnosis of periampullary cancer, the detection of lymph node metastases and invasion of the Portal/Superior Mesenteric vein as compared to CT scanning. Electronic search of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases was performed from 1982 to May 2009 to identify relevant studies. Articles meeting the criteria were retrieved and studied according to a standard proforma. Data were extracted from the articles into an Excel database and compared. The search revealed 211 published articles. Twenty-one papers matched the selection criteria. Sixteen articles were prospective and five retrospective. The data compared included local staging of the tumour, lymph node and venous involvement. CT scanning remains the initial investigation of choice in the diagnosis and staging of periampullary tumours but EUS might be superior for overall detection of lesions, especially those smaller than 2 cm. Although CT remains the investigation of choice, it is essential that EUS is performed by experienced operators and used when the clinical suspicion is high and CT fails to demonstrate a mass. This could increase the number of early lesions detected and improve the overall prognosis.

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Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

Suits

Frazee²,

Erickson³

1999

Arch Surg

123

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Hypothesis: Endoscopic ultrasound (EUS) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are accurate for the preoperative staging of pancreatic ductal carcinoma.Design: Retrospective medical record review.Patients: A prospective registry of 98 patients having EUS-FNA for peripancreatic masses from April 1994 to April 1998 was analyzed.Main Outcome Measure: The accuracy of EUS-FNA for preoperative diagnosis and staging of peripancreatic neoplasms.Results: Ninety-eight patients, aged 41 to 91 years (mean age, 67 years) with peripancreatic masses were evaluated by EUS-FNA. All patients had initial computed tomography scanning with a mass seen in 49 patients, "fullness" to the pancreas in 28 patients, and no mass seen in 21 pa-tients. Evaluation with EUS-FNA revealed 22 benign lesions, 18 T2 masses, 37 T3 masses, 1 T4 mass, and 20 masses representing nonpancreatic tumors. Results of EUS-FNA of adjacent lymph nodes were positive in 27 patients. Twenty-seven patients had surgical resection or palliation permitting operative and pathologic staging. On comparison of EUS-FNA staging with surgical staging, 12 patients were the same stage, 14 patients were upstaged, and 1 patient was downstaged. The remaining patients who did not have surgery have been followed up for a mean of 15 months. Overall accuracy of EUS-FNA for differentiating benign from malignant masses was 96%.Conclusions: Endoscopic ultrasound-guided fine needle aspiration is a useful technique for the evaluation of pancreatic masses. It is highly accurate for differentiating between benign and malignant lesions and for predicting T stage, but is limited for predicting nodal status.

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Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma

Cited by 108 publications

References 23 publications

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

Acute Pancreatitis as a Possible Indicator of Pancreatic Cancer: The Importance of Mass Detection

The Difference Between EUS & CT Scan in Diagnosing and Staging Peri Ampullary Tumours: An evidence-based approach

Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

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