ENDOSCOPIC ULTRASONOGRAPHY IN THE DIAGNOSIS AND STAGING OF PANCREATICADENOCARCINOMA - RESULTS OF A PROSPECTIVE-STUDY WITH COMPARISON TO ULTRASONOGRAPHY AND CT SCAN

Endoscopic ultrasonography (EUS) was compared to ultrasonography (US) and CT scan (CT) in order to evaluate its role in the diagnosis and th e locoregional spread assessment of pancreatic cancer. Sixty-four pati ents suspected of pancreatic cancer were studied prospectively, and th e results of imaging techniques were compared to histology and surgica l exploration. There were 49 cases of pancreatic adenocarcinoma, 11 of pancreatitis, 2 of common bile duct carcinoma, 1 lymphoma and 1 hepat ocellular carcinoma with peripancreatic metastatic lymph nodes. EUS wa s significantly more accurate (91 %) than CT (66 %) and US (64 %) for diagnosis of pancreatic cancer. EUS was able to image all 7 cancers le ss than 25 mm in diameter, US and CT only one. There were 4 false posi tives with EUS which were all cases of pseudotumorous pancreatitis. Fo r detecting lymph node involvement, EUS was significantly more sensiti ve (62 %) and accurate (74 %) than US (8 % and 37 %) and CT (19 % and 42 %), respectively. Invaded lymph nodes adjacent to large tumors and micrometastatic involvement were responsible for this lack of sensitiv ity. EUS was significantly more sensitive (100 %) than CT (71 %) and U S (17 %) for detecting venous involvement. The specificity of EUS was lower (67 %) because of duodenal bulb stenosis and large tumors. In co nclusion, this prospective and comparative study confirms that EUS is an accurate tool for diagnosis and locoregional spread assessment of p ancreatic cancer when performed in a reference center. EUS is of parti cular interest for small tumors. However, EUS does not enable differen tiation of pseudotumorous pancreatitis from adenocarcinoma.