Preoperative evaluation of periampullary tumors by endoscopic sonography, transabdominal sonography, and computed tomography

Purpose. The purpose of this retrospective study was to compare the sensiti vity of endoscopic sonography (EUS), transabdominal sonography (US), and CT in the detection of, local staging of, and prediction of vascular involvem ent by or distant metastasis from periampullary tumors. Methods. Seventy-four consecutive patients with presumed periampullary tumo rs were evaluated by EUS, US, and CT during a 3.25-year period. The local s taging accuracy of the modalities was assessed in the 36 patients with soli d tumors who underwent surgery. The sensitivity of the modalities in predic ting vascular involvement and distant metastasis was assessed in the 56 pat ients with carcinomas. Results. EUS was the most sensitive modality in the detection (EUS, 97%; US , 24%; and CT, 39%; p < 0.001 for EUS versus US or CT) and T classification (EUS, 72%; US, 11%; CT, 22%; p < 0.001 for EUS versus US or CT) of periamp ullary tumors. EUS also had better sensitivity than US in detecting lymph n ode metastasis from periampullary cancers (EUS, 47%; US, 7%; and CT, 33%; p = 0.02 for EUS versus US; p = 0.7 for EUS versus CT). The accuracy of EUS in determining the T classification (without stent, 81%; with stent, 65%) a nd N classification (without stent, 80%; with stent, 70%) tended to decreas e in the presence of an endobiliary stent, but the differences were not sig nificant. EUS was the most sensitive modality in demonstrating vascular inv olvement (EUS, 100%; US, 0%; and CT, 33%; p = 0.002 for EUS versus US; p = 0.03 for EUS versus CT) but was not significantly different in detecting di stant metastasis (EUS, 11%; US, 44%; and CT, 44%). Conclusions. EUS is superior to US and CT in the local assessment of periam pullary tumors. The staging accuracy of EUS is minimally but not significan tly affected by the presence of an endobiliary stent. (C) 2001 John Wiley & Sons, Inc.