Comparison of Endoscopic Ultrasonography and Multidetector Computed Tomography for Detecting and Staging Pancreatic Cancer

  1. John DeWitt, MD;
  2. Benedict Devereaux, MD;
  3. Melissa Chriswell, RN;
  4. Kathleen McGreevy, RN;
  5. Thomas Howard, MD;
  6. Thomas F. Imperiale, MD;
  7. Donato Ciaccia, MD;
  8. Kathleen A. Lane, MS;
  9. Dean Maglinte, MD;
  10. Kenyon Kopecky, MD;
  11. Julia LeBlanc, MD;
  12. Lee McHenry, MD;
  13. James Madura, MD;
  14. Alex Aisen, MD;
  15. Harvey Cramer, MD;
  16. Oscar Cummings, MD; and
  17. Stuart Sherman, MD
  1. From Indiana University Medical Center, Roudebush Veterans Affairs Medical Center, and Regenstrief Institute, Inc., Indianapolis, Indiana.

    Abstract

    Background: Accurate preoperative detection and staging of pancreatic cancer may identify patients with locoregional disease that is amenable to surgical resection.

    Objective: To compare endoscopic ultrasonography and multidetector computed tomography (CT) for the detection, staging, and resectability of known or suspected locoregional pancreatic cancer.

    Design: Prospective, observational, cohort study.

    Setting: Single, tertiary referral hospital in Indianapolis, Indiana.

    Patients: 120 participants with known or suspected locoregional pancreatic cancer.

    Interventions: Endoscopic ultrasonography followed by multidetector CT was performed in all patients. Patients with known or suspected pancreatic cancer deemed potentially resectable by 1 or both tests were considered for surgery.

    Measurements: Detection, staging, and resectability of pancreatic cancer. Surgically resected pancreatic cancer with negative microscopic histologic margins was considered resectable.

    Results: Of 120 patients enrolled, 104 (87%) underwent endoscopic ultrasonography and CT. Of the 80 patients with pancreatic cancer, 27 (34%) were managed nonoperatively, and 53 (66%) treated surgically had resectable (n = 25) or unresectable (n = 28) cancer. For the 80 patients with cancer, the sensitivity of endoscopic ultrasonography (98% [95% CI, 91% to 100%]) for detecting a pancreatic mass was greater than that of CT (86% [CI, 77% to 93%]; P = 0.012). For the 53 surgical patients, endoscopic ultrasonography was superior to CT for tumor staging accuracy (67% vs. 41%; P < 0.001) but equivalent for nodal staging accuracy (44% vs. 47%; P > 0.2). Of the 25 resectable pancreatic tumors in patients recommended for surgery, endoscopic ultrasonography and CT correctly identified 88% and 92%, respectively, as resectable. Of the 28 unresectable pancreatic tumors in patients recommended for surgery, endoscopic ultrasonography and CT correctly identified 68% and 64%, respectively, as unresectable.

    Limitations: Radiologists who read the scans and endosonographers were not blinded to previous radiographic information. Because of the modest sample size, CIs of the sensitivity estimates were sometimes wide.

    Conclusion: Compared with multidetector CT, endoscopic ultrasonography is superior for tumor detection and staging but similar for nodal staging and resectability of preoperatively suspected nonmetastatic pancreatic cancer.

    Article and Author Information

    • Grant Support: By 2 grants from the American Society of Gastrointestinal Endoscopy (Dr. Devereaux received an Endoscopic Outcomes and Effectiveness Award for 2001, and Dr. DeWitt received an Endoscopic Outcomes and Effectiveness Award for 2003) and 1 grant (K24 DK02756) to Dr. Imperiale from the National Institute of Diabetes and Digestive and Kidney Diseases.

    • Potential Financial Conflicts of Interest: Grants received: J. DeWitt (American Society of Gastrointestinal Endoscopy), B. Devereaux (American Society of Gastrointestinal Endoscopy).

    • Requests for Single Reprints: John M. DeWitt, MD, Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202-5121; e-mail, jodewitt{at}iupui.edu.

    • Current Author Addresses: Drs. DeWitt, Imperiale, Ciaccia, LeBlanc, McHenry, and Sherman, Ms. Chriswell, and Ms. McGreevy: Division of Gastroenterology, Department of Internal Medicine, Indiana University Medical Center, 550 North University Boulevard, UH 4100, Indianapolis, IN 46202-5121.

    • Dr. Devereaux, Level 1 Medical Centre, Holy Spirit Northside, 627 Rode Road, Chermside Q 4032, Australia.

    • Drs. Howard and Madura: Division of Surgery, Indiana University Medical Center, 550 North University Boulevard, Indianapolis, IN 46202-5121.

    • Ms. Lane: Indiana University School of Medicine, 1050 Wishard Boulevard, Indianapolis, IN 46202.

    • Drs. Maglinte and Aisen: Department of Radiology, Indiana University Medical Center, 550 North University Boulevard, Indianapolis, IN 46202-5121.

    • Dr. Kopecky: Irvington Radiologists, 7205 Shadeland Station, Suite 150, Indianapolis, IN 46256.

    • Drs. Cramer and Cummings: Division of Pathology, Indiana University Medical Center, 550 North University Boulevard, Indianapolis, IN 46202-5121.

    • Author Contributions: Conception and design: B. Devereaux, T.F. Imperiale, D. Ciaccia, K. Kopecky, H. Cramer, O. Cummings, S. Sherman.

    • Analysis and interpretation of the data: T.F. Imperiale, K.A. Lane, K. Kopecky, L. McHenry, O. Cummings, S. Sherman.

    • Drafting of the article: J. DeWitt.

    • Critical revision of the article for important intellectual content: J. DeWitt, T. Howard, T.F. Imperiale, K.A. Lane, D. Maglinte, J. LeBlanc, L. McHenry, J. Madura, A. Aisen, H. Cramer.

    • Final approval of the article: J. DeWitt, M. Chriswell, K. McGreevy, T. Howard, T.F. Imperiale, D. Ciaccia, K.A. Lane, D. Maglinte, K. Kopecky, J. LeBlanc, L. McHenry, J. Madura, A. Aisen, H. Cramer, O. Cummings, S. Sherman.

    • Provision of study materials or patients: J. DeWitt, T. Howard, D. Ciaccia, L. McHenry, J. Madura, S. Sherman.

    • Statistical expertise: J. DeWitt, T.F. Imperiale, K.A. Lane, J. LeBlanc.

    • Obtaining of funding: J. DeWitt, B. Devereaux.

    • Administrative, technical, or logistic support: M. Chriswell, K. McGreevy, J. LeBlanc, S. Sherman.

    • Collection and assembly of data: J. DeWitt, B. Devereaux, M. Chriswell, K. McGreevy, D. Ciaccia, D. Maglinte, K. Kopecky, J. LeBlanc, A. Aisen, O. Cummings.

    Responses to this article

    • Response to letter from Tierney W et al.
      • John M DeWitt and
      • Thomas Imperiale MD, Stuart Sherman MD
      Ann Intern Med published online October 26, 2009
    • CT vs. EUS for Pancreatic Cancer Staging: A Note of Caution to Clinicians
      • William M. Tierney and
      • Michael L. Kochman MD; Hospital of the University of Pennsylvania, and James M Scheiman MD; University of Michigan Medical Center
      Ann Intern Med published online October 26, 2009

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    1. Ann Intern Med November 16, 2004 vol. 141 no. 10 753-763
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