Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery

B. Brand, T. Pfaff, K. F. Binmoeller, Sreeram Parupudi, A. Fritscher-Ravens, W. T. Knofel, S. Jackle, N. Soehendra

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Abstract

Background: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. Methods: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. Results: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95%, 53%, 83%, 83% and 82%, respectively. Endosonographic diagnosis of the lesions (% correct) were: pancreatic cancer, 84 (63.3%); chronic pancreatitis, 14 (71.4%); ampullary cancer, 9 (77.8%); cystadenoma, 5 (80%); ampullary adenoma, 2 (50%); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61% and 75%, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. Conclusions: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.

Original languageEnglish (US)
Pages (from-to)1221-1228
Number of pages8
JournalScandinavian Journal of Gastroenterology
Volume35
Issue number11
StatePublished - 2000
Externally publishedYes

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Chronic Pancreatitis
Pancreatic Neoplasms
Differential Diagnosis
Cystadenoma
Neoplasms
Pancreatitis
Endosonography
Neuroendocrine Tumors
Adenoma
Histology
Lymph Nodes
Sensitivity and Specificity

Keywords

  • Chronic pancreatitis
  • Differential diagnosis
  • Endoscopic ultrasound
  • Fine needle aspiration biopsy
  • Pancreatic carcinoma
  • Pancreatic surgery
  • Tumour staging

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Brand, B., Pfaff, T., Binmoeller, K. F., Parupudi, S., Fritscher-Ravens, A., Knofel, W. T., ... Soehendra, N. (2000). Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery. Scandinavian Journal of Gastroenterology, 35(11), 1221-1228.

Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery. / Brand, B.; Pfaff, T.; Binmoeller, K. F.; Parupudi, Sreeram; Fritscher-Ravens, A.; Knofel, W. T.; Jackle, S.; Soehendra, N.

In: Scandinavian Journal of Gastroenterology, Vol. 35, No. 11, 2000, p. 1221-1228.

Research output: Contribution to journalArticle

Brand, B, Pfaff, T, Binmoeller, KF, Parupudi, S, Fritscher-Ravens, A, Knofel, WT, Jackle, S & Soehendra, N 2000, 'Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery', Scandinavian Journal of Gastroenterology, vol. 35, no. 11, pp. 1221-1228.
Brand, B. ; Pfaff, T. ; Binmoeller, K. F. ; Parupudi, Sreeram ; Fritscher-Ravens, A. ; Knofel, W. T. ; Jackle, S. ; Soehendra, N. / Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery. In: Scandinavian Journal of Gastroenterology. 2000 ; Vol. 35, No. 11. pp. 1221-1228.
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abstract = "Background: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. Methods: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. Results: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95{\%}, 53{\%}, 83{\%}, 83{\%} and 82{\%}, respectively. Endosonographic diagnosis of the lesions ({\%} correct) were: pancreatic cancer, 84 (63.3{\%}); chronic pancreatitis, 14 (71.4{\%}); ampullary cancer, 9 (77.8{\%}); cystadenoma, 5 (80{\%}); ampullary adenoma, 2 (50{\%}); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61{\%} and 75{\%}, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. Conclusions: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.",
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T1 - Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery

AU - Brand, B.

AU - Pfaff, T.

AU - Binmoeller, K. F.

AU - Parupudi, Sreeram

AU - Fritscher-Ravens, A.

AU - Knofel, W. T.

AU - Jackle, S.

AU - Soehendra, N.

PY - 2000

Y1 - 2000

N2 - Background: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. Methods: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. Results: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95%, 53%, 83%, 83% and 82%, respectively. Endosonographic diagnosis of the lesions (% correct) were: pancreatic cancer, 84 (63.3%); chronic pancreatitis, 14 (71.4%); ampullary cancer, 9 (77.8%); cystadenoma, 5 (80%); ampullary adenoma, 2 (50%); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61% and 75%, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. Conclusions: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.

AB - Background: Endoscopic ultrasound is increasingly used for evaluation of pancreatic cancer. The potential of sonographic morphology to differentiate histology type and biological behaviour of pancreatic lesions is doubtful. Methods: We prospectively studied 115 patients with focal pancreatic lesions on endoscopic ultrasound. Morphology was assessed using Olympus UM3/20/200 echoendoscopes. Histologic confirmation of diagnosis was obtained in all patients. Results: Endoscopic ultrasound correctly diagnosed 18/34 benign and 77/81 malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV for diagnosing malignancy were 95%, 53%, 83%, 83% and 82%, respectively. Endosonographic diagnosis of the lesions (% correct) were: pancreatic cancer, 84 (63.3%); chronic pancreatitis, 14 (71.4%); ampullary cancer, 9 (77.8%); cystadenoma, 5 (80%); ampullary adenoma, 2 (50%); acute pancreatitis, 1 (0). In 13 patients of chronic pancreatitis, diagnosed as cancer, diagnosis was based on absence of sonographic features of chronic pancreatitis (7) or suspected involvement of adjacent structures (6). In 3 patients malignancy was missed owing to features of chronic pancreatitis. Non-suspected neuroendocrine tumours were misjudged in all 10 cases using morphologic criteria as pancreatic cancer (8), cystadenoma and chronic pancreatitis. Accuracy for prediction of metastatic lymph nodes and an advanced pancreatic cancer stage (TxN1 or T3Nx) was 61% and 75%, respectively. On retrospective analysis, a lesion >2 cm, vessel ingrowth, absence of cystic spaces and absence of diffuse pancreatitis were associated with pancreatic cancer. Conclusions: While overall sensitivity was high, specificity of endoscopic ultrasound for diagnosis of malignancy was low, especially in presence of chronic pancreatitis. In addition, endosonography had only a limited potential to predict the histological type of lesions.

KW - Chronic pancreatitis

KW - Differential diagnosis

KW - Endoscopic ultrasound

KW - Fine needle aspiration biopsy

KW - Pancreatic carcinoma

KW - Pancreatic surgery

KW - Tumour staging

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JO - Scandinavian Journal of Gastroenterology

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