TY - JOUR
T1 - Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions
T2 - A tertiary oncology center experience
AU - Krishna, Somashekar G.
AU - Li, Feng
AU - Bhattacharya, Abhik
AU - Ladha, Harshad
AU - Porter, Kyle
AU - Singh, Amanpal
AU - Ross, William A.
AU - Bhutani, Manoop S.
AU - Lee, Jeffrey H.
N1 - Publisher Copyright:
© 2015 American Society for Gastrointestinal Endoscopy.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background Pancreatic ductal adenocarcinoma (PDAC), pancreatic neuroendocrine tumors (pNET), and metastatic lesions (pMET) are the most common neoplastic solid pancreatic lesions (SPLs). Early diagnosis enables prompt treatment. Objective To identify factors differentiating PDAC from non-PDAC lesions and assess the accuracy of EUS-guided FNA. Design and Setting Retrospective tertiary center. Patients and Intervention Consecutive patients referred for EUS evaluation of SPLs from 2004 to 2011. Main Outcome Measurements Pretest (preceding EUS-guided FNA [EUS-FNA]) predictors of PDAC among neoplastic SPLs and accuracy of EUS-FNA. Results A total of 1333 EUS scans with 1108 EUS-FNAs were performed for pancreatic lesions. Of the 672 patients with neoplastic SPLs, 528 had PDAC and 144 non-PDAC. The sensitivity, specificity, positive predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 97.3%, 99.3%, 99.8%, and 97.8%, respectively. Years of EUS experience significantly correlated with fewer needle passes (Rs = -0.18, P <.001). Controlling for all potential confounders, multivariable regression analysis demonstrated that patients with PDAC compared with pNETs and pMETs were older (odds ratio [OR] 4.42; 95% confidence interval [CI], 2.1-9.5; P <.001), had weight loss (OR 3.0; 95% CI, 1.6-5.4; P <.001), hyperbilirubinemia (OR 3.7; 95% CI, 1.8-7.5; P <.001), elevated CA19-9 (OR 6.9; 95% CI, 2.4-20.3; P <.01), evidence of arterial invasion (OR 6.5; 95% CI, 2.7-15.4; P <.001), and PD dilation (OR 3.3; 95% CI, 1.8-5.9; P <.001). Limitations Retrospective design, single center. Conclusions When evaluating neoplastic SPLs, demographic, clinical, laboratory, and imaging characteristics can reliably discern and suggest PDAC. In addition, EUS-FNA is exceedingly sensitive and specific for PDAC.
AB - Background Pancreatic ductal adenocarcinoma (PDAC), pancreatic neuroendocrine tumors (pNET), and metastatic lesions (pMET) are the most common neoplastic solid pancreatic lesions (SPLs). Early diagnosis enables prompt treatment. Objective To identify factors differentiating PDAC from non-PDAC lesions and assess the accuracy of EUS-guided FNA. Design and Setting Retrospective tertiary center. Patients and Intervention Consecutive patients referred for EUS evaluation of SPLs from 2004 to 2011. Main Outcome Measurements Pretest (preceding EUS-guided FNA [EUS-FNA]) predictors of PDAC among neoplastic SPLs and accuracy of EUS-FNA. Results A total of 1333 EUS scans with 1108 EUS-FNAs were performed for pancreatic lesions. Of the 672 patients with neoplastic SPLs, 528 had PDAC and 144 non-PDAC. The sensitivity, specificity, positive predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 97.3%, 99.3%, 99.8%, and 97.8%, respectively. Years of EUS experience significantly correlated with fewer needle passes (Rs = -0.18, P <.001). Controlling for all potential confounders, multivariable regression analysis demonstrated that patients with PDAC compared with pNETs and pMETs were older (odds ratio [OR] 4.42; 95% confidence interval [CI], 2.1-9.5; P <.001), had weight loss (OR 3.0; 95% CI, 1.6-5.4; P <.001), hyperbilirubinemia (OR 3.7; 95% CI, 1.8-7.5; P <.001), elevated CA19-9 (OR 6.9; 95% CI, 2.4-20.3; P <.01), evidence of arterial invasion (OR 6.5; 95% CI, 2.7-15.4; P <.001), and PD dilation (OR 3.3; 95% CI, 1.8-5.9; P <.001). Limitations Retrospective design, single center. Conclusions When evaluating neoplastic SPLs, demographic, clinical, laboratory, and imaging characteristics can reliably discern and suggest PDAC. In addition, EUS-FNA is exceedingly sensitive and specific for PDAC.
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U2 - 10.1016/j.gie.2014.08.023
DO - 10.1016/j.gie.2014.08.023
M3 - Article
C2 - 25442085
AN - SCOPUS:84921457211
SN - 0016-5107
VL - 81
SP - 370
EP - 379
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -