Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: A tertiary oncology center experience

Somashekar G. Krishna, Feng Li, Abhik Bhattacharya, Harshad Ladha, Kyle Porter, Amanpal Singh, William A. Ross, Manoop S. Bhutani, Jeffrey H. Lee

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)370-379
Number of pages10
JournalGastrointestinal endoscopy
Volume81
Issue number2
DOIs
StatePublished - Feb 1 2015

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Fingerprint

Dive into the research topics of 'Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: A tertiary oncology center experience'. Together they form a unique fingerprint.

Cite this