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Endosc Ultrasound. 2018 Nov-Dec;7(6):395-403. doi: 10.4103/eus.eus_24_18.

Discriminating chronic pancreatitis from pancreatic cancer: Contrast-enhanced EUS and multidetector computed tomography in direct comparison.

Author information

1
Department of Internal Medicine II, St. Elisabeth-Krankenhaus Leipzig, Leipzig; Medical Department, University of Muenster, Germany.
2
Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany.
3
Medical Department II, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany.
4
Department of Internal Medicine II, Hospital Meiningen, Meiningen, Germany.

Abstract

Background and Objectives:

To compare the ability of multidetector computed tomography (MDCT) and contrast-enhanced EUS to discriminate chronic pancreatitis (CP) from pancreatic ductal adenocarcinoma (PDAC).

Subjects and Methods:

A total of 215 patients (age: 62 ± 15 years, sex: f/m 80/135) were included in this retrospective study. All patients were examined by conventional endoscopic B-mode and contrast-enhanced high mechanical index EUS (CEHMI-EUS). CELMI-EUS was performed in 159 patients and endoscopic sonoelastography (ESE) in 210 patients. MDCT was carried out in 131 patients as part of their clinical work-up. Radiological reports were retrospectively analyzed. Final diagnosis was achieved by biopsy and evaluation of cytological specimens collected was performed by EUS-FNA, surgery, or follow-up of 12 months or more in patients with benign findings. In a subgroup of 100 patients, all diagnostic five methods were performed, and head-to-head analysis was performed.

Results:

Sensitivity and specificity for MDCT were 89% and 70% and for CEHMI-EUS were 96% and 91%, respectively. Sensitivities and specificities for EUS were 92% and 63% for B-Mode EUS, 96% and 38% for ESE, and 82% and 76% for CELMI-EUS, respectively. In the head-to-head analysis, each modality had shown lower numbers for specificity than shown in the overall group analysis because of high drop-out rate. EUS-FNA for PDAC had a sensitivity of 96% and a specificity of 100%.

Conclusions:

Contrast-enhanced EUS is a reliable tool in discriminating PDAC from CP.

KEYWORDS:

Adenocarcinoma; elastography; guidelines; pancreas; pancreatitis

PMID:
30246709
DOI:
10.4103/eus.eus_24_18
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Conflict of interest statement

D. Domagk has received honoraria for lectures from Olympus Europe and Falk Foundation. Consultancy fees were received from Hitachi Medical Systems and AbbVie.

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