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Gastrointest Endosc. 2015 Nov;82(5):812-8. doi: 10.1016/j.gie.2015.02.028. Epub 2015 Apr 27.

Linear-array EUS improves detection of pancreatic lesions in high-risk individuals: a randomized tandem study.

Author information

1
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
2
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
3
Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
4
Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
5
Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA.
6
Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

BACKGROUND:

Studies comparing linear and radial EUS for the detection of pancreatic lesions in an asymptomatic population with increased risk for pancreatic cancer are lacking.

OBJECTIVES:

To compare pancreatic lesion detection rates between radial and linear EUS and to determine the incremental diagnostic yield of a second EUS examination.

DESIGN:

Randomized controlled tandem study.

SETTING:

Five academic centers in the United States.

PATIENTS:

Asymptomatic high-risk individuals (HRIs) for pancreatic cancer undergoing screening EUS.

INTERVENTIONS:

Linear and radial EUS performed in randomized order.

MAIN OUTCOME MEASUREMENTS:

Pancreatic lesion detection rate by type of EUS, miss rate of 1 EUS examination, and incremental diagnostic yield of a second EUS examination (second-pass effect).

RESULTS:

Two hundred seventy-eight HRIs were enrolled, mean age 56 years (43.2%), and 90% were familial pancreatic cancer relatives. Two hundred twenty-four HRIs underwent tandem radial and linear EUS. When we used per-patient analysis, the overall prevalence of any pancreatic lesion was 45%. Overall, 16 of 224 HRIs (7.1%) had lesions missed during the initial EUS that were detected by the second EUS examination. The per-patient lesion miss rate was significantly greater for radial followed by linear EUS (9.8%) than for linear followed by radial EUS (4.5%) (P = .03). When we used per-lesion analysis, 73 of 109 lesions (67%) were detected by radial EUS and 99 of 120 lesions (82%) were detected by linear EUS (P < .001) during the first examination. The overall miss rate for a pancreatic lesion after 1 EUS examination was 47 of 229 (25%). The miss rate was significantly lower for linear EUS compared with radial EUS (17.5% vs 33.0%, P = .007).

LIMITATIONS:

Most detected pancreatic lesions were not confirmed by pathology.

CONCLUSION:

Linear EUS detects more pancreatic lesions than radial EUS. There was a "second-pass effect" with additional lesions detected with a second EUS examination. This effect was significantly greater when linear EUS was used after an initial radial EUS examination.

Comment in

PMID:
25930097
PMCID:
PMC4609234
DOI:
10.1016/j.gie.2015.02.028
[Indexed for MEDLINE]
Free PMC Article

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