Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer

被引:345
作者
DeWitt, J
Devereaux, B
Chriswell, M
McGreevy, K
Howard, T
Imperiale, TF
Ciaccia, D
Lane, KA
Maglinte, D
Kopecky, K
LeBlanc, J
McHenry, L
Madura, J
Aisen, A
Cramer, H
Cummings, O
Sherman, S
机构
[1] Indiana Univ, Med Ctr, Dept Med,Roudebush Vet Affairs Med Ctr, Div Gastroenterol, Indianapolis, IN 46202 USA
[2] Regenstrief Inst Inc, Indianapolis, IN USA
关键词
D O I
10.7326/0003-4819-141-10-200411160-00006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Accurate preoperative detection and staging of pancreatic cancer may identify patients with locoregional disease that is amenable to surgical resection. Objective: To compare endoscopic ultrasonography and multidetector computed tomography (CT) for the detection, staging, and resectability of known or suspected locoregional pancreatic cancer. Design: Prospective, observational, cohort study. Setting: Single, tertiary referral hospital in Indianapolis, Indiana. Patients: 120 participants with known or suspected locoregional pancreatic cancer. Interventions: Endoscopic ultrasonography followed by multidetector CT was performed in all patients. Patients with known or suspected pancreatic cancer deemed potentially resectable by 1 or both tests were considered for surgery. Measurements: Detection, staging, and resectability of pancreatic cancer. Surgically resected pancreatic cancer with negative microscopic histologic margins was considered resectable. Results: Of 120 patients enrolled, 104 (87%) underwent endoscopic ultrasonography and CT. Of the 80 patients with pancreatic cancer, 27 (34%) were managed nonoperatively, and 53 (66%) treated surgically had resectable (n = 25) or unresectable (n = 28) cancer. For the 80 patients with cancer, the sensitivity of endoscopic ultrasonography (98% [95% CI, 91% to 100%]) for detecting a pancreatic mass was greater than that of CT (86% [CI, 77% to 93%]; P = 0.012). For the 53 surgical patients, endoscopic ultrasonography was superior to CT for tumor staging accuracy (67% vs. 41%; P < 0.001) but equivalent for nodal staging accuracy (44% vs. 47%; P > 0.2). Of the 25 resectable pancreatic tumors in patients recommended for surgery, endoscopic ultrasonography and CT correctly identified 88% and 92%, respectively, as resectable. Of the 28 unresectable pancreatic tumors in patients recommended for surgery, endoscopic ultrasonography and CT correctly identified 68% and 64%, respectively, as unresectable. Limitations: Radiologists who read the scans and endosonographers were not blinded to previous radiographic information. Because of the modest sample size, CIs of the sensitivity estimates were sometimes wide. Conclusion: Compared with multidetector CT, endoscopic ultrasonography is superior for tumor detection and staging but similar for nodal staging and resectability of preoperatively suspected nonmetastatic pancreatic cancer.
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页码:753 / 763
页数:11
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