Endoscopic ultrasound (EUS) can effectively diagnose and predict resectability of pancreatic cancers

INTRODUCTION:Patients suspected of having cancer of the pancreas frequently undergo extensive testing to confirm malignancy and determine tumor resectability. Radial and linear array EUS systems can be used to identify masses in the pancreas and guide fine needle aspiration (FNA) biopsy respectively. The purpose of this study was to determine the ability of EUS to diagnose cancer and judge resectability. METHODS: Between 5/91-11 /95, 54 patients were preoperatively evaluated by contrast-enhanced CT and radial array EUS prior to surgical exploration for potentially resectable cancers of the pancreas and periampullary region. From 6/94-11/95, masses in this region were also biopsied with a 23 gauge needle using the linear array EUS system with color Doppler to identify vascular structures. The FNA was reviewed by a cytopathologist in the endoscopy suite. RESULTS: There were 51 adenocarcinomas (42 pancreas, 6 ampulla, 3 distal bile duct) and 3 islet cell tumors. A mass was identified by CT in 36 (67%) cases and by EUS in 50 (93%). In 18 patients, EUS localized the cancer while CT did not (p<0.001 by Sign Test). The 4 EUS negative results were during the first 2 years of study. EUS-guided biopsy confirmed cancer in 22 of 23 patients in which it was attempted: 19 pancreatic adenocarcinoma (14 head, 3 body, 2 tail), and 3 pancreatic islet cell tumors (2 head, 1 tail). EUS was further analyzed for effectiveness at predicting resectability: EUS Stage Total Resected T1 (localized) 18 12 (67%) T2 (outside pancreas) 14 12 (86%) T3 (invading large vessel) 18 3 (17%)1, 2 1 Both "resected" T3 tumors were removed by distal pancreatectomy 2 p<0.001 for T1 and T2 vs T3 by Fisher's Exact Test CONCLUSION: EUS is superior to CT for localizing pancreatic tumors and can direct the FNA of these lesions. Most patients in which EUS identifies vascular invasion (T3) have unresectable cancers, and may therefore be able to avoid the morbidity and expense of numerous preoperative radiologic and endoscopic tests.