A prospective comparison of endoscopic ultrasound (EUS) versus spiral computed tomography(SCT) for pancreatic, biliary and ampullary cancer staging and determination of vascular invasion and resectability

F. Gress, S. Ikenberry, S. Sherman, J. Wonn, G. Lehman

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

INTRODUCTION EUS has been shown to be an accurate imaging device to locally stage pancreatic cancer (Pea). Our previous retrospective study showed EUS staging of Pea to be more accurate than conventional CT. Spiral CT is a new technique that reportedly allows for enhanced imaging of vascular structures and has been suggested to provide improved staging of pancreatic & biliary tumors. To date, there is no data to support this nor has EUS staging been previously compared with SCT staging AIMS OF STUDY To prospectively compare our EUS staging accuracy for ampullary, biliary, and PCa to spiral CT staging. METHODS 58 consecutive pts with Pca, biliary and ampullary Ca between 7/93-10/95 were enrolled. Prospective data was collected and analyzed for 43 PCa, 9 biliary and 7 ampullary CA. Local staging was based on the TNM system. 58% (34 pts) went to surgery. In 90% (31/34) there was local T staging information and in 74% (25/34) local N staging information. Vascular invasion data was available in 97% (32/34). RESULTS Since the majority of pts in this study had Pea this data is depicted: PATHOLOGY T1 T2 T3 Total % Overall Accuracy =18/20 = 90% T1 3 0 0 3/3 100% Sensitivity = 100%, Specificity=100% EUS T2 0 4 0 4/14 100% Sensitivity = 70%, Specificity = 100% T3 0 2 11 11/13 85% Sensitivity = 100%, Specificity = 78% N0 N1 Total % Overall Accuracy=13/19 = 70% N0 6 3 6/9 75% Sensitivity = 56% N1 5 15 7/10 65% Specificity = 63% T0 T1 T2 T3 Total % Overall Accuracy :6/21 = 29% SPIRAL T0 0 1 3 2 0/6 0% CT T1 0 3 2 4 3/9 33% Sensitivity =75%, Spec = 65% T2 0 0 0 2 0/2 0% Sensitivity = 0, Spec = 86% T3 0 0 1 3 3/4 75% sensitivity = 27%, Spec = 90% N N1 Total % Overall Accuracy: 11/20 = 55% N0 8 8 8/16 50% Sensitivity = 27% N1 1 3 3/4 75% Specificity = 88% EUS was 87% accurate for vascular invasion (sensitivity 91%) versus 60% (sensitivity 33%) for spiral CT. SUMMARY: Our EUS staging of pancreaticobiliary and ampullary CA is accurate and similar to previous reports. EUS assessment of vascular invasion was highly accurate. Spiral CT appears to have improved T staging accuracy for T3 tumors since tumor size was directly proportional to the improved accuracy of spiral CT. CONCLUSION: This is the first study that compares EUS and SCT staging of pancreaticobiliary and ampullary Ca and appears to support the routine use of EUS for staging Pca and predicting resectability and survival.

Original languageEnglish (US)
Number of pages1
JournalGastrointestinal endoscopy
Volume43
Issue number4
DOIs
StatePublished - Jan 1 1996

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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