Endoscopic ultrasound (EUS) versus spiral computed tomography (SCT)for staging pancreatic, biliary and ampullary tumors: A prospective comparison

F. Gress, D. Ciaccia, J. Kiel, Glen Lehman

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Abstract

INTRODUCTION: EUS has been shown to be an accurate imaging modality for locally staging pancreatic cancer (Pea). Spiral CT is a new technique that allows for enhanced imaging and suggested to provide improved staging of pancreatic & biliary tumors. We previously reported pilot data showing EUS to be more accurate than spiral CT for staging of Pancreatobiliary CA. AIM OF STUDY: To prospectively compare EUS and spiral CT staging accuracy for ampullary, distal cholangio CA, and Pea including data on vascular invasion and resectability. METHODS: 92 patients diagnosed with Pea, biliary and ampullary CA were enrolled between 7/93-11/96. Data was prospectively collected for EUS and Spiral CT stage and follow-up including surgical correlation. Data was analyzed for 70 Pea, 13 biliary and 9 ampullary CA. EUS and CT staging was based on the TNM system with 63% (58 pts) having surgery, hi 86% (50/58 pts) T staging information was available and in 79% (46/58) N staging information. Vascular invasion data was available in 90% (52/58). RESULTS: EUS and Spiral CT Staging data is depicted below: T1 T2 T3 Total % Overall Accuracy =45/50= 90% T1 4 0 0 4/4 100% Sensitivity =90%, Specificity =80% EUS T2 2 12 1 12/15 80% T3 0 2 29 29/31 94% N0 N1 Total % Overall Accuracy =29/46 =67% N0 15 7 15/22 68% Sensitivity = 70% N1 8 16 16/24 67% Specificity = 80% T0 T1 T2 13 Total % Overall Accuracy :9/46 = 20% SPIRAL T0 0 1 4 10 0/15 0% CT T1 0 4 6 11 4/21 20% Sensitivity =55%, Spec = 65% T2 0 0 1 4 1/5 20% T3 0 0 1 4 4/5 80% N0 N1 Total % Overall Accuracy: 20/38=55% N0 13 15 13/28 47% Sensitivity = 27% N1 37 7/10 70% Specificity = 78% EUS was 88% accurate for vascular invasion (sensitivity 91%) versus 51% (sensitivity 33%) for spiral CT. SUMMARY: EUS staging of pancreatic, biliary and ampullary CA is accurate and similar to our previous report. EUS assessment of vascular invasion is highly accurate. Spiral CT appears to have improved T staging accuracy for large tumors (T3) since tumor size was directly proportional to the improved accuracy of Spiral CT. CONCLUSION: This study compares EUS and Spiral CT for staging pancreatobiliary CA and suggests that EUS is still the most accurate modality for local staging and predicting vascular invasion and resectability of these malignancies. Further studies are now needed to evaluate the impact of EUS on clinical decisions, cost-effectiveness and outcome in patients with pancreatobiliary malignancies.

Original languageEnglish
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997

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Spiral Computed Tomography
Blood Vessels
Pancreatic Neoplasms
Neoplasms
Cost-Benefit Analysis
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{34afa4b7bd164bcbab13d70f348dab8f,
title = "Endoscopic ultrasound (EUS) versus spiral computed tomography (SCT)for staging pancreatic, biliary and ampullary tumors: A prospective comparison",
abstract = "INTRODUCTION: EUS has been shown to be an accurate imaging modality for locally staging pancreatic cancer (Pea). Spiral CT is a new technique that allows for enhanced imaging and suggested to provide improved staging of pancreatic & biliary tumors. We previously reported pilot data showing EUS to be more accurate than spiral CT for staging of Pancreatobiliary CA. AIM OF STUDY: To prospectively compare EUS and spiral CT staging accuracy for ampullary, distal cholangio CA, and Pea including data on vascular invasion and resectability. METHODS: 92 patients diagnosed with Pea, biliary and ampullary CA were enrolled between 7/93-11/96. Data was prospectively collected for EUS and Spiral CT stage and follow-up including surgical correlation. Data was analyzed for 70 Pea, 13 biliary and 9 ampullary CA. EUS and CT staging was based on the TNM system with 63{\%} (58 pts) having surgery, hi 86{\%} (50/58 pts) T staging information was available and in 79{\%} (46/58) N staging information. Vascular invasion data was available in 90{\%} (52/58). RESULTS: EUS and Spiral CT Staging data is depicted below: T1 T2 T3 Total {\%} Overall Accuracy =45/50= 90{\%} T1 4 0 0 4/4 100{\%} Sensitivity =90{\%}, Specificity =80{\%} EUS T2 2 12 1 12/15 80{\%} T3 0 2 29 29/31 94{\%} N0 N1 Total {\%} Overall Accuracy =29/46 =67{\%} N0 15 7 15/22 68{\%} Sensitivity = 70{\%} N1 8 16 16/24 67{\%} Specificity = 80{\%} T0 T1 T2 13 Total {\%} Overall Accuracy :9/46 = 20{\%} SPIRAL T0 0 1 4 10 0/15 0{\%} CT T1 0 4 6 11 4/21 20{\%} Sensitivity =55{\%}, Spec = 65{\%} T2 0 0 1 4 1/5 20{\%} T3 0 0 1 4 4/5 80{\%} N0 N1 Total {\%} Overall Accuracy: 20/38=55{\%} N0 13 15 13/28 47{\%} Sensitivity = 27{\%} N1 37 7/10 70{\%} Specificity = 78{\%} EUS was 88{\%} accurate for vascular invasion (sensitivity 91{\%}) versus 51{\%} (sensitivity 33{\%}) for spiral CT. SUMMARY: EUS staging of pancreatic, biliary and ampullary CA is accurate and similar to our previous report. EUS assessment of vascular invasion is highly accurate. Spiral CT appears to have improved T staging accuracy for large tumors (T3) since tumor size was directly proportional to the improved accuracy of Spiral CT. CONCLUSION: This study compares EUS and Spiral CT for staging pancreatobiliary CA and suggests that EUS is still the most accurate modality for local staging and predicting vascular invasion and resectability of these malignancies. Further studies are now needed to evaluate the impact of EUS on clinical decisions, cost-effectiveness and outcome in patients with pancreatobiliary malignancies.",
author = "F. Gress and D. Ciaccia and J. Kiel and Glen Lehman",
year = "1997",
language = "English",
volume = "45",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Endoscopic ultrasound (EUS) versus spiral computed tomography (SCT)for staging pancreatic, biliary and ampullary tumors

T2 - A prospective comparison

AU - Gress, F.

AU - Ciaccia, D.

AU - Kiel, J.

AU - Lehman, Glen

PY - 1997

Y1 - 1997

N2 - INTRODUCTION: EUS has been shown to be an accurate imaging modality for locally staging pancreatic cancer (Pea). Spiral CT is a new technique that allows for enhanced imaging and suggested to provide improved staging of pancreatic & biliary tumors. We previously reported pilot data showing EUS to be more accurate than spiral CT for staging of Pancreatobiliary CA. AIM OF STUDY: To prospectively compare EUS and spiral CT staging accuracy for ampullary, distal cholangio CA, and Pea including data on vascular invasion and resectability. METHODS: 92 patients diagnosed with Pea, biliary and ampullary CA were enrolled between 7/93-11/96. Data was prospectively collected for EUS and Spiral CT stage and follow-up including surgical correlation. Data was analyzed for 70 Pea, 13 biliary and 9 ampullary CA. EUS and CT staging was based on the TNM system with 63% (58 pts) having surgery, hi 86% (50/58 pts) T staging information was available and in 79% (46/58) N staging information. Vascular invasion data was available in 90% (52/58). RESULTS: EUS and Spiral CT Staging data is depicted below: T1 T2 T3 Total % Overall Accuracy =45/50= 90% T1 4 0 0 4/4 100% Sensitivity =90%, Specificity =80% EUS T2 2 12 1 12/15 80% T3 0 2 29 29/31 94% N0 N1 Total % Overall Accuracy =29/46 =67% N0 15 7 15/22 68% Sensitivity = 70% N1 8 16 16/24 67% Specificity = 80% T0 T1 T2 13 Total % Overall Accuracy :9/46 = 20% SPIRAL T0 0 1 4 10 0/15 0% CT T1 0 4 6 11 4/21 20% Sensitivity =55%, Spec = 65% T2 0 0 1 4 1/5 20% T3 0 0 1 4 4/5 80% N0 N1 Total % Overall Accuracy: 20/38=55% N0 13 15 13/28 47% Sensitivity = 27% N1 37 7/10 70% Specificity = 78% EUS was 88% accurate for vascular invasion (sensitivity 91%) versus 51% (sensitivity 33%) for spiral CT. SUMMARY: EUS staging of pancreatic, biliary and ampullary CA is accurate and similar to our previous report. EUS assessment of vascular invasion is highly accurate. Spiral CT appears to have improved T staging accuracy for large tumors (T3) since tumor size was directly proportional to the improved accuracy of Spiral CT. CONCLUSION: This study compares EUS and Spiral CT for staging pancreatobiliary CA and suggests that EUS is still the most accurate modality for local staging and predicting vascular invasion and resectability of these malignancies. Further studies are now needed to evaluate the impact of EUS on clinical decisions, cost-effectiveness and outcome in patients with pancreatobiliary malignancies.

AB - INTRODUCTION: EUS has been shown to be an accurate imaging modality for locally staging pancreatic cancer (Pea). Spiral CT is a new technique that allows for enhanced imaging and suggested to provide improved staging of pancreatic & biliary tumors. We previously reported pilot data showing EUS to be more accurate than spiral CT for staging of Pancreatobiliary CA. AIM OF STUDY: To prospectively compare EUS and spiral CT staging accuracy for ampullary, distal cholangio CA, and Pea including data on vascular invasion and resectability. METHODS: 92 patients diagnosed with Pea, biliary and ampullary CA were enrolled between 7/93-11/96. Data was prospectively collected for EUS and Spiral CT stage and follow-up including surgical correlation. Data was analyzed for 70 Pea, 13 biliary and 9 ampullary CA. EUS and CT staging was based on the TNM system with 63% (58 pts) having surgery, hi 86% (50/58 pts) T staging information was available and in 79% (46/58) N staging information. Vascular invasion data was available in 90% (52/58). RESULTS: EUS and Spiral CT Staging data is depicted below: T1 T2 T3 Total % Overall Accuracy =45/50= 90% T1 4 0 0 4/4 100% Sensitivity =90%, Specificity =80% EUS T2 2 12 1 12/15 80% T3 0 2 29 29/31 94% N0 N1 Total % Overall Accuracy =29/46 =67% N0 15 7 15/22 68% Sensitivity = 70% N1 8 16 16/24 67% Specificity = 80% T0 T1 T2 13 Total % Overall Accuracy :9/46 = 20% SPIRAL T0 0 1 4 10 0/15 0% CT T1 0 4 6 11 4/21 20% Sensitivity =55%, Spec = 65% T2 0 0 1 4 1/5 20% T3 0 0 1 4 4/5 80% N0 N1 Total % Overall Accuracy: 20/38=55% N0 13 15 13/28 47% Sensitivity = 27% N1 37 7/10 70% Specificity = 78% EUS was 88% accurate for vascular invasion (sensitivity 91%) versus 51% (sensitivity 33%) for spiral CT. SUMMARY: EUS staging of pancreatic, biliary and ampullary CA is accurate and similar to our previous report. EUS assessment of vascular invasion is highly accurate. Spiral CT appears to have improved T staging accuracy for large tumors (T3) since tumor size was directly proportional to the improved accuracy of Spiral CT. CONCLUSION: This study compares EUS and Spiral CT for staging pancreatobiliary CA and suggests that EUS is still the most accurate modality for local staging and predicting vascular invasion and resectability of these malignancies. Further studies are now needed to evaluate the impact of EUS on clinical decisions, cost-effectiveness and outcome in patients with pancreatobiliary malignancies.

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