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EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates.
Am J Gastroenterol. 2005 Jun; 100(6):1381-5.AJ

Abstract

BACKGROUND

Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses.

METHODS

All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor.

RESULTS

30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered.

CONCLUSIONS

EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.

Authors+Show Affiliations

Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15929774

Citation

Aslanian, Harry, et al. "EUS Diagnosis of Vascular Invasion in Pancreatic Cancer: Surgical and Histologic Correlates." The American Journal of Gastroenterology, vol. 100, no. 6, 2005, pp. 1381-5.
Aslanian H, Salem R, Lee J, et al. EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates. Am J Gastroenterol. 2005;100(6):1381-5.
Aslanian, H., Salem, R., Lee, J., Andersen, D., Robert, M., & Topazian, M. (2005). EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates. The American Journal of Gastroenterology, 100(6), 1381-5.
Aslanian H, et al. EUS Diagnosis of Vascular Invasion in Pancreatic Cancer: Surgical and Histologic Correlates. Am J Gastroenterol. 2005;100(6):1381-5. PubMed PMID: 15929774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates. AU - Aslanian,Harry, AU - Salem,Ronald, AU - Lee,Jeffrey, AU - Andersen,Dana, AU - Robert,Marie, AU - Topazian,Mark, PY - 2005/6/3/pubmed PY - 2005/8/10/medline PY - 2005/6/3/entrez SP - 1381 EP - 5 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 100 IS - 6 N2 - BACKGROUND: Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses. METHODS: All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor. RESULTS: 30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered. CONCLUSIONS: EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/15929774/EUS_diagnosis_of_vascular_invasion_in_pancreatic_cancer:_surgical_and_histologic_correlates_ L2 - http://Insights.ovid.com/pubmed?pmid=15929774 DB - PRIME DP - Unbound Medicine ER -