Comparison of endoscopic ultrasound and computed tomography for detecting and staging malignant pancreatic masses

Introduction: Endoscopic ultrasound [EUS] is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral computed tomography [CT] scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than endoscopic ultrasound guided fine needle aspiration [EUS-FNA], cheaper and, therefore, more frequently used In this study, we evaluated the use of EUS-FNA in comparison with spiral CT for detection and staging of malignant pancreatic massesMethods: This prospective study was carried in El-Ebrashi unit of Gastroenterology and Hepatology, Internal Medicine department, Cairo University over 3 years from 2011 to 2014. It included 68 patient with suspected pancreatic mass lesions based on abdominal ultrasound, CT or MRI and patients with obstructive jaundice due to common bile duct [CBD] stricture as proved by endoscopic retrograde cholangiopancreatography [ERCP] or Magnetic resonance cholangiopancreatography [MRCP]. The patients were subjected to dual phase pancreatic control multi-detector computed tomography [MDCT] to be followed by EUS-FNA, then cytopathological examination of the studied patients to determine the nature of pancreatic masses, normal and benign cases are followed up after 6 months by EUS for exclusion of malignancy

Results: The final diagnosis in this study was that, 61 patients were malignant and 7 benign cases. The sensitivity of CT was 75% compared to 100% for EUS. While the specificity for CT was 14% compared to 100% for EUS. The negative predictive value for CT was 6.25% compared to 100% for EUS. With an overall accuracy of MDCT was 69% compared to 100% for EUS for diagnosing pancreatic cancer. The sensitivity of CT for detection of small lesions

Conclusion: EUS is more accurate than CT for detection of pancreatic cancer especially in small tumors. EUS is more accurate than CT in staging of pancreatic cancer in early stages

Recommendation: Early diagnosis of pancreatic cancer is the most important step in the way of decreasing its mortality rate. For screening of patients with suspected pancreatic cancer, initially CT should be performed to be followed by EUS whether to exclude masses in negative CT patients or to confirm the mass and to provide a tool for sample/or cytopathological diagnosis in patients with positive CT We recommend a future study to correlate the accuracy of staging by EUS and CT with post-operative histopathological staging

Role of endoscopic ultrasound [EUS] and EUS-guided-fine needle aspiration in diagnosis of mediastinal and abdominal lymphadenopathy

Background and aim: Endoscopic ultrasound [EUS] and the subsequent EUS-guided fine needle aspirate [EUS-FNA] represent a major breakthrough in interventional methods especially for sampling suspicious-appearing lymph nodes. Therefore, we aimed to evaluate the diagnostic yield EUS-FNA in setting of a given abdominal and/or mediastinal lymph nodes. Also, to detect the echo- features that may predict lymph node malignant potentials

Methods: Between January 2014 and May 2015, all consecutive patients with intra-abdominal and/or mediastinal lymphadenopathy were enrolled. EUS-FNA was carried out and the aspirate then sent for cytological and histological studies and Immune stains [IHC]. EUS-FNA results were categorized into benign or malignant. The gold- standards for final diagnosis were the postoperative pathological results or the follow-up course

Results: during the period of the study, a total of 86 patients [50 males, mean age 57.62 +/- 8.47] were enrolled. No major complications were reported. The main proven final diagnoses of the LNs were pancreatic cancer [34.88%, n=30], and cholangiocarcinoma [12.8%, n=11] and 75.6% [n=65] were malignant. The sensitivity, specificity, and accuracy rates of EUS-FNA were 95.38%, 100%, and 95.5%, respectively [No false positive cases]. The multivariate Binary logistic regression revealed that only the echo-texture [odds ratio 29.8; P=0.003] and short axis diameter of the lymph nodes [odds ratio 1.6; P=0. 025] are the most predictors of malignant potentiality

Conclusions: EUS-FNA is an accurate and safe method for diagnosis of abdominal and mediastinal lymphadenopathy

Endosonography as a predictive tool for first oesophagogastric variceal bleeding

Endosonography [EUS] is a useful tool for evaluating the fine details of the vascular structures at the gastroesophageal junction. The aim of this study is to evaluate the value of extraluminal gastroesophageal vascular collaterals as predictors for first variceal bleeding. Fifty cirrhotic patients with no history of previous upper gastrointestinal [GI] bleeding were recruited into this prospective cohort study. All patients were subjected to upper endoscopy and EUS for assessing the number and size of extramural vascular collaterals and perforating vessels. All patients were followed up for 24 +/- 7.5 months for upper gastrointestinal bleeding. Eighteen out of 50 patients [36%] had at least one attack of upper GI bleeding during the follow up period. All patients had one or more types of extraluminal venous collaterals. The presence of gastric varices [p = 0.02], perigastric collaterals [p = 0.03] and perforators [p = 0.02] were independent risk factors for first variceal bleeding. The presence of 3 or more paraoesophageal collaterals and the presence of perforators were significantly higher in bleeders when compared to non-bleeders [p = 0.034]. Perigastric and paragastric collateral sizes were significantly larger in bleeders than in non-bleeders [p = 0.019 and 0.038, respectively]. Perigastric and paragastric collaterals of size more than or equal to 2 mm and 6.20 mm, respectively were associated with significantly increased risk of first variceal bleeding. EUS may be a promising tool for predicting first variceal bleeding in cirrhotic patients