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

Familial mediterranean fever: a prevalent condition amongest the arabs

Autoinflammatory diseases are a group of disorders characterized by seemingly unprovoked inflammation in the absence of high-titer autoantibodies or antigen-specific T-cells and include the hereditary periodic fever syndromes. Familial Mediterranean Fever [FMF] is the prototype of the autoinflammatory disorder. It is an autosomal recessive disorder with high prevalence in non Ashkenazi Jews, Armenians, Turks and Arabs. The classic clinical picture is recurrent acute short-lived febrile and painful attacks with variable periods of remission. It is complicated by amyloidosis that leads to renal failure in a subset of patients. The gene responsible for FMF, MEFV, has been identified and its role in inflammation is under study. There appears to be a distinctive clinical picture among Arab FMF patients and the spectrum and distribution of MEFV mutations is different from other ethnic groups commonly affected by FMF. The clinical and molecular aspects of FMF in the Arabs are discussed