Endoscopy 2006; 39 - TH19
DOI: 10.1055/s-2006-947674

Difference in Endoscopic Ultrasound's diagnostic accuracy of vascular involvement between different vessels in pancreatic cancer

S Puli 1, S Singh 1, J Talapaneni 1, M Oropeza-vail 1, M Olyaee 1
  • 1University of Kansas Medical Center, Kansas City, US

Introduction: The difference in accuracy for vascular invasion (VI) between portal vein and superior mesenteric (SM) vessels in patients with pancreatic cancer has not been well studied. Goal: To asses difference in accuracy of EUS to diagnose vascular invasion or adherence between portal vein and superior mesenteric vessels. Method: Patients who had pre-operative EUS and subsequently underwent surgery were identified in a retrospective manner. EUS criteria for vascular adhesion was loss of echoplane alone. Vascular invasion was defined as tumor in the lumen, abnormal vessel contour, the presence of collateral vessels in the absence of a main vascular structure. Surgical definition for vascular adhesion was – tumor adherence but resectable and vascular invasion was defined as tumor encasing the vessel or vascular unresectability. Results: Total of 77 patients with pancreatic cancer and VI were identified. 41 patients had surgery at our institution. EUS showed vascular involvement in 25 patients and no involvement in 16 patients. The accuracy of EUS for vascular invasion and vascular adhesion between portal vein and superior mesenteric vessels is shown in table 1.

Table 1: Accuracy of EUS to diagnose vascular involvement in patients with pancreatic cancer.

Sensitivity

Specificity

Positive Predictive Value

Negative Predictive Value

Portal Vein

Vascular Invasion

75.00%

94.12%

90.00%

55.17%

Vascular Adhesion

40.00%

90.48%

50.00%

86.36%

SM vessels

Vascular Invasion

41.67%

100%

>99.99

65.00%

Vascular Adhesion

100%

90%

50.00%

100.00%

Conclusion: EUS is a good test to diagnose vascular invasion in portal veins but it performs poorly when it comes to diagnosing the same in superior mesenteric vessels. The sensitivity of EUS to diagnose vascular adhesion is portal vein is very low compared to superior mesenteric vessels. Studies with larger number of patients are needed to confirm this finding.