CT: “Pancreatic Fullness“... EUS: “Full of What?“

Background: CT findings of “pancreatic prominence or fullness“ are common referral indications for EUS pancreatic evaluations. Limited data exists regarding the yield of EUS for evaluating such CT findings.

Aims: To determine the incremental yield by EUS in patients found to have isolated “pancreatic prominence or fullness“ on CT scans.

Methods: 607 out of 1548 EUSs were performed to evaluate pancreatico-biliary disorders over a 2 yr-period at a tertiary referral center. Out of the 607 patients with pancreatic indications and abnormal imaging, the search terms “prominence and fullness“ were used to identify 29 patients. Patients with dilated ducts, adenopathy, discrete masses or cysts were excluded leaving 22 patients (mean age 57.5; 12F, 10 M).

Results: The findings on EUS are presented in Table 1. Individuals found to have a normal EUS had a median follow-up 8.0 mos (range 0.25–21). 6 month follow-up (either repeat imaging or clinical) was available in 4 of 5 patients with benign findings by EUS-FNA.

Table 1. EUS Findings

Normal 13	chronic pancreatits 5 entirely normal 8
Abnormal (FNA performed) 9	mass lesion 8 (adenoca 4, benign 4) suspicious lymph node 1 (benign 1)

Conclusions: Approximately 40% of patients with pancreatic prominence were found to have a lesion that warranted EUS-FNA. Overall, nearly 25% (5/22) of patients were found to have malignancy with EUS confirming the diagnosis in 80% (4/5). No malignancy was subsequently found in individuals with a normal EUS. Although limited by numbers and duration of follow-up, our findings suggest that „pancreatic prominence or fullness“ by CT necessitates further evaluation by EUS.