Comparative analysis and assessment of diagnostic accuracy of 256 slice CT and endoscopic ultrasound in evaluation of pancreatic masses

Abstract

Context: Pancreatic masses are routinely encountered on imaging and often present as a diagnostic dilemma. These masses range from benign inflammatory masses, requiring no intervention to malignant masses, which carry grave prognosis and hence require aggressive management. Aims: Compare the diagnostic accuracy of 256 multislice CT and endoscopic ultrasound (EUS) in characterization and assessment of resectability of pancreatic masses and compare the multidetector computed tomography (MDCT) and EUS findings with histopathological findings. Settings and Design: Prospective study. Subjects and Methods: 36 patients with pancreatic masses were included who underwent dual phase CT using pancreatic protocol and EUS using 5–13 MHz transducer. Fine needle aspiration cytology (FNAC) was done wherever feasible. Parameters regarding tumor size, location, imaging morphology, and vessel involvement were recorded. Findings were compared with histopathological/operative diagnosis/clinical follow-up. Statistical Analysis Used: Descriptive statistics with percentages and proportions and Chi-square test. Results: Multidetector computed tomography (MDCT) and EUS established diagnosis consistent with tissue diagnosis in 30 (83%) and 22 (61%) patients, respectively. However, the best results were obtained with the combined use of MDCT and EUS. The number of patients categorized as inconclusive by MDCT were lower compared to EUS. Assessing resectability for pancreatic adenocarcinoma, MDCT showed specificity and positive predictive value (PPV) of 100% compared to EUS, which had specificity and PPV of 75% and 92.3%, respectively. MDCT is the first-line imaging modality in detection, characterization of pancreatic masses, and assessment of resectability in malignant neoplasms. EUS is beneficial in the detection of masses <2 cm in size causing pancreatic contour deformity on CT, for guiding FNAC. MDCT and EUS with EUS-guided FNA are complementary not competitive tools in preoperative imaging of pancreatic masses.

Keywords

Endoscopic ultrasound - multidetector CT - pancreas

Publication History

Received: 24 December 2019

Accepted: 03 June 2020

Article published online:
19 July 2021

• References

• 1 Rafique A, Freeman S, Carroll N. A clinical algorithm for the assessment of pancreatic lesions: Utilization of 16- and 64-section multidetector CT and endoscopic ultrasound. Clin Radiol 2007; 62: 1142-53
• 2 Varadarajulu S, Wallace MB. Applications of endoscopic ultrasonography in pancreatic cancer. Cancer Control 2004; 11: 15-20
• 3 Goldberg J, Rosenblat J, Khatri G, Shwender B, Kaushik N, Katz D. et al. Complementary roles of CT and endoscopic ultrasound in evaluating a pancreatic Mass. AJR Am J Roentgenol 2010; 194: 984-92
• 4 Angelis CD, Brizzi FR, Pellicano R. Endoscopic ultrasonography for pancreatic cancer: Current and future perspectives. J Gastrointest Oncol 2013; 4: 220-30
• 5 Stiff GM, Webster P, Frost B, Lewis WG, Puntis MCA, Roberts SA. Endoscopic ultrasound reliably identifies chronic pancreatitis when other imaging modalities have been non- diagnostic. J Pancreas 2009; 10: 280-3
• 6 Varadhachary GR, Tamm EP, Crane C, Evans DB, Wolff RA. Borderline resectable pancreatic cancer. Curr Treat Options Gastroenterol 2005; 8: 377-84
• 7 Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS. The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. AJR Am J Roentgenol 1997; 168: 971-977
• 8 Tummala P, Junaidi O, Agarwal B. Imaging of pancreatic cancer: An overview. J Gastrointest Oncol 2011; 2: 168-74
• 9 Bronstein YL, Loyer EM, Kaur H, Choi H, David C, Dubrow RA. et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR AM J Roentgenol 2004; 182: 619-623
• 10 Agarwal B, Abu-Hamda E, Molke KL, Correa AM, Ho L. Endoscopic ultrasound guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol 2004; 99: 844-850
• 11 Agrawal B, Correa M, Ho L. Survival in pancreatic carcinoma based on tumor size. Pancreas 2008; 36: 15-20
• 12 Wang W, Shpaner A, Krishna SG, Ross WA, Bhutani MS, Tamm EP. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73-80
• 13 Raptopoulos VD, Kruskal JB. Comprehensive Preoperative assessment of Pancreatic Adenocarcinoma with 64-Section Volumetric CT. RadioGraphics 2007; 27: 1653-66
• 14 Rösch T, Dittler HJ, Lorenz R, Braig C, Gain T, Feuerbach S. et al. The endosonographic staging of pancreatic carcinoma. Dtsch Med Wochenschr 1992; 117: 563-9