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Clinical utility of endoscopic ultrasound in solid pancreatic mass lesions deemed resectable by computer tomography
Mark A Virtue1, Shawn Mallery, Rebecca Li
1Department of Medicine, Division of Gastroenterology, University of Minnesota. Minneapolis, MN, USA. timothy.sielaff@allina.com.
Context:
Appropriate surgical exploration and resection of pancreatic carcinoma depends on accurate preoperative evaluation.
Objective:
Determine the accuracy of endoscopic ultrasound in predicting the need for surgical exploration in patients with solid pancreatic masses deemed by computer tomography to be resectable without venous grafting (absence of distant metastatic disease or major vascular involvement).
Patients:
All patients between March 2000 and November 2003 with focal pancreatic mass lesions deemed to be surgically resectable by computer tomography. Forty-nine patients participated (29 males, 20 females; age range: 40-86 years).
Intervention:
Preoperative linear-array endoscopic ultrasound.
Main Outcome Measure:
Surgical pathology compared to computer tomography and endoscopic ultrasound results.
Results:
Out of the 49 patients, 33 (67.3%) had pancreatic neoplasms and 16 (32.7%) had chronic pancreatitis. Endoscopic ultrasound correctly diagnosed all 16 patients with chronic pancreatitis. Endoscopic ultrasound correctly identified 18 (54.5%) of those with neoplasms as having unresectable disease while 6 (18.2%) patients were appropriately identified as resectable by endoscopic ultrasound. The remaining 9 patients (27.3%) were deemed resectable by endoscopic ultrasound, but were unresectable at the time of surgery. None of the patients were falsely designated as unresectable by endoscopic ultrasound.
Conclusion:
Endoscopic ultrasound is an important compliment to computed tomography in predicting resectability and in avoiding nontherapeutic laparotomy of solid pancreatic neoplasms. Moreover, endoscopic ultrasound classification did not discourage surgery of resectable pancreatic masses.
