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Digestive Diseases and Sciences

, Volume 64, Issue 12, pp 3623–3629 | Cite as

Role of Endoscopic Ultrasound in Detecting Pancreatic Cancer Missed on Cross-Sectional Imaging in Patients Presenting with Pancreatitis: A Retrospective Review

  • Nicholas Bartell
  • Krystle Bittner
  • Mary S. Vetter
  • Truptesh Kothari
  • Vivek Kaul
  • Shivangi KothariEmail author
Original Article

Abstract

Introduction

Pancreatic cancer is the fourth leading cause of cancer-related death in the USA. Early detection of pancreatic cancer may help improve patient survival. It has been hypothesized that acute idiopathic or chronic pancreatitis is associated with an increased risk of pancreatic cancer; however, these conditions may also represent an early manifestation of pancreatic cancer, rather than just being risk factors. Endoscopic ultrasound (EUS) is a sensitive diagnostic modality for the detection of small, early-stage pancreatic tumors. The aim of this study was to evaluate the diagnostic yield of EUS for pancreatic cancer in patients with acute idiopathic or chronic pancreatitis when cross-sectional imaging (CT and/or MRI) was negative for a mass lesion in the pancreas.

Methods

This study was an IRB-approved retrospective chart review conducted for the period of August 2005 to September 2018. Any patient presenting with acute idiopathic or chronic pancreatitis with a CT and/or MRI imaging negative for a pancreatic mass lesion that underwent an EUS during the study period was selected for inclusion. A retrospective review was performed to evaluate the outcomes of patients who had pancreatic cancer diagnosed from an EUS–FNA (fine needle aspiration) sample. Data were collected on patient demographics and clinical characteristics, inclusive of specific post-diagnosis treatment course. An “event rate” was calculated and is defined as the number of positive pancreatic cancer diagnoses on EUS–FNA from all patients presenting with acute idiopathic or chronic pancreatitis who underwent an EUS examination following a CT and/or MRI study negative for pancreatic mass lesion.

Results

A total of 565 patients met inclusion criteria, with 30 cases of confirmed pancreatic cancer diagnosed with EUS–FNA from this group. The event rate for EUS diagnosis of pancreatic cancer was 5.3%. The majority of patients (52.0%) diagnosed with cancer were stages I–II.

Conclusions

Endoscopic ultrasound should be a routine part of the diagnostic algorithm when evaluating a patient with acute idiopathic or chronic pancreatitis of unclear etiology, particularly when cross-sectional imaging is negative for a mass lesion and clinical suspicion is high for neoplasia. Further prospective studies are needed to evaluate the role of EUS in this setting.

Keywords

Chronic pancreatitis Idiopathic pancreatitis Endoscopic ultrasound Pancreatic cancer 

Notes

Compliance with Ethical Standards

Conflict of interest

No authors have any conflict of interest or financial interest to report associated with this research.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Division of Gastroenterology and Hepatology, Center for Advanced Therapeutic EndoscopyUniversity of Rochester Medical CenterRochesterUSA

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