Annals of Surgical Oncology

, Volume 10, Issue 8, pp 890–897 | Cite as

Comparison of Linear Array Endoscopic Ultrasound and Helical Computed Tomography for the Staging of Periampullary Malignancies

  • David E. Rivadeneira
  • Mark Pochapin
  • Stephen R. Grobmyer
  • Michael D. Lieberman
  • Paul J. Christos
  • Ira Jacobson
  • John M. DalyEmail author
Original Articles


Background: The purpose of this study was to compare linear array endoscopic ultrasound (EUS) and helical computed tomography (CT) scan in the preoperative local staging evaluation of patients with periampullary tumors.

Methods: Patients evaluated with EUS and CT for suspected periampullary malignancies from 1996 to 2000 were analyzed. Surgical/pathology staging results were the reference standard.

Results: Forty-eight patients (28 men and 20 women; mean age, 62 ± 4.9 years; range, 18–90 years) were identified. Malignancy was histologically confirmed in 44 patients. Parameters evaluated included tumor size, lymph node metastases, and major vascular invasion. EUS was significantly more sensitive (100%), specific (75%), and accurate (98%) than helical CT (68%, 50%, and 67%, respectively) for evaluation of the periampullary mass (P < .05). In addition, EUS detected regional lymph node metastases in more patients than helical CT. Sensitivity, specificity, and accuracy of EUS were 61%, 100%, and 84%, in comparison to 33%, 92%, and 68%, respectively, with CT. Major vascular involvement was noted in 9 of 44 patients. EUS correctly identified vascular involvement in 100% compared with 45% with CT (P < .05).

Conclusions: Linear array EUS was consistently superior to helical CT in the preoperative local staging of periampullary malignancies.

Key Words

Endoscopic ultrasound Computed tomography Periampullary cancer Pancreatic cancer 


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  1. 1.
    Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455–65.CrossRefPubMedGoogle Scholar
  2. 2.
    Baumel H, Hugier M, Manderscheid JC, et al. Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery. Br J Surg 1994;81:102–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 1995;221:721–31.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Rosch T, Briag C, Gain T, et al. Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography: comparison with conventional sonography, computed tomography, and angiography. Gastroenterology 1992;102:188–99.CrossRefPubMedGoogle Scholar
  5. 5.
    Campell JP, Wilson SR. Pancreatic neoplasms: how useful is evaluation with US? Radiology 1988;167:341–44.CrossRefGoogle Scholar
  6. 6.
    Freeny PC, Ball TJ. ERCP (endoscopic retrograde cholangiopancreatography) and PTC (percutaneous transhepatic cholangiography) in the evaluation of suspected pancreatic disease. Radiology 1988;166:125–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Mueller MF, Meyenberger C, Bertschinger P, et al. Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology 1994;190:745–51.CrossRefGoogle Scholar
  8. 8.
    Megibow AJ, Zhou XH, Rotterdam H, et al. Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability—report of the Radiology Diagnostic Oncology Group. Radiology 1995;195:327–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Warshaw AL, Gu Z, Wittenberg J, Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990;125:230–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Garra BS, Shawker TH, Doppman JL, Sindelar WF. Comparison of angiography and ultrasound in the evaluation of the portal venous system in pancreatic carcinoma. J Clin Ultrasound 1987;15:83–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Freeny PC, Marks WM, Ryan JA, Traverso LW. Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. Radiology 1988;166:125–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Ross CB, Sharp KW, Kaufman AJ, Andrews T, Williams LF. Efficacy of computerized tomography in the preoperative staging of pancreatic carcinoma. Am Surg 1988;54:221–6.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Palazzo L, Roseau G, Gayet B, et al. Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma: results of a prospective study, with comparison to ultrasonography and CT scan. Endoscopy 1993;25:143–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Yasuda K, Mukai H, Fujimoto S, et al. The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc 1988;34:1–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Rosch T, Lorenz R, Braig C, et al. Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc 1991;37:347–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Palazzo L. Staging of pancreatic carcinoma by endoscopic ultrasonography. Gastroenterology 1992;102:188–99.CrossRefGoogle Scholar
  17. 17.
    Ward EM, Stephens DH, Sheedy PR. Computed tomographic characteristics of pancreatic carcinoma: an analysis of 100 cases. Radiographics 1983;4:525–30.Google Scholar
  18. 18.
    Winkelmann M, Schoppe WD, Volke N, et al. Correlation of abdominal CT imaging with autopsy findings in patients with malignant tumors. J Cancer Res Clin Oncol 1987;113:279–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Bluemke DA, Cameron JL, Hruban RH, et al. Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 1995;197:381–5.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Bluemke DA, Fishman EK. CT and MR evaluation of pancreatic cancer. Surg Clin North Am 1998;7:103–24.CrossRefGoogle Scholar
  21. 21.
    Isenberg G, Chak A, Canto MI, et al. Endoscopic ultrasound in restaging of esophageal cancer after neoadjuvant chemoradiation. Gastrointest Endosc 1998;48:158–63.CrossRefPubMedGoogle Scholar
  22. 22.
    Levy M, Hammel P, Lamarque D, et al. Endoscopic ultrasonography for the initial staging and follow-up in patients with low-grade gastric lymphoma of mucosa-associated lymphoid tissue treated medically. Gastrointest Endosc 1997;46:328–33.CrossRefPubMedGoogle Scholar
  23. 23.
    Rotondano G, Esposito P, Pellecchia L, et al. Early detection of locally recurrent rectal cancer by endosonography. Br J Radiol 1997;70:567–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Rivadeneira DE, Wong WD. Preoperative staging of rectal cancer. Clin Colon Rectal Surg 2002;1:17–26.CrossRefGoogle Scholar
  25. 25.
    Gress F, Savides T, Cummings O, et al. Radial scanning and linear array endosonography for staging pancreatic cancer: a prospective randomized comparison. Gastrointest Endosc 1997;45:138–42.CrossRefPubMedGoogle Scholar
  26. 26.
    Kochman ML, Elta GH, Bude R, et al. Utility of a linear array ultrasound endoscope in the evaluation of suspected pancreatic disease. J Gastrointest Surg 1998;2:217–222.CrossRefPubMedGoogle Scholar
  27. 27.
    Sugiyama M, Hagi H, Atomi Y, Saito M. Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography. Abdom Imaging 1997;22:434–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Jenkel, JF eds. 1996Epidemiology, Biostatistics, and Preventive Medicine.WB SaundersPhiladelphia:8991Google Scholar
  29. 29.
    Midwinter MJ, Beveridge CJ, Wilsdon JB, Bennett MK, Baudouin CJ, Charnley RM. Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumors. Br J Surg 1999;86:189–93.CrossRefPubMedGoogle Scholar
  30. 30.
    Gress FG, Hawes RH, Savides TJ, et al. Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience. Gastrointest Endosc 1999;50:786–91.CrossRefPubMedGoogle Scholar
  31. 31.
    Chang K, Nguyen P, Erickson RA, et al. The clinical utility of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997;45:387–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Tio TL, Tytgat GN, Cikot RJ, Houthoff HJ, Sars PR. Ampullopancreatic carcinoma: preoperative TNM classification with endosonography. Radiology 1990;175:455–61.CrossRefPubMedGoogle Scholar
  33. 33.
    Howard TJ, Chin AC, Streib EW, et al. Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma. Am J Surg 1997;174:237–41.CrossRefPubMedGoogle Scholar
  34. 34.
    Legmann P, Vignaux O, Dousset B, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998;170:1315–22.CrossRefPubMedGoogle Scholar
  35. 35.
    Akahoshi K, Chijiiwa Y, Nakano I, et al. Diagnosis and staging of pancreatic cancer by endoscopic ultrasound. Br J Radiol 1998;71:492–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Kubo H, Chijiiwa Y, Akahoshi K, et al. Pre-operative staging of ampullary tumours by endoscopic ultrasound. Br J Radiol 1999;72:443–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Cannon ME, Carpenter SL, Elta GH, et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 1999;50:27–33.CrossRefPubMedGoogle Scholar
  38. 38.
    Shoup M, Hodul P, Aranha GV, et al. Defining a role for endoscopic ultrasound in staging periampullary tumors. Am J Surg 2000;179:453–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Schwarz M, Pauls S, Sokiranski R, et al. Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective? Am J Surg 2001;182:243–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Chen CH, Tseng LJ, Yang CC, Yeh YH. Preoperative evaluation of periampullary tumors by endoscopic sonography, transabdominal sonography, and computed tomography. J Clin Ultrasound 2001;29:313–21.CrossRefPubMedGoogle Scholar
  41. 41.
    Skordilis P, Mouzas IA, Dimoulios PD, et al. Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study. BMC Surg 2002;2:1–8.CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    Meining A, Dittler HJ, Wolf A, et al. You get what you expect? A critical appraisal of imaging methodology in endosonographic cancer staging. Gut 2002;50:599–603.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • David E. Rivadeneira
    • 1
  • Mark Pochapin
    • 2
    • 3
  • Stephen R. Grobmyer
    • 1
  • Michael D. Lieberman
    • 1
  • Paul J. Christos
    • 3
  • Ira Jacobson
    • 2
    • 3
  • John M. Daly
    • 3
    • 4
    Email author
  1. 1.Department of SurgeryNew York Presbyterian Hospital-Cornell Medical CenterNew York
  2. 2.Department of GastroenterologyNew York Presbyterian Hospital-Cornell Medical CenterNew York
  3. 3.Joan and Sanford I. Weill Medical College of Cornell UniversityNew York
  4. 4.Temple University School of MedicinePhiladelphia

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