Endoscopic ultrasound identifies pancreatic lesions missed by abdominal CT

Endoscopic ultrasound identified pancreatic lesions when abdominal CT findings showed only enlarged or prominent pancreas. This finding is a common result of CT scans of the pancreas, but its clinical significance is unclear. One group of researchers that followed up such CT scans using endoscopic ultrasound was able to conclusively identify lesions, including pancreatic cancer.

Dr. Shailender Singh of the department of gastroenterology and hepatology at the University of Kansas Medical Center and colleagues published the results in Digestive Diseases and Sciences, which made the report available March 5. The researchers studied 107 consecutive patients, 56 men and 51 women, with inconclusive CT results. Their aim was to identify pancreatic lesions using endoscopic ultrasound and perform ultrasound-guided fine-needle aspiration for histological analysis.

Using endoscopic ultrasound, the researchers were able to diagnose 22 patients, or 21%, with pancreatic adenocarcinoma and 14 patients, or 13%, with chronic pancreatitis. The risk of a cancer diagnosis was higher in patients with significant weight loss (OR 10.1; 95% CI: 3.3-30.6), hyperbilirubinemia (OR 9; 95% CI: 3-26), or common bile duct dilatastion (OR 3.2; 95% CI: 1.25-8.5).

Benign lesions were identified in 28 patients, or 26%, and 35 scans, or 33%, were normal.

The researchers concluded that endoscopic ultrasound is an effective way to follow up on inconclusive pancreatic CT findings, especially for patients with pancreatic cancer warning signs such as hyperbilirubinemia, significant weight loss, or common bile duct dilatation. Their study showed that ultrasound allowed for prompt diagnosis and treatment of serious conditions, including cancer.