Comparison of endoscopic ultrasound and computed tomography for the staging and determination of resectability of pancreatic cancer

Devereaux, Benedict Michael (2006). Comparison of endoscopic ultrasound and computed tomography for the staging and determination of resectability of pancreatic cancer MPhil Thesis, School of Medicine, University of Queensland.

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Author Devereaux, Benedict Michael
Thesis Title Comparison of endoscopic ultrasound and computed tomography for the staging and determination of resectability of pancreatic cancer
School, Centre or Institute School of Medicine
Institution University of Queensland
Publication date 2006
Thesis type MPhil Thesis
Supervisor Associate Professor Barbara Leggett
Subjects 300509 Radiology and Imaging
Abstract/Summary Pancreatic cancer remains a dismal disease. Despite vast advances in pancreas imaging technology over the past three decades, our ability to predict a patient's suitability for attempted curative surgical resection remains very limited. The two primary objectives of this body of work were to critically appraise the available literature comparing computed tomography (CT) and endoscopic ultrasound (EUS) and then compare the latest generations of these two techniques in a prospective study. The most common imaging modalities currently used in the diagnosis and staging of pancreatic cancers are CT and EUS. Because of the controversy of this issue and inconsistent findings of the published studies, the literature is reviewed systematically to answer the question, "Does the current literature define which is the superior imaging modality, EUS or CT, for the preoperative assessment of pancreatic cancer?" This paper attempts to compare the test characteristics of EUS and CT across studies. More importantly, the methodological rigor of each study is assessed according to standards for assessing the validity of studies evaluating diagnostic tests. Between 1992 and June 2001, fourteen published studies appeared in the literature comparing endoscopic ultrasound and computed tomography for the staging and lor determination of resectability of pancreatic neoplasms, pancreatic and ampullary neoplasms or pancreatic and biliary neoplasms. Ten studies concluded that EUS was superior to CT for the staging of pancreatic cancer, while three concluded that EUS was inferior to CT for the determination of resectability of pancreatic cancer. One study concluded that EUS and CT were equivalent for the staging of pancreatic cancer. A large, prospective study was needed to determine the optimal imaging modality. During a two Fellowship at Indiana University Medical Centre in Indianapolis, Indiana, in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound the author established a multidisciplinary group for the study of pancreatic neoplasms. The author formulated and conducted the study: Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. This was a prospective, single-center, observational study. Of the 482 patients screened, 154 were eligible and 120 were enrolled. No procedural complications fkom CT or endoscopic ultrasonography were noted. Of 104 patients, 63 (61%) underwent surgery. In this study, endoscopic ultrasonography was superior to multidetector CT for tumour detection and tumour staging but equivalent for nodal staging and determination of resectability of preoperatively suspected locoregional pancreatic cancer. These data suggest that detection of peritumoural adenopathy is not essential for assessing resectability of pancreatic neoplasms, particularly for masses located in the head of the pancreas. No significant difference was found between endoscopic ultrasonography and multidetector CT for preoperative determination of tumour resectability. Importantly, concordance for resectability between these tests does not seem to improve assessment compared with either test alone. Therefore, if multidetector CT detects a pancreatic mass that appears resectable in an appropriate surgical candidate with suspected cancer, preoperative endoscopic ultrasonography does not seem to be necessary unless tissue confirmation of suspected cancer is desired. However, when multidetector CT fails to detect a mass in patients with suspected pancreatic cancer, we believe that preoperative endoscopic ultrasonography is necessary for tumour detection. This study and the extensive review of the published literature affirms the role of EUS in the preoperative assessment of pancreatic cancer. One of the key factors limiting the applicability of this study's results is the unavailability of expert endosonographers in Australia. The challenge, therefore will be to adequately train therapeutic endoscopists in this technique making EUS available to patients with pancreatic cancer.

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Created: Fri, 21 Nov 2008, 14:58:44 EST