4550 Endoscopic ultrasound in the preoperative staging of pancreatic cancer.

Abstract

Background and Aims: Endoscopic ultrasound (EUS) is believed to be highly accurate in the T- and N-staging of pancreatic cancer. However, there is scant data demonstrating the predictive value of EUS for determining resectability of pancreatic adenocarcinoma. This study was performed to a) determine the accuracy of TNM staging by EUS in patients with pancreatic adenocarcinoma and b) to evaluate the role of preoperative TNM staging by EUS for determining resectability in patients with pancreatic adenocarcinoma. Methods: We performed a retrospective review of a cohort of 89 patients evaluated preoperatively with EUS for pancreatic adenocarcinoma between January 1995 and December 1997. Preoperative TNM classification by EUS was compared with surgical and histopathological TNM staging. Resectability rates were determined and compared to the preoperative TNM staging by EUS. Results: The overall accuracy of EUS for T- and N-staging was found to be 69% and 54%, respectively. The overall proportion of tumors that were deemed resectable by EUS and were actually found to be resectable during surgical exploration was 46%. The proportion of tumors staged as T4N1, T4N0, T3N1 and T3N0 by EUS that were found to be resectable during surgical exploration was 45%, 37%, 44% and 62%, respectively. Conclusions: In a tertiary referral population, EUS is not as accurate as previously reported in the T- and N- staging of pancreatic cancer. EUS is also not predictive of resectability in stage T3 or T4 pancreatic cancer. Background and Aims: Endoscopic ultrasound (EUS) is believed to be highly accurate in the T- and N-staging of pancreatic cancer. However, there is scant data demonstrating the predictive value of EUS for determining resectability of pancreatic adenocarcinoma. This study was performed to a) determine the accuracy of TNM staging by EUS in patients with pancreatic adenocarcinoma and b) to evaluate the role of preoperative TNM staging by EUS for determining resectability in patients with pancreatic adenocarcinoma. Methods: We performed a retrospective review of a cohort of 89 patients evaluated preoperatively with EUS for pancreatic adenocarcinoma between January 1995 and December 1997. Preoperative TNM classification by EUS was compared with surgical and histopathological TNM staging. Resectability rates were determined and compared to the preoperative TNM staging by EUS. Results: The overall accuracy of EUS for T- and N-staging was found to be 69% and 54%, respectively. The overall proportion of tumors that were deemed resectable by EUS and were actually found to be resectable during surgical exploration was 46%. The proportion of tumors staged as T4N1, T4N0, T3N1 and T3N0 by EUS that were found to be resectable during surgical exploration was 45%, 37%, 44% and 62%, respectively. Conclusions: In a tertiary referral population, EUS is not as accurate as previously reported in the T- and N- staging of pancreatic cancer. EUS is also not predictive of resectability in stage T3 or T4 pancreatic cancer.