EUS diagnosis of vascular invasion in pancreatic cancer: Surgical and histologic correlates

Harry Aslanian, Ronald Salem, Jeffrey Lee, Dana Andersen, Marie Robert, Mark Topazian

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Abstract

BACKGROUND: Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses. METHODS: All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor. RESULTS: 30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered. CONCLUSIONS: EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)1381-1385
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume100
Issue number6
DOIs
StatePublished - Jun 2005
Externally publishedYes

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Pancreatic Neoplasms
Blood Vessels
Sensitivity and Specificity
Neoplasms
Surgical Pathology
Palpation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

EUS diagnosis of vascular invasion in pancreatic cancer : Surgical and histologic correlates. / Aslanian, Harry; Salem, Ronald; Lee, Jeffrey; Andersen, Dana; Robert, Marie; Topazian, Mark.

In: American Journal of Gastroenterology, Vol. 100, No. 6, 06.2005, p. 1381-1385.

Research output: Contribution to journalArticle

Aslanian, Harry ; Salem, Ronald ; Lee, Jeffrey ; Andersen, Dana ; Robert, Marie ; Topazian, Mark. / EUS diagnosis of vascular invasion in pancreatic cancer : Surgical and histologic correlates. In: American Journal of Gastroenterology. 2005 ; Vol. 100, No. 6. pp. 1381-1385.
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abstract = "BACKGROUND: Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses. METHODS: All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. {"}Vascular adherence{"} was defined as tumor adherence requiring vascular resection during surgery, and {"}vascular invasion{"} as histologic invasion of vessel wall by tumor. RESULTS: 30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18{\%} of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29{\%} of those with loss of echoplane alone, and 50{\%} of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12{\%} of patients with an intact echoplane, 0{\%} of those with loss of echoplane alone, and 33{\%} of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63{\%}, 64{\%}, 43{\%} and 80{\%} for vascular adherence and 50{\%} 58{\%}, 28{\%} and 82{\%} for vascular invasion. NPV rose to 90{\%} for vascular adherence if only the portal confluence vessels were considered. CONCLUSIONS: EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.",
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AU - Aslanian, Harry

AU - Salem, Ronald

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AU - Andersen, Dana

AU - Robert, Marie

AU - Topazian, Mark

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N2 - BACKGROUND: Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses. METHODS: All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor. RESULTS: 30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered. CONCLUSIONS: EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.

AB - BACKGROUND: Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses. METHODS: All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified. The relationship of pancreatic masses to adjacent vessels was prospectively assessed by EUS. EUS findings were compared to surgical and pathology gold standards. "Vascular adherence" was defined as tumor adherence requiring vascular resection during surgery, and "vascular invasion" as histologic invasion of vessel wall by tumor. RESULTS: 30 of 68 patients were resectable. Among these 30, vascular adherence was present in 8, including 18% of patients with an intact echoplane between tumor and adjacent vessels at EUS, 29% of those with loss of echoplane alone, and 50% of those with additional EUS features of vascular involvement. Vascular invasion was present in 4, including 12% of patients with an intact echoplane, 0% of those with loss of echoplane alone, and 33% of those with additional EUS features. Sensitivity, specificity, PPV, and NPV of EUS were 63%, 64%, 43% and 80% for vascular adherence and 50% 58%, 28% and 82% for vascular invasion. NPV rose to 90% for vascular adherence if only the portal confluence vessels were considered. CONCLUSIONS: EUS has poor sensitivity, specificity, and positive predictive value for diagnosis of venous involvement by pancreatic cancer.

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