Original Article: Clinical Endoscopy
Diagnostic performance of EUS for chronic pancreatitis: a comparison with histopathology

https://doi.org/10.1016/j.gie.2006.09.026Get rights and content

Background

EUS has been proposed as a minimally invasive and accurate test to detect chronic pancreatitis (CP).

Objective

To investigate the correlation between EUS criteria and histopathology grading in patients with presumed CP.

Design

Retrospective study.

Setting and Patients

Patients who received pancreatic surgery according to presumed CP from the Medical University of South Carolina surgical database between 1995 and 2003 were identified and included if EUS was performed within 1 year before surgery. The number of EUS criteria for CP was compared with a histologic fibrosis score (FS).

Main Outcome Measurements

Sensitivity and specificity of number of EUS criteria compared with FS.

Results

Seventy-one patients were identified (38 women). Median FS was 7 (range, 0-12). Of the patients with calcifications: calcifications were detected by EUS in 30 (42%), 14 (47%) had calcifications missed by other imaging modalities, and 28 (93%) were confirmed to have abnormal histology (FS ≥ 2). Of the patients without calcifications: in the 41 patients without calcifications on EUS, 36 (88%) had FS ≥ 2; median FS was 5 (range, 0-12); the correlation between the number of EUS criteria and FS was low but statistically significant (r = 0.40; P = .01). Three or more EUS criteria provided the best balance of sensitivity (83.3%) and specificity (80.0%) for predicting abnormal histology.

Limitations

Retrospective study. All patients were believed to need surgery.

Conclusions

A threshold of 3 or more EUS criteria provides the best balance of sensitivity and specificity for histologic pancreatic fibrosis. Calcifications seen by EUS but missed by other imaging are common in this group of patients.

Section snippets

Patients and methods

All patients between 1995 and 2003 with chronic pain and presumed CP undergoing a pancreatic surgery that involved obtaining an intraoperative histologic specimen were identified from the Medical University of South Carolina surgical database. Patients were included in the study if an EUS was performed within 1 year before surgery. Pancreatic malignancies were excluded. All EUS procedures were performed by experienced endosonographers at a single center by using radial echoendoscopes (EU-M20,

Results

A total of 71 patients were eligible, all of whom had clinical features consistent with CP. Thirty-eight were women (54%). The age range of the cohort was 18 to 73 years, with a mean of 45 years. The specimens were obtained from the following procedures: distal pancreatectomy in 19 (27%), lateral pancreaticojejunostomy in 25 (35%), pancreaticoduodenostomy in 26 (37%), and a total pancreatectomy in 1 (1%). In patients with lateral pancreaticojejunostomies, the specimen evaluated by histology

Discussion

This is, to date, the largest study comparing EUS findings with histopathology in CP in human beings. The only other study to do so, published in abstract form, compared EUS findings with histopathology in 6 patients with CP.6 One other study compared intraductal US (IDUS) with ex vivo pancreatic specimens but did not specifically address the correlation between the number of IDUS features and histologic changes in patients with CP.7

The cutoff number of EUS criteria used to diagnose CP has

References (21)

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