Ann Chen

Publication Details

• Predictive Value of Pancreatic Ductal Dilation on Endoscopic Ultrasound Diagnosis of Pancreatic Cancer

  Nguyen W, Chen AM, Chen W, Lee J, Muthusamy V, Mclaren C, Chang K. Gastrointestinal Endoscopy. 2007; 65 (5): AB298

  Background: Endoscopic ultrasound (EUS) provides superior imaging resolution of the pancreas but benign parenchymal changes can mimic mass-like lesions and cytology is essential for diagnosis. Tumors in the head of the pancreas will often cause dilation of the main pancreatic duct (PD). Whether PD size in the upstream body/tail of pancreas can predict the presence of downstream malignant tumor is unknown. Methods: Data on patients undergoing EUS at our institution from 11/2005 to 11/2006 for possible pancreatic tumor were analyzed. Patients found with a suspected mass in the head or neck of the pancreas who underwent fine needle aspiration were included in the study. Benign histologic diagnosis was confirmed by repeat EUS or by clinical follow-up. The predictive value of age, gender, and pancreatic duct diameter at the body and tail of the pancreas for malignant tumors in the head/neck of the pancreas was evaluated. Data were analyzed using univariate analysis and multivariate logistic regression. Results: Ninety-four patients (52 men, 42 women) who underwent FNA for lesions found on EUS in the head or neck of the pancreas were studied. Twenty-four patients had a final benign diagnosis and 70 had malignant tumors (adenocarcinoma [n = 62], neuroendocrine tumor [n = 5], lymphoma [n = 3]). Age (mean 71 vs. 64 years, p = 0.01) diameter of PD in the body (median 3.9 mm vs. 2.2 mm, p < 0.0001) and tail (mean 3.2 mm vs. 1.5 mm, p < 0.0001), but not gender (p = 0.7), was significantly different between the malignant and benign groups (See figure 1). Using a normal body PD size of 2 mm, the Odds Ratio of having a malignant tumor with a PD size between 2-3 mm was 2.4(p = 0.8); and with a PD size ≥3 mm was 8.7 (p = 0.0045). Conclusion: Pancreatic duct size greater than 3 mm as measured by EUS at the body and tail of the pancreas is highly predictive of a downstream malignant tumor.