Pancreatic carcinomas smaller than 3.0cm: endosonography (EUS) in diagnosis, staging and prediction of resectability

BackgroundThe size of a pancreatic carcinoma determines prognosis and resection. The aim of this study was to review our clinical experience with endoscopic ultrasound (EUS) in diagnosing and staging pancreatic tumours <3.0 in diameter.MethodsFrom February 1997 to October 2000 medical records and results of abdominal ultrasound (US), spiral computed tomography (CT) and EUS with fine‐needle aspiration biopsy (FNA) were reviewed in 17 patients operated for histologically proven pancreatic adenocarcinoma measuring ≤3.0cm in diameter. The mean age of the patients was 64 years (range 42–76 years).ResultsUS identified a pancreatic lesion in 11/17 (65%) patients. Spiral CT showed a total of 16/17 (94%) patients with a lesion. EUS identified pancreatic tumour in all patients (100%), and tissue was obtained from 15/17 patients (88%). Mean tumour size was 2.5cm (range 0.8–3.0cm). EUS accuracy in evaluating the portal vessels was 78%, superior mesenteric artery 100%, tumour stage (T) 88%, isolated node stage (N) 65% and combined TN staging was 53%. Regarding resectability, EUS sensitivity was 88%, specificity 89%, negative predictive value 89%, positive predictive value 88% and accuracy 88%. Besides cytological material, EUS‐FNA histological diagnosis was possible in 12/17 patients (71%). There was only one case of mild post‐procedure acute pancreatitis.ConclusionEUS‐FNA is safe and has high diagnostic (100%) and local staging (88%) accuracy in pancreatic cancers