Differentiation of pancreatic ductal adenocarcinoma from other neoplastic solid pancreatic lesions: a tertiary oncology center experience

作者：Krishna Somashekar G; Li Feng; Bhattacharya Abhik; Ladha Harshad; Porter Kyle; Singh Amanpal; Ross William A; Bhutani Manoop S; Lee Jeffrey H^*

来源：Gastrointestinal Endoscopy, 2015, 81(2): 370-379.

DOI：10.1016/j.gie.2014.08.023

Background: Pancreatic ductal adenocarcinoma (PDAC), pancreatic neuroendocrine tumors (pNET), and metastatic lesions (pMET) are the most common neoplastic solid pancreatic lesions (SPLs). Early diagnosis enables prompt treatment.
Objective: To identify factors differentiating PDAC from non-PDAC lesions and assess the accuracy of EUS-guided FNA.
Design and Setting: Retrospective tertiary center.
Patients and Intervention: Consecutive patients referred for EUS evaluation of SPLs from 2004 to 2011.
Main Outcome Measurements: Pretest (preceding EUS-guided FNA [EUS-FNA]) predictors of PDAC among neoplastic SPLs and accuracy of EUS-FNA.
Results: A total of 1333 EUS scans with 1108 EUS-FNAs were performed for pancreatic lesions. Of the 672 patients with neoplastic SPLs, 528 had PDAC and 144 non-PDAC. The sensitivity, specificity, positive predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 97.3%, 99.3%, 99.8%, and 97.8%, respectively. Years of EUS experience significantly correlated with fewer needle passes (R-s = -0.18, P < .001). Controlling for all potential confounders, multivariable regression analysis demonstrated that patients with PDAC compared with pNETs and pMETs were older (odds ratio [OR] 4.42; 95% confidence interval [CI], 2.1-9.5; P < .001), had weight loss (OR 3.0; 95% CI, 1.6-5.4; P < .001), hyperbilirubinemia (OR 3.7; 95% CI, 1.8-7.5; P < .001), elevated CA19-9 (OR 6.9; 95% CI, 2.4-20.3; P < .01), evidence of arterial invasion (OR 6.5; 95% CI, 2.7-15.4; P < .001), and PD dilation (OR 3.3; 95% CI, 1.8-5.9; P < .001).
Limitations: Retrospective design, single center.
Conclusions: When evaluating neoplastic SPLs, demographic, clinical, laboratory, and imaging characteristics can reliably discern and suggest PDAC. In addition, EUS-FNA is exceedingly sensitive and specific for PDAC.

• 出版日期2015-2