Endoscopic Ultrasonography in Suspected Pancreatic Malignancy and Indecisive CT

Background: In the assessment of patients with a clinical suspicion of malignant pancreatic disease, computed tomography (CT) findings are sometimes negative or inconclusive.

Aims: To determine whether endoscopic ultrasonography (EUS) with or without fine needle aspiration (EUS÷FNA) was conclusive in patients with a clinical suspicion of pancreatic malignancy, in whom CT scan was negative or inconclusive.

Methods: Retrospective case series in a tertiary referral centre. From February 2006 to December 2007, EUS÷FNA was performed in all patients suspected of having malignant pancreatic disease with negative or inconclusive CT findings. Main outcome measurement was the diagnostic yield of EUS in these patients.

Results: 34 patients had a negative (n=11) or inconclusive (n=23) CT scan. EUS÷FNA established a correct diagnosis in 30÷34 cases (88%). Malignancy was diagnosed in 19÷34 patients and nonmalignant disease in 8÷34 cases. In 3÷34 patients no lesions were found and no malignant disease developed during follow-up (mean=728 days). EUS÷FNA was inconclusive in 4÷34 patients.

Conclusion: In patients with a clinical suspicion of pancreatic malignancy with negative or inconclusive CT findings, EUS÷FNA was able to establish a diagnosis in 88% of cases. EUS should therefore be considered a diagnostic modality in this complex group of patients.