Pedro Moutinho-Ribeiro, MD, MSc, Pedro Costa-Moreira, MD, Rui Morais, MD, Filipe Vilas-Boas, MD, Susana Lopes, MD, PhD, Guilherme Macedo, MD, PhD, FACG
Centro Hospitalar São Joãoo / Porto University / WGO Porto Gastroenterology and Hepatology Training Center, Porto, Porto, Portugal
Introduction: Computed Tomography (CT) and Endoscopic Ultrasound (EUS) with or without tissue acquisition have been widely used for diagnosing and staging pancreatic adenocarcinoma (PDAC). Previous studies showed conflicting results in the pathologic findings and the role of each modality in diagnosis and staging this disease is still mater of discussion.
We aimed to compare CT and EUS in terms of mass detection, mass size, vascular and lymph node involvement and metastatic disease detection according to TNM Classification of Malignant Tumors (8thedition).
Methods: We included a consecutive sample of patients proposed for EUS for diagnosis/staging of PDAC in which a CT scan was performed in the same institution (within one-month period) between 2016 and 2018, in a tertiary referral center. Concordance between CT and EUS was assessed using a retrospective chart review and statistical analysis with Cohen's κ.
Results: We evaluated 44 patients with a median age of 66.9±11.6 years, 52% were male. The median follow-up after EUS was 4 (IQR 0-10) months. All cases were submitted to tissue acquisition, with pathologic confirmation of PDAC in 91% (n=40). Only 5 patients were submitted to surgical resection. EUS and CT agreed in TNM staging in 41% of the cases. The sub analysis for TNM categories revealed a concordance rate in 66% of the cases for T stage, 75% for N stage and 73% for M stage. In the T-stage, the highest non-concordance rate was found for T4: of the 16 cases with involvement of the celiac axis or the superior mesenteric artery identified in CT, only 7 cases (44%) were classified as T4 in EUS staging. Global Cohen's κ between two imaging methods was low: 0.25 (p< 0.01). However, when applied to each TNM category, we found values of 0.58 (T, p< 0.01), 0.36 (N, p< 0.01) and 0.7 (M, p< 0.01).
Discussion: Between TNM categories, CT and EUS agreed moderately well in the definition of T stage. Discrepancies between the two modalities were more common in those with T4 (unresectable) disease. EUS, with tissue acquisition, has the unique capacity to provide the definite cytohistological diagnosis. Clinicians should consider the role of both methods for proper diagnosis and staging of PDAC.
Citation: Pedro Moutinho-Ribeiro, MD, MSc, Pedro Costa-Moreira, MD, Rui Morais, MD, Filipe Vilas-Boas, MD, Susana Lopes, MD, PhD, Guilherme Macedo, MD, PhD, FACG. P0007 - ENDOSCOPIC ULTRASOUND IN THE DIAGNOSIS AND STAGING OF PANCREATIC CANCER: A COMPARISON WITH COMPUTER TOMOGRAPHY IMAGING. Program No. P0007. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.