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Comparison of Linear Array Endoscopic Ultrasound and Helical Computed Tomography for the Staging of Periampullary Malignancies

From the Departments of Surgery (DER, SRG, MDL, JMD) and Gastroenterology (MP, IJ), New York Presbyterian Hospital-Cornell Medical Center; and Joan and Sanford I. Weill Medical College of Cornell University (DER, MP, SRG, MDL, PJC, IJ, JMD), New York, New York.

Correspondence: Address correspondence and reprint requests to: John M. Daly, MD, Temple University School of Medicine, 3420 North Broad Street, Philadelphia, PA 19140; Fax: 215-707-8431; E-mail: dalyj{at}mail.temple.edu

Background: The purpose of this study was to compare linear array endoscopic ultrasound (EUS) and helical computed tomography (CT) scan in the preoperative local staging evaluation of patients with periampullary tumors.

Methods: Patients evaluated with EUS and CT for suspected periampullary malignancies from 1996 to 2000 were analyzed. Surgical/pathology staging results were the reference standard.

Results: Forty-eight patients (28 men and 20 women; mean age, 62 ± 4.9 years; range, 18–90 years) were identified. Malignancy was histologically confirmed in 44 patients. Parameters evaluated included tumor size, lymph node metastases, and major vascular invasion. EUS was significantly more sensitive (100%), specific (75%), and accurate (98%) than helical CT (68%, 50%, and 67%, respectively) for evaluation of the periampullary mass (P < .05). In addition, EUS detected regional lymph node metastases in more patients than helical CT. Sensitivity, specificity, and accuracy of EUS were 61%, 100%, and 84%, in comparison to 33%, 92%, and 68%, respectively, with CT. Major vascular involvement was noted in 9 of 44 patients. EUS correctly identified vascular involvement in 100% compared with 45% with CT (P < .05).

Conclusions: Linear array EUS was consistently superior to helical CT in the preoperative local staging of periampullary malignancies.

Key Words: Endoscopic ultrasound • Computed tomography • Periampullary cancer • Pancreatic cancer

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