الفهرس 
Solid pancreatic masses
Solid pseudopapillary tumor of the pancreasOnly 14 pages are availabe for public view
 |  | from | 216 |  |  |
| | | from | 216 | | |
Abstract
may be caused by various etiologies including pancreatic tumors whether malignant or benign. Pancreatic adenocarcinoma is the most common malignant SPL with 5-year survival rates of less than 5% , therefore early and accurate diagnosis of pancreatic focal lesions would help to decrease such disease related morbidity and mortality and improve the efficacy of treatment. Therefore, the aim of this study was to evaluate the role of endosonography in the diagnosis of SPL in comparison with the various radiological studies (CT and MRI), and to determine the diagnostic value of EUS-FNA and elastography in the differentiating between benign and malignant pancreatic lesions. This prospective study was conducted in the endoscopy unit, Kasr Al Aini Hospitals, Cairo University in the period between March 2017 to March 2018. The study included 50 patients with SPL (33 males and 17 females). Inclusion criteria: Patients ≥ 18 years old. Patients with identified SPL from prior radiological imaging (CT or MRI). Patients with extrahepatic biliary obstruction and suspected to have pancreatic lesion with negative imaging results and referred for EUS. Exclusion criteria: Patients with cystic pancreatic lesions identified by radiological imaging or EUS Patients with contraindication to the procedure. Patients who declined to participate to the study. Patients whose final diagnosis couldn’t be reached. Patients were divided into 2 groups, malignant pancreatic mass group including 38 patients and benign pancreatic mass group including 12 patients. All patients were subjected to carful history taking, thorough clinical examination, laboratory investigations, pelvi-abdominal ultrasonography and other imaging modalities (CT scan of abdomen and pelvis and/or; MRI of abdomen and pelvis and/or; MRCP &/or; ERCP). EUS examination was done to all patients by one endosongrapher and for EUS-FNA biopsies; we used the Cook needle 22G. Elastography was done to all patients by both the qualitative technique using the 5 score classification system and the semi-quantitative technique using the strain ratio. Final diagnosis of malignant or benign tumor was defined according to the following: (1) Histology of surgical specimens in cases undergoing surgery; (2) A definitely positive cytology by EUS-FNA for malignancy together with compatible EUS and CT scan findings for final diagnosis of malignant disease in unresectable tumors; and (3) EUS and CT scan findings at entry, clinical presentation, and a minimum follow-up period of 6 months including EUS ± FNA and CT scan, for final diagnosis of benign disease in cases of benign cytology. SPL were shown to be benign in 12 patients and malignant in 38 patients. Elastography score alone had a sensitivity of 89.4%, a specificity of 75%, a PPV of 91.8% and an NPV of 69.2% and an accuracy of 86%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 8.4 with a sensitivity of 92.1%, specificity of 83.3%, PPV of 94.6%, NPV of 76.9% and an accuracy of 93.1%. Adding both elastography to strain ratio (cut-off level 8.4) resulted in a sensitivity of 94.7%, specificity of 83.3%, PPV of 94.7%, NPV of 83.3% and accuracy of 94.3% for the diagnosis of SPL.