الفهرس | Only 14 pages are availabe for public view |
Abstract Accumulated evidence has revealed that endoscopic ultrasonography (EUS) has had a great impact on the clinical evaluation of pancreatic tumors. Accordingly, the aim of this work was to assess the role of EUS in the diagnosis of pancreatic tumors. This was an observational cross-sectional study conducted at the Alexandria Fever Hospital from January 2018 to December 2021. The study included 80 patients who presented with clinical and laboratory manifestations of pancreatic tumors and were subjected to EUS. Most of the patients were males (62.5%), with ages ranging from 28 to 83 years with a mean of 56.6 ± 12.52 years. Most of them reported a history of jaundice (72.5%) and abdominal pain (75.0%). Only 27.5% of them reported having palpable abdominal mass on examination. The commonest site of pancreatic tumors was the head of the pancreas (55%) followed by the pancreatic body (17.5%), ampulla (10.0%), the uncinate process (7.5%), and lastly, only 5% had tumor site at the CBD and Tail. Also, most of the cases (62.5%) were with a size ≤3 cm. Using EUS, most of the lesions were solid (60.0%), had ill-defined margins (50%), were heterogeneous (47.5%), and hypovascular (75.0%). Extra-pancreatic extension was detected in 35%. Also, 47.5% had associated lymph nodes while only 30% had vascular involvement. Dilated CBD was demonstrated in 65% and dilated pancreatic duct in 57.7%. Regarding the consistency during the FNA, the majority of them (62.5%) were firm while 27.5% were soft and only 10% were hard. As regards CT, 45.0% of cases had a malignant lesion, 37.5% had benign lesions and 17.5% had an inflammatory lesion. By EUS, there were 55.0% with malignant lesions, 27.5% with benign lesions, and 17.5% with inflammatory lesions. Finally, regarding the histopathology, 57.5% of cases had a malignant lesion, 30.0% had benign lesions and only 12.5% had inflammatory lesions. The findings of the EUS and CT in comparison to the histopathological diagnosis as the gold standard for identification of the lesion revealed an accuracy for diagnosis of 90% and 70% for EUS and CT respectively. There was an excellent diagnostic performance of EUS in diagnosing malignant, benign, and inflammatory pancreatic lesions. The accuracy of EUS for diagnosing malignant lesions was 93% with 91% sensitivity, 94% specificity, 95% PPV, and 89% NPV. For benign lesions, EUS showed an accuracy of 93% with 83% sensitivity, 96% specificity, 91% PPV, and 93% NPV. While the EUS accuracy was 95% with 100% sensitivity, 94% specificity, 71% PPV, and 100% NPV for diagnosing inflammatory pancreatic lesions. There was a moderate to excellent diagnostic performance of CT in diagnosing malignant, benign, and inflammatory pancreatic lesions. The accuracy of CT for diagnosing malignant lesions was 83% with 74% sensitivity, 94% specificity, 94% PPV, and 73% NPV. For benign lesions, CT showed an accuracy of 78% with 75% sensitivity, 79% specificity, 60% PPV, and 88% NPV. While the CT accuracy was 80% with 40% sensitivity, 86% specificity, 29% PPV, and 91% NPV for diagnosing inflammatory pancreatic lesions. There was a good agreement between the EUS and histopathology regarding the diagnosis of malignant, benign, and inflammatory pancreatic lesions. While the agreement of EUS and CT together and CT and histopathology together as regards the diagnosis of malignant, benign, and inflammatory pancreatic lesions was poor to moderate. |