Diagnostic concordance of abdominal CT scans, Endoscopic Ultrasonography and Fine Needle Puncture Aspiration for solid pancreatic lesions suggestive of malignant neoplasms
DOI:
https://doi.org/10.22516/25007440.370Keywords:
Epidemiology, Pancreatic malignancies, Biliopancreatic ultrasound, PAAF, Concordance studiesAbstract
Introduction and objective: Diagnostic tests for solid pancreatic lesions frequently produce discordant results which lead to confusion and delays of therapeutic decisions. Concordance among abdominal computed tomography with contrast, endoscopic ultrasound (EUS) pancreatobiliary and EUS guided fine needle aspiration had not previously been evaluated in Colombia.
Materials and methods: We evaluated a series of adult patients with solid pancreatic masses suspected of malignancy treated at the San Ignacio University Hospital in Bogotá, Colombia. At least two of the following tests were performed: CT scans, EUS, and EUS guided fine needle aspiration. Results were defined as compatible with neoplasia, not compatible with neoplasia or inconclusive. Concordance of results was then evaluated.
Results: Fifty-seven patients were included. A high percentage EUS results compatible with neoplasia were discordant with CT scan results and with EUS guided fine needle aspiration results (33.3% and 52.5%, respectively). Agreement between imaging and EUS guided fine needle aspiration results was minimal (Kappa 0.02; 95% CI:-0.04 to 0.08). The probability of detecting vascular compromises was significantly higher for EUS (42.1% vs. 23.8%, p: 0.06), but lymph node compromises were detected more frequently by imaging (CT or MRI) (23.8% vs. 7.1%, p: 0.01).
Conclusions: The results of this study suggest poor agreement between these diagnostic methods implying a need for improvements such as elastography and contrast media, new needle modalities for sampling, and/or the an on-site cytopathologist.
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