Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography: Comparison with conventional sonography, computed tomography, and angiography

Abstract In a prospective study, endoscopic ultrasonography was compared with transabdominal ultrasonography, computed tomography, and angiography in 60 consecutive patients with pancreatic (n = 46) and ampullary (n = 14) cancer considered to be candidates for surgery. The diagnostic value of these imaging procedures in determining local resectability was assessed. The diagnosis of ampullopancreatic malignancy was made by operation (n = 40) or puncture/biopsy (n = 20). In the 40 patients who underwent surgery, endoscopic ultrasonography was significantly superior to abdominal ultrasonography and computed tomography in determining tumor size and extent and lymph node metastases of pancreatic and ampullary cancer. Furthermore, involvement of the portal venous system as judged by histopathology or surgical exploration was correctly assessed by endoscopic ultrasonography in 95%, whereas angiography (85%), computed tomography (75%) and abdominal ultrasonography (55%) were less sensitive. Of 11 cases of portal venous infiltration found at surgery, endoscopic ultrasonography correctly predicted 10, abdominal ultrasonography only 1, computed tomography 4, and angiography 5 ( P