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ASSESSMENT OF CHRONIC PANCREATITIS BY USING ENDOSCOPIC ULTRASOUND AND FINE-NEEDLE ASPIRATION CYTOLOGY (EUS-FNA)
S Hollerbach1, T Topalidis2, A Klamann1, W Schmiegel1
1Department of Medicine, Ruhr-Universitaet Bochum, Knappschafts-Krankenhaus; 2Cytologic Institute, Hannover, Germany
The diagnosis of chronic pancreatitis at its early stage is difficult. Endoscopic ultrasonography (EUS) can sensitively detect morphologic abnormalities in pancreatic structure. However, the clinical impact of EUS findings in this setting is unknown.
AIMS: Investigate the diagnostic accuracy of EUS and fine-needle aspiration cytology (FNA) in patients with chronic pancreatitis compared to ERCP.
MATERIALS/METHODS: In 37 consecutive patients with clinical signs & symptoms suggestive of chronic pancreatitis (48±13 years), EUS-FNA was performed. Morphologic criteria included the presence of echointense septae/echoreduced foci (=pseudolobularity), ductal irregularities, and calcifications. Cytology was assessed by using a standardized inflammation score. ERCP and indirect function tests served as reference (Cambridge classification). Malignancy or major concomitant disorders were excluded.
RESULTS: 31 out of 37 patients had chronic pancreatitis. EUS disclosed morphologic abnormalities of the pancreas in 32 patients, while 6 had normal findings during ERCP. EUS-FNA reached a sensitivity of 97% with a specificity of 83% compared with ERCP. Based on the presence of pseudolobularity alone, EUS reached a sensitivity of 96% with a specificity of 72%, while the positive predictive value (PPV) was 93%, and the negative predictive value (NPV) 83%. Based on 3 EUS criteria including ductal irregularities, the specificity decreased to 46%, while the sensitivity reached 97%. Compared with pancreatic function tests, EUS reached a sensitivity of only 86% with a specificity of 73%. EUS was in agreement with the severity of chronic pancreatitis in 6/8 patients with grade I, in 11/13 patients with grade II, and in 10/10 patients with grade III.
CONCLUSIONS: EUS is a highly sensitive tool to detect morphologic abnormalities of the pancreas. However, the EUS findings are less specific due to possibly transient organ abnormalities that may resolve completely over time. FNA improves the specificity and should be performed routinely during EUS. The correlation between morphologic findings and pancreatic function appears to be poor.