Elsevier

Gastrointestinal Endoscopy

Volume 66, Issue 3, September 2007, Pages 501-509
Gastrointestinal Endoscopy

Original Article
Clinical Endoscopy
Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study

https://doi.org/10.1016/j.gie.2006.12.043Get rights and content

Background

Studies that correlated EUS features of chronic pancreatitis (CP) with histopathology are retrospective and only include patients with severe disease or calcific pancreatitis. Controversies regarding the significance of EUS features of noncalcific CP (NCCP) remain unresolved.

Objective

To correlate EUS criteria for NCCP with histology from surgical specimens.

Design

Prospective study.

Setting

Tertiary referral center.

Patients

All patients who underwent EUS for pancreaticobiliary indications and subsequent pancreatic surgery. Patients with calcific pancreatitis were excluded.

Methods

Individual CP features on EUS were carefully documented with relation to different parts of the pancreas. Standard EUS criteria for CP were adopted. All patients underwent surgery within 2 months of EUS. A single pathologist blinded to EUS findings reviewed the specimens and graded fibrosis (total score, 12; ≥6 = unequivocal CP). A quantitative receiver operating characteristic (ROC) curve analysis was performed, and Spearman rank correlation coefficients were calculated.

Main Outcome Measurements

Correlate EUS criteria for NCCP, with histology from surgical specimens.

Results

Of the 42 patients evaluated, NCCP was diagnosed histologically in 21 patients (50%). None of the patients had CP diagnosis by CT. ROC curve analysis revealed that 4 or more EUS criteria provided the best sensitivity (90.5%), specificity (85.7%), and accuracy (88.1%) for diagnosing NCCP. Parenchymal EUS features that were significantly associated with histopathologic NCCP were foci (P < .0001), stranding (P < .001), and lobulations (P = .04); ductal features that were significantly associated with histopathologic NCCP were dilated (P < .0001) or irregular main pancreatic duct (P < .0001), side branches (P < .001), and hyperechoic duct margins (P = .03). There was a significant correlation between the number of EUS criteria and severity of NCCP on histology (r = 0.85; P < .0001).

Limitations

Small number of patients.

Conclusions

An excellent correlation exists between EUS and histologic findings of NCCP.

Section snippets

Patients and methods

This was a prospective study of consecutive patients referred for evaluation of pancreaticobiliary complaints who underwent subsequent pancreatic surgery over a 15-month period, from June 2004 to September 2005. All patients with pancreatic lesions that were potentially operable by EUS were eligible for inclusion in this study. Exclusion criteria were (1) inadequate visualization of the pancreas; (2) refusal to undergo surgery; (3) poor surgical candidates; (4) patients who required

Results

Of 82 eligible patients who underwent EUS over a 12-month period, 40 were excluded because of metastatic or locally advanced disease at CT in 12 patients, locally advanced disease diagnosed at EUS (11), poor surgical candidates (5), preoperative chemoradiation (3), advanced disease diagnosed at surgery (3), poor visualization of the pancreas at EUS (1), calcific pancreatitis by CT/ERCP (2), and refusal to undergo surgery (3). Of the 42 patients who underwent pancreatic resection (Whipple

Discussion

The results of this prospective study support the concept that EUS CP changes correlate with histologic NCCP.

Studies on CP by using a histologic criterion standard are desirable but have remained impractical for obvious ethical considerations. Hence, CP, in general, is diagnosed based on imaging or function testing. ERCP and secretin stimulation test are regarded as the criterion standard for imaging and for function testing, respectively.15 Contrary to ERCP, EUS has a very low risk of

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