Journal Mobile Options
Table of Contents
Vol. 1, No. 6, 2001
Issue release date: 2001
Pancreatology 2001;1:625–632

Accuracy of Endoscopic Ultrasound in Diagnosing and Staging Pancreatic Carcinoma

Wiersema M.J.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: The role of endosonography in diagnosing and staging pancreatic adenocarcinoma is evolving. The aim of this review is to present recently published material comparing the performance of endosonography relative to other imaging modalities when evaluating a patient with a suspected or known carcinoma of the pancreas. Methods: Medline was searched using the terms ‘endosonography’ and ‘pancreas neoplasms’. References from retrieved papers were reviewed to identify other reports. Emphasis was placed on peer-reviewed material published within the past 3 years that included comparison with other imaging modalities. Results: Despite advances in cross-sectional imaging modalities, endosonography remains the most sensitive and specific method to identify pancreatic mass lesions. Resectability determination of pancreatic carcinoma is best done with dual-phase helical CT, although endosonography may have slightly improved accuracy for lymph node assessment. Endosonography-guided fine-needle aspiration biopsy has high sensitivity (93%) and specificity (100%) when employed in patients with masses in whom pancreatic cancer is suspected but prior biopsies are negative. Conclusions: Endosonography can aid in diagnosing patients with pancreatic neoplasms through definitive inclusion or exclusion of a mass lesion as well as biopsy confirmation of malignancy. The role of endosonography in determination of resectability has been eclipsed by dual-phase helical CT.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Muller MF, Meyenberger C, Bertschinger P, Schaer R, Marincek B: Pancreatic tumors: Evaluation with endoscopic US, CT, and MR imaging. Radiology 1994;190:745–751.
  2. Legmann P, Vignaux O, Dousset B, Baraza AJ, Palazzo L, Dumontier I, Coste J, Louvel A, Roseau G, Couturier D, Bonnin A: Pancreatic tumors: Comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998;170:1315–1322.
  3. Gress FG, Hawes RH, Savides TJ, Ikenberry SO, Cummings O, Kopecky K, Sherman S, Wiersema M, Lehman GA: Role of EUS in the preoperative staging of pancreatic cancer: A large single-center experience. Gastrointest Endosc 1999;50:786–791.
  4. Mertz HR, Sechopoulos P, Delbeke D, Leach S: EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc 2000;52:367–371.
  5. Bender GN, Case B, Tsuchida A, Timmons JH, Williard W, Lyons MF, Makuch R: Using sector endoluminal ultrasound to identify the normal pancreas when axial computed tomography is falsely positive. Invest Radiol 1999;34:71–74.
  6. Zimmer T, Ziegler K, Bader M, Fett U, Hamm B, Riecken EO, Wiedenmann B: Localisation of neuroendocrine tumours of the upper gastrointestinal tract. Gut 1994;35:471–475.
  7. Koito K, Namieno T, Nagakawa T, Shyonai T, Hirokawa N, Morita K: Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointest Endosc 1997;45:268–276.
  8. Warshaw AL, Compton CC, Lewandrowski K, Cardenosa G, Mueller PR: Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990;212:432–443; discussion 444–445.
  9. Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK: Evaluation of a serologic marker, CA 19-9, in the diagnosis of pancreatic cancer. Ann Intern Med 1989;110:704–709.

    External Resources

  10. Albert MB, Steinberg WM, Henry JP: Elevated serum levels of tumor marker CA 19-9 in acute cholangitis. Dig Dis Sci 1988;33:1223–1225.
  11. Rosch T, Lorenz R, Braig C, Feuerbach S, Siewert JR, Schusdziarra V, Classen M: Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc 1991;37:347–352.
  12. Glasbrenner B, Schwarz M, Pauls S, Preclick G, Beger HG, Adler G: Prospective comparison of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the preoperative assessment of masses in the pancreatic head. Dig Surg 2000;17:468–474.
  13. Baron PL, Aabakken LE, Cole DJ, LeVeen MB, Baron LF, Daniel DM, Cunningham JT, Hawes RH, Adams DB, Hoffman BJ: Differentiation of benign from malignant pancreatic masses by endoscopic ultrasound. Ann Surg Oncol 1997;4:639–643.
  14. Yasuda K, Mukai H, Fugimoto S, Nakajima M, Kawai K: The diagnosis of pancreatic cancer by endoscopic ultrasonography. Gastrointest Endosc 1988;34:1–8.

    External Resources

  15. Rosch T, Braig C, Gain T, Feuerbach S, Siewert JR, Schusdziarra V, Classen M: Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography. Gastroenterology 1992;102:188–199.
  16. Palazzo L, Roseau G, Gayet B, Vilgrain V, Belghiti J, Fekete F: Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy 1993;25:143–150.
  17. Howard TJ, Chin AC, Streib EW, Kopecky KK, Wiebke EA: Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma. Am J Surg 1997;174:237–241.
  18. Midwinter MJ, Beveridge CJ, Wilsdon JB, Bennett MK, Baudouin CJ, Charnley RM: Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours. Br J Surg 1999;86:189–193.
  19. Megibow AJ, Zhou XH, Rotterdam H, Francis IR, Zerhouni EA, Balfe DM, Weinreb JC, Aisen A, Kuhlman J, Heiken JP: Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability – Report of the Radiology Diagnostic Oncology Group. Radiology 1995;195:327–332.
  20. Sheridan MB, Ward J, Guthrie JA, Spencer JA, Craven CM, Wilson D, Guillou PJ, Robinson PJ: Dynamic contrast-enhanced MR imaging and dual-phase helical CT in the preoperative assessment of suspected pancreatic cancer: A comparative study with receiver operating characteristic analysis. Am J Roentgenol 1999;173:585–590.
  21. Welch TJ, Sheedy PFD, Johnson CD, Johnson CM, Stephens DH: CT-guided biopsy: Prospective analysis of 1,000 procedures. Radiology 1989;171:493–496.

    External Resources

  22. Faigel DO, Ginsberg GG, Bentz JS, Gupta PK, Smith DB, Kochman ML: Endoscopic ultrasound-guided real-time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. J Clin Oncol 1997;15:1439–1443.
  23. Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, Van Velse A, Osborne JF, Hoffman BJ: Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy 1997;29:854–858.
  24. Cahn M, Chang K, Nguyen P, Butler J: Impact of endoscopic ultrasound with fine-needle aspiration on the surgical management of pancreatic cancer. Am J Surg 1996;172:470–472.
  25. Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD: The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997;45:387–393.
  26. Erickson RA: Endoscopic ultrasonography: A new diagnostic imaging modality. Am Fam Physician 1997;55:2219–2228.
  27. Giovannini M, Seitz JF, Monges G, Perrier H, Rabbia I: Fine-needle aspiration cytology guided by endoscopic ultrasonography: Results in 141 patients. Endoscopy 1995;27:171–177.
  28. Gress FG, Hawes RH, Savides TJ, Ikenberry SO, Lehman GA: Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography. Gastrointest Endosc 1997;45:243–250.
  29. Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM: Endosonography-guided fine-needle aspiration biopsy: Diagnostic accuracy and complication assessment. Gastroenterology 1997;112:1087–1095.
  30. Gress F, Gottlieb K, Sherman S, Lehman G: Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med 2001;134:459–464.
  31. Trede M, Schwall G, Saeger HD: Survival after pancreatoduodenectomy. Ann Surg 1990;211:447–458.
  32. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J: One hundred and forty-five consecutive pancreatoduodenectomies without mortality. Ann Surg 1993;217:430–438.
  33. Livingston EH, Welton ML, Reber HA: The United States’ experience with surgery for pancreatic cancer. Int J Pancreatol 1991;9:153–157.
  34. Nitecki SS, Sarr MG, Colby TV, van Heerden JA: Long-term survival after resection for ductal adenocarcinoma of the pancreas: Is it really improving? Ann Surg 1994;221:59–66.
  35. Fleming ID, Cooper JS, Henson DE, Hutter RVP, Kennedy BJ, Murphy GP, O’Sullivan B, Sobin LH, Yarbro JW: AJCC Cancer Staging Manual. Philadelphia, Lippincott-Raven, 1997.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50