Role of ultrasoun
Role of ultrasound guided fine needle biopsy, EUS and serum CA19-9 level in diagnosis of Pancreatic Masses
Ahmed A. ELNaggar1, Mohamed Naguib Abdalla1, Waleed Elnabawey1, Hany Khattab2, Khaled Abdel Azim3 and Amr Mostafa4
Departments of 1Internal Medicine; 2Pathology and 3Clinical Pathology, Faculty of Medicine, Cairo University, 4Department of Surgery, National Liver Institute, Minofeya
Abstract:Objective: Pancreatic Cancer is a very aggressive tumor with an extremely poor prognosis. Early diagnosis, accurate preoperative staging and better adjuvant treatment remain a challenge. Abdominal ultrasound, abdominal CT, EUS and ERCP are common tools used for imaging of pancreatic cancer. Fine needle aspiration has made significant contribution to the diagnosis of cancer pancreas. The aim of the present work was to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the diagnosis of pancreatic masses and in the differentiation of cancer pancreas from benign lesions. In addition to that, the level of serum CA19-9 was measured to assess its accuracy in differentiating cancerous from benign lesions. Methods: This cross section descriptive study included 40 patients with pancreatic lesions. They were subjected to full clinical examination, laboratory tests (including serum level CA19-9), abdominal ultrasound, percutaneous sonar guided FNAC of pancreatic lesions, endosonography and surgical interference (was done to 32 patients). Results: Thirty three patients proved to have pancreatic malignancy while seven patients proved to have pancreatitis. Ultrasonography (US) showed a sensitivity of 70%, specificity of 86% and accuracy of 73% for malignancy detection. Adding CA19-9 to ultrasound raised to sensitivity to 94%, specificity remained 86% and accuracy to 93%. Adding FNAC to US raised the sensitivity to 85%, specificity remained 86% and accuracy to 91%. EUS showed a sensitivity of 90%, specificity of 100% and accuracy of 91%. Adding CA19-19 to EUS showed a sensitivity of 94%, specificity of 100% and accuracy of 91%. Adding FNAC to EUS showed a sensitivity of 97%, specificity of 86% and accuracy of 97%. Conclusion: The combination of EUS, serum CA 19-9 level and Sonar guided fine needle aspiration showed accuracy of 97% in diagnosis of pancreatic lesions. These investigatory tools are cheap and available and thus may be an excellent alternative to EUS guided fine needle aspiration which is expensive and available in only few centers.
[Ahmed A. EL Naggar, Mohamed Naguib Abdalla, Waleed Elnabawey, HanyKhattab, Khaled Abdel Azimand Amr Mostafa. Role of ultrasound guided fine needle biopsy, EUS and serum CA19-9 level in diagnosis of Pancreatic Masses. J Am Sci 2012;8(10):58-64]. (ISSN: 1545-1003).http://www.jofamericanscience.org. 10
Keywords: ultrasound; biopsy; serum; diagnosis; pancreatic mass Full Text 10