Prognosis and Clinical Characteristics of Patients with Pancreatic Ductal Adenocarcinoma Diagnosed by Endoscopic Ultrasonography but Indeterminate on Computed Tomography
Sung Woo Ko,
Tae Hyeon Kim,
Tae Jun Song,
Seong-Hun Kim,
Dong-Wan Seo,
Jai Hoon Yoon,
Chang Min Cho,
Jae Hee Cho,
Jun-Ho Choi,
Dong Wook Lee,
Sang Hyub Lee,
Seung Bae Yoon,
Tae Hoon Lee,
Gwang Ha Kim,
Hoon Jai Chun
Affiliations
Sung Woo Ko
Department of Gastroenterology, Asan Medical Center, Seoul, Korea
Tae Hyeon Kim
Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
Tae Jun Song
Department of Gastroenterology, Asan Medical Center, Seoul, Korea
Seong-Hun Kim
Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
Dong-Wan Seo
Department of Gastroenterology, Asan Medical Center, Seoul, Korea
Jai Hoon Yoon
Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
Chang Min Cho
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
Jae Hee Cho
Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
Jun-Ho Choi
Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
Dong Wook Lee
Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
Sang Hyub Lee
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Seung Bae Yoon
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Tae Hoon Lee
Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea
Gwang Ha Kim
Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
Hoon Jai Chun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea
Background/Aims: Endoscopic ultrasonography (EUS) provides high-resolution images and is superior to computed tomography (CT) scan in diagnosing small pancreatic ductal adenocarcinoma (PDAC). As a result, the use of EUS for early detection of PDAC has attracted attention. This study aimed to identify the clinical and radiological characteristics of patients with PDAC diagnosed by EUS but not found on CT scan. Methods: The medical records of patients diagnosed with PDAC at 12 tertiary referral centers in Korea from January 2003 to April 2019 were reviewed. This study included patients with pancreatic masses not clearly observed on CT scan but identified on EUS. The clinical characteristics and radiological features of the patients were analyzed, and survival analysis was performed. Results: A total of 83 patients were enrolled. The most common abnormal CT findings other than a definite mass was pancreatic duct dilatation, which was identified in 61 patients (73.5%). All but four patients underwent surgery. The final pathologic stages were as follows: IA (n=31, 39.2%), IB (n=8, 10.1%), IIA (n=20, 25.3%), IIB (n=17, 21.5%), III (n=2, 2.5%), and IV (n=1, 1.4%). The 5-year survival rate of these patients was 50.6% (95% confidence interval, 38.8% to 66.7%). Elevated liver function testing and R1 resection emerged as significant predictors of mortality in the multivariable Cox regression analysis. Conclusions: This multicenter study demonstrated favorable long-term prognosis in patients with PDAC diagnosed by EUS but indeterminate on CT scan. EUS should be considered for patients with suspected PDAC but indeterminate on CT scan.
