Linear-array EUS improves detection of pancreatic lesions in high-risk individuals: a randomized tandem study

Published:April 27, 2015DOI:https://doi.org/10.1016/j.gie.2015.02.028

      Background

      Studies comparing linear and radial EUS for the detection of pancreatic lesions in an asymptomatic population with increased risk for pancreatic cancer are lacking.

      Objectives

      To compare pancreatic lesion detection rates between radial and linear EUS and to determine the incremental diagnostic yield of a second EUS examination.

      Design

      Randomized controlled tandem study.

      Setting

      Five academic centers in the United States.

      Patients

      Asymptomatic high-risk individuals (HRIs) for pancreatic cancer undergoing screening EUS.

      Interventions

      Linear and radial EUS performed in randomized order.

      Main Outcome Measurements

      Pancreatic lesion detection rate by type of EUS, miss rate of 1 EUS examination, and incremental diagnostic yield of a second EUS examination (second-pass effect).

      Results

      Two hundred seventy-eight HRIs were enrolled, mean age 56 years (43.2%), and 90% were familial pancreatic cancer relatives. Two hundred twenty-four HRIs underwent tandem radial and linear EUS. When we used per-patient analysis, the overall prevalence of any pancreatic lesion was 45%. Overall, 16 of 224 HRIs (7.1%) had lesions missed during the initial EUS that were detected by the second EUS examination. The per-patient lesion miss rate was significantly greater for radial followed by linear EUS (9.8%) than for linear followed by radial EUS (4.5%) (P = .03). When we used per-lesion analysis, 73 of 109 lesions (67%) were detected by radial EUS and 99 of 120 lesions (82%) were detected by linear EUS (P < .001) during the first examination. The overall miss rate for a pancreatic lesion after 1 EUS examination was 47 of 229 (25%). The miss rate was significantly lower for linear EUS compared with radial EUS (17.5% vs 33.0%, P = .007).

      Limitations

      Most detected pancreatic lesions were not confirmed by pathology.

      Conclusion

      Linear EUS detects more pancreatic lesions than radial EUS. There was a “second-pass effect” with additional lesions detected with a second EUS examination. This effect was significantly greater when linear EUS was used after an initial radial EUS examination.

      Abbreviations:

      CAPS 3 (Cancer of the Pancreas Screening 3), HRI (high-risk individuals), MRI (magnetic resonance imaging)
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