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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 27, 2015
Accepted:
February 13,
2015
Received:
September 30,
2014
Footnotes
DISCLOSURE: All authors received research support for this study from National Cancer Institute Specialized Program in Research Excellence (SPORE) Clinical Intervention Supplement 2 P50 CA62924, The Lustgarten Foundation for Pancreatic Cancer Research, The Michael Rolfe Foundation, Olympus Corporation, Cooke Medical, Karp Family H.H. & M. Metals, Inc. Fund for Cancer Research, and ChiRhoClin. All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 924.
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© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
