Abstract
Inconclusive findings on abdominal computerized tomography (CT) scans such as "enlarged or prominent pancreas" are commonly reported; however, their clinical significance is not clearly understood. The objective was to evaluate the efficacy of endoscopic ultrasound (EUS) in a cohort of patients with indeterminate findings on CT. We undertook a retrospective, single-center study at a tertiary care university hospital. About 107 consecutive patients (56 men) underwent EUS evaluation for inconclusive CT findings. The main intervention was EUS with fine needle aspiration (FNA) The main outcome measurement was to describe lesions identified by EUS in this cohort of patients. About 22 patients (21%) had pancreatic adenocarcinoma, 14 (13%) had chronic pancreatitis, 28 (26%) had benign lesions, and 35 patients (33%) had a normal EUS exam. Pancreatic cancer was more likely to be found on EUS in patients with significant weight loss (OR 10.1; 95% CI: 3.3-30.60), hyperbilirubinemia (OR 9; 95% CI: 3-26.0), or common bile duct (CBD) dilatation (OR 3.2; 95% CI: 1.25-8.5). The limitations of the study were that we were unable to control the uniformity of CT interpretation because the scans were reviewed by multiple radiologists. There were also limited follow-up data on patients who had benign lesions or normal EUS. In conclusion, EUS is an effective modality for evaluating pancreatic lesions in patients with inconclusive findings on abdominal CT. This assists in the prompt diagnosis and institution of appropriate treatment strategies for a variety of pancreatic diseases including cancer. In the setting of inconclusive CT findings, patients with hyperbilirubinemia, significant weight loss, or CBD dilatation should undergo EUS evaluation as they are at a higher risk of having underlying pancreatic cancer.