Predicting Factors for Pancreatic Malignancy with Computed Tomography and Endoscopic Ultrasonography in Chronic Pancreatitis

Diagnosing pancreatic malignancy is challenging, especially in patients with chronic pancreatitis (CP). Endoscopic ultrasonography (EUS) is a promising diagnostic procedure for discriminating between malignancy and CP. We aimed to investigate the predictive factors and reliability of computed tomography (CT) and EUS for differentiating pancreatic mass lesions and the diagnostic accuracy of EUS-FNA or FNB in patients with CP. Forty patients with CP, receiving CT and EUS-FNA or FNB for pancreatic mass lesion evaluation, were enrolled in the study. Patients' data, CT and EUS characteristics, image-based diagnosis, cytopathology, and final diagnosis were recorded. EUS was superior to CT in terms of diagnostic accuracy (92.5% vs. 82.5%, p = 0.02). Both CT and EUS showed significant predictive factors (all p < 0.05) with the tumor image hypoattenuation pattern or vessel invasion on CT and pancreatic duct dilatation, or distal pancreatic atrophy on EUS. EUS imaging is a reliable modality for evaluating pancreatic lesions, even with a CP background. The EUS image has a higher diagnostic accuracy than CT. Predicting factors, including hypoechoic pattern, pancreatic duct dilatation, and distal pancreas atrophy, may help to differentiate benign or malignant in patients with CP.

Automated summary

This study compared the predictive factors and reliability of computed tomography (CT) and endoscopic ultrasonography (EUS) in patients with pancreatic mass lesions, as well as the diagnostic accuracy of EUS-guided fine needle aspiration (FNA) or fine needle biopsy (FNB) in patients with chronic pancreatitis (CP). The results showed that EUS had superior diagnostic accuracy compared to CT. Hypoattenuation pattern or vessel invasion on CT and pancreatic duct dilatation or distal pancreatic atrophy on EUS were significant predictive factors. The study concluded that EUS imaging is a reliable modality for evaluating pancreatic lesions in patients with CP.