The no endosonographic detection of tumor (NEST) study

A case series of pancreatic cancers missed on endoscopic ultrasonography

M. S. Bhutani, F. G. Gress, M. Giovannini, R. A. Erickson, M. F. Catalano, A. Chak, P. H. Deprez, Douglas Orrick Faigel, Cuong C Nguyen

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Background and Study Aims: The purpose of this study was to identify possible associated factors that may have contributed to failure to detect a pancreatic neoplasm during endoscopic ultrasound (EUS) examinations by experienced endosonographers. Patients and Methods: A multicenter retrospective study was organized, and 20 cases of pancreatic neoplasms missed by nine experienced endosonographers were identified. Careful analysis of each case was carried out to identify the factors that might have led to the missed diagnosis on EUS. Results: Twelve patients with a missed pancreatic neoplasm had EUS features of chronic pancreatitis. Other factors that might have increased the likelihood of a false-negative EUS examination included a diffusely infiltrating carcinoma (n = 3), a prominent ventral/dorsal split (n = 2), and a recent episode (within the previous 4 weeks) of acute pancreatitis (n = 1). Five patients with a negative initial EUS underwent a follow-up EUS after 2-3 months, with a pancreatic mass being found in all cases. Three patients had a diffusely infiltrating pancreatic adenocarcinoma. Conclusions: EUS is not a foolproof method of detecting a pancreatic neoplasm. Possible associated factors that may increase the likelihood of a false-negative EUS examination include chronic pancreatitis, a diffusely infiltrating carcinoma, a prominent ventral/dorsal split and a recent episode (<4 weeks) of acute pancreatitis. If there is a high clinical suspicion of pancreatic neoplasm, if EUS and other imaging methods are negative, and if the patient does not undergo surgery, this study suggests that a repeat EUS after 2-3 months may be useful for detecting an occult pancreatic neoplasm.

Original languageEnglish (US)
Pages (from-to)385-389
Number of pages5
JournalEndoscopy
Volume36
Issue number5
DOIs
StatePublished - May 2004

Fingerprint

Endosonography
Pancreatic Neoplasms
Neoplasms
Chronic Pancreatitis
Pancreatitis
Carcinoma
Multicenter Studies
Ultrasonography
Adenocarcinoma
Retrospective Studies

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

The no endosonographic detection of tumor (NEST) study : A case series of pancreatic cancers missed on endoscopic ultrasonography. / Bhutani, M. S.; Gress, F. G.; Giovannini, M.; Erickson, R. A.; Catalano, M. F.; Chak, A.; Deprez, P. H.; Faigel, Douglas Orrick; Nguyen, Cuong C.

In: Endoscopy, Vol. 36, No. 5, 05.2004, p. 385-389.

Research output: Contribution to journalArticle

Bhutani, M. S. ; Gress, F. G. ; Giovannini, M. ; Erickson, R. A. ; Catalano, M. F. ; Chak, A. ; Deprez, P. H. ; Faigel, Douglas Orrick ; Nguyen, Cuong C. / The no endosonographic detection of tumor (NEST) study : A case series of pancreatic cancers missed on endoscopic ultrasonography. In: Endoscopy. 2004 ; Vol. 36, No. 5. pp. 385-389.
@article{64d86eefb976411187119158b9b2e974,
title = "The no endosonographic detection of tumor (NEST) study: A case series of pancreatic cancers missed on endoscopic ultrasonography",
abstract = "Background and Study Aims: The purpose of this study was to identify possible associated factors that may have contributed to failure to detect a pancreatic neoplasm during endoscopic ultrasound (EUS) examinations by experienced endosonographers. Patients and Methods: A multicenter retrospective study was organized, and 20 cases of pancreatic neoplasms missed by nine experienced endosonographers were identified. Careful analysis of each case was carried out to identify the factors that might have led to the missed diagnosis on EUS. Results: Twelve patients with a missed pancreatic neoplasm had EUS features of chronic pancreatitis. Other factors that might have increased the likelihood of a false-negative EUS examination included a diffusely infiltrating carcinoma (n = 3), a prominent ventral/dorsal split (n = 2), and a recent episode (within the previous 4 weeks) of acute pancreatitis (n = 1). Five patients with a negative initial EUS underwent a follow-up EUS after 2-3 months, with a pancreatic mass being found in all cases. Three patients had a diffusely infiltrating pancreatic adenocarcinoma. Conclusions: EUS is not a foolproof method of detecting a pancreatic neoplasm. Possible associated factors that may increase the likelihood of a false-negative EUS examination include chronic pancreatitis, a diffusely infiltrating carcinoma, a prominent ventral/dorsal split and a recent episode (<4 weeks) of acute pancreatitis. If there is a high clinical suspicion of pancreatic neoplasm, if EUS and other imaging methods are negative, and if the patient does not undergo surgery, this study suggests that a repeat EUS after 2-3 months may be useful for detecting an occult pancreatic neoplasm.",
author = "Bhutani, {M. S.} and Gress, {F. G.} and M. Giovannini and Erickson, {R. A.} and Catalano, {M. F.} and A. Chak and Deprez, {P. H.} and Faigel, {Douglas Orrick} and Nguyen, {Cuong C}",
year = "2004",
month = "5",
doi = "10.1055/s-2004-814320",
language = "English (US)",
volume = "36",
pages = "385--389",
journal = "Endoscopy",
issn = "0013-726X",
publisher = "Georg Thieme Verlag",
number = "5",

}

TY - JOUR

T1 - The no endosonographic detection of tumor (NEST) study

T2 - A case series of pancreatic cancers missed on endoscopic ultrasonography

AU - Bhutani, M. S.

AU - Gress, F. G.

AU - Giovannini, M.

AU - Erickson, R. A.

AU - Catalano, M. F.

AU - Chak, A.

AU - Deprez, P. H.

AU - Faigel, Douglas Orrick

AU - Nguyen, Cuong C

PY - 2004/5

Y1 - 2004/5

N2 - Background and Study Aims: The purpose of this study was to identify possible associated factors that may have contributed to failure to detect a pancreatic neoplasm during endoscopic ultrasound (EUS) examinations by experienced endosonographers. Patients and Methods: A multicenter retrospective study was organized, and 20 cases of pancreatic neoplasms missed by nine experienced endosonographers were identified. Careful analysis of each case was carried out to identify the factors that might have led to the missed diagnosis on EUS. Results: Twelve patients with a missed pancreatic neoplasm had EUS features of chronic pancreatitis. Other factors that might have increased the likelihood of a false-negative EUS examination included a diffusely infiltrating carcinoma (n = 3), a prominent ventral/dorsal split (n = 2), and a recent episode (within the previous 4 weeks) of acute pancreatitis (n = 1). Five patients with a negative initial EUS underwent a follow-up EUS after 2-3 months, with a pancreatic mass being found in all cases. Three patients had a diffusely infiltrating pancreatic adenocarcinoma. Conclusions: EUS is not a foolproof method of detecting a pancreatic neoplasm. Possible associated factors that may increase the likelihood of a false-negative EUS examination include chronic pancreatitis, a diffusely infiltrating carcinoma, a prominent ventral/dorsal split and a recent episode (<4 weeks) of acute pancreatitis. If there is a high clinical suspicion of pancreatic neoplasm, if EUS and other imaging methods are negative, and if the patient does not undergo surgery, this study suggests that a repeat EUS after 2-3 months may be useful for detecting an occult pancreatic neoplasm.

AB - Background and Study Aims: The purpose of this study was to identify possible associated factors that may have contributed to failure to detect a pancreatic neoplasm during endoscopic ultrasound (EUS) examinations by experienced endosonographers. Patients and Methods: A multicenter retrospective study was organized, and 20 cases of pancreatic neoplasms missed by nine experienced endosonographers were identified. Careful analysis of each case was carried out to identify the factors that might have led to the missed diagnosis on EUS. Results: Twelve patients with a missed pancreatic neoplasm had EUS features of chronic pancreatitis. Other factors that might have increased the likelihood of a false-negative EUS examination included a diffusely infiltrating carcinoma (n = 3), a prominent ventral/dorsal split (n = 2), and a recent episode (within the previous 4 weeks) of acute pancreatitis (n = 1). Five patients with a negative initial EUS underwent a follow-up EUS after 2-3 months, with a pancreatic mass being found in all cases. Three patients had a diffusely infiltrating pancreatic adenocarcinoma. Conclusions: EUS is not a foolproof method of detecting a pancreatic neoplasm. Possible associated factors that may increase the likelihood of a false-negative EUS examination include chronic pancreatitis, a diffusely infiltrating carcinoma, a prominent ventral/dorsal split and a recent episode (<4 weeks) of acute pancreatitis. If there is a high clinical suspicion of pancreatic neoplasm, if EUS and other imaging methods are negative, and if the patient does not undergo surgery, this study suggests that a repeat EUS after 2-3 months may be useful for detecting an occult pancreatic neoplasm.

UR - http://www.scopus.com/inward/record.url?scp=2342642828&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2342642828&partnerID=8YFLogxK

U2 - 10.1055/s-2004-814320

DO - 10.1055/s-2004-814320

M3 - Article

VL - 36

SP - 385

EP - 389

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 5

ER -