Vascular invasion in a patient with pancreatic or periampullary cancers precludes surgery and indicates a poor prognosis.
Published data on the accuracy of endoscopic ultrasound (EUS) in diagnosing vascular invasion is varied.
Dr Srinivas Puli and colleagues from Kansas evaluated the accuracy of endoscopic ultrasound in diagnosing vascular invasion in pancreatic and periampullary cancers.
The research team undertook a meta-analysis and pooled endoscopic ultrasound studies according to the Mantel-Haenszel and DerSimonian Laird methods.
The researchers selected endoscopic ultrasound studies in which vascular invasion was confirmed by surgery or angiography.
The team calculated pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of endoscopic ultrasound.
| Sensitivity of EUS in diagnosing vascular invasion was 73%|
Data were extracted from 29 studies involving 1308 patients that met the inclusion criteria.
The researchers also calculated the odds of having vascular invasion in positive as compared with negative endoscopic ultrasound studies.
The team found that the pooled sensitivity of endoscopic ultrasound in diagnosing vascular invasion was 73%, and the pooled specificity was 90%.
The positive likelihood ratio for diagnosing vascular invasion by endoscopic ultrasound was 9, and the negative likelihood ratio was less than 1.
The team noted that the diagnostic odds ratio was 40.
Dr Puli's team comments, "Endoscopic ultrasound is the best noninvasive test to diagnose vascular invasion in pancreatic and periampullary cancers."
"However, this meta-analysis showed that the specificity is high but the sensitivity is not as high as suggested."
"Further refinements in endoscopic ultrasound technologies and interpretation may improve the sensitivity for detecting vascular invasion."