It is uncertain whether computed tomography or endoscopic ultrasound is superior for the detection, staging, and resectability of pancreatic cancer.
Dr Thomas Imperiale and colleagues therefore performed a systematic literature review to determine which test is more accurate.
The research team identified relevant studies from MEDLINE published between 1986 and 2004.
The team evaluated study quality, which was measured on the basis of guidelines for assessing studies of diagnostic tests.
Quantitative outcomes data were abstracted from the studies.
The researchers found 11 studies with 678 patients that satisfied the inclusion criteria.
The team noted that 9 studies assessed tumor detection, all of which concluded that the sensitivity of endoscopic ultrasound was superior to computed tomography.
| 4 of 5 studies assessing tumor staging show that endoscopic ultrasound is more accurate|
|Clinical Gastroenterology & Hepatology|
The 4 of 5 studies that assessed tumor staging accuracy, and 5 of 8 that assessed nodal staging accuracy concluded that endoscopic ultrasound was superior to computed tomography.
The team noted that among the 4 studies that assessed resectability, 2 showed no difference between the 2 techniques, and 1 favored each modality.
Of the 11 studies included, only 3 met all but 1 of the quality criteria.
The researchers reported that the most important and frequent study limitations were lack of a consecutive series of patients and biased patient selection for surgery.
Quantitative comparisons among studies were precluded by differences in tumor staging classifications, surgical selection, techniques, and reporting of operating characteristics.
Dr Imperiale's team commented, “The published literature comparing endoscopic ultrasound and computed tomography for preoperative assessment of pancreatic cancer is heterogeneous in study design, quality, and results.”
“All studies have methodologic limitations that potentially affect validity.”
“Prospective studies with state-of-the-art imaging are needed to further define the role of each test.”