Linear-array EUS improves detection of pancreatic lesions in high-risk individuals: a randomized tandem study | SNFGE.org - Société savante médicale française d'hépato-gastroentérologie et d’oncologie digestive

Thématique :
- Endoscopie/Imagerie
- Pancréas/Voies biliaires

Originalité :
Intermédiaire

Solidité :

Très solide

Doit faire évoluer notre pratique :

Dans certains cas

Nom du veilleur :
Docteur Florian ROSTAIN

Coup de coeur :


	Gastrointestinal Endoscopy
	2015/12

	2015 Nov;82(5):812-8
	doi: 10.1016/j.gie.2015.02.028

	Linear-array EUS improves detection of pancreatic lesions in high-risk individuals: a randomized tandem study

	Shin EJ, Topazian M, Goggins MG, Syngal S, Saltzman JR, Lee JH, Farrell JJ, Canto MI

	http://www.ncbi.nlm.nih.gov/pubmed/25930097

	BACKGROUND Studies comparing linear and radial EUS for the detection of pancreatic lesions in an asymptomatic population with increased risk for pancreatic cancer are lacking. OBJECTIVES To compare pancreatic lesion detection rates between radial and linear EUS and to determine the incremental diagnostic yield of a second EUS examination. DESIGN Randomized controlled tandem study. SETTING Five academic centers in the United States. PATIENTS Asymptomatic high-risk individuals (HRIs) for pancreatic cancer undergoing screening EUS. INTERVENTIONS Linear and radial EUS performed in randomized order. MAIN OUTCOME MEASUREMENTS Pancreatic lesion detection rate by type of EUS, miss rate of 1 EUS examination, and incremental diagnostic yield of a second EUS examination (second-pass effect). RESULTS Two hundred seventy-eight HRIs were enrolled, mean age 56 years (43.2%), and 90% were familial pancreatic cancer relatives. Two hundred twenty-four HRIs underwent tandem radial and linear EUS. When we used per-patient analysis, the overall prevalence of any pancreatic lesion was 45%. Overall, 16 of 224 HRIs (7.1%) had lesions missed during the initial EUS that were detected by the second EUS examination. The per-patient lesion miss rate was significantly greater for radial followed by linear EUS (9.8%) than for linear followed by radial EUS (4.5%) (P = .03). When we used per-lesion analysis, 73 of 109 lesions (67%) were detected by radial EUS and 99 of 120 lesions (82%) were detected by linear EUS (P < .001) during the first examination. The overall miss rate for a pancreatic lesion after 1 EUS examination was 47 of 229 (25%). The miss rate was significantly lower for linear EUS compared with radial EUS (17.5% vs 33.0%, P = .007). LIMITATIONS Most detected pancreatic lesions were not confirmed by pathology. CONCLUSION Linear EUS detects more pancreatic lesions than radial EUS. There was a "second-pass effect" with additional lesions detected with a second EUS examination. This effect was significantly greater when linear EUS was used after an initial radial EUS examination.

	Comparer les taux de détection de lésions pancréatiques entre écho-endoscopie radiale ou linéaire dans une population de d’individus à haut risque.


	Etude prospective comparative dans 5 centres américains. 224 patients à haut risque individuel de lésion pancréatique ont eu successivement les 2 types d’écho-endoscopie, 110 patients dans le bras radiale puis linéaire, 114 dans le bras linéaire puis radiale. La prévalence globale de lésion pancréatique quel qu’en soit la nature était de 45%. En analyse per-patient, le taux global de lésion manquée par la première écho-endoscopie et détectée par la seconde était de 7,1% (16/224). Ce taux était plus important pour la séquence écho-endoscopie radiale puis linéaire (9,8%) que pour la séquence écho-endoscopie linéaire puis radiale (4,6%) p : 0,03. En analyse per-lésion, 69 des 109 lésions (67%) étaient détectées par l’écho-endoscopie radiale ; 109 des 120 lésions (82%) par l’écho-endoscopie linéaire p<0,001.



	L’analyse cytologique ou histologique des lésions non vues n’a pas pu être obtenue pour toutes les lésions. Pour celles qui ont eu une analyse histologiques ou cytologique, la plupart étaient des TIPMP des canaux secondaires ; il y a eu 3 tumeurs neuroendocrines. Aucun adénocarcinome pancréatique n’a été diagnostiqué dans les lésions non vues en EES.