Endoscopic ultrasound approach of pancreatic cancer in chronic pancreatitis patients in a tertiary referral centre.

BACKGROUND

A positive correlation between chronic pancreatitis and pancreatic cancer was mentioned, with a risk for cancer development of 2.3 -18.5%.

AIMS

To assess the frequency of pancreatic cancer in patients with chronic pancreatitis and its correlation with the severity of pancreatitis.

METHODS

We evaluated 72 consecutive patients with chronic pancreatitis (2003-2005) diagnosed by clinical criteria, endoscopic ultrasound (EUS), computer tomography, and endoscopic retrograde pancreatography. The severity of chronic pancreatitis was assessed by EUS (at least 3 criteria for the positive diagnosis). Diagnosis of cancer was confirmed by cytological (smears provided by EUS-FNA) or pathological examination (specimen after surgery).

RESULTS

Pancreatic cancer was found in 17 (23.6%) patients with chronic pancreatitis. In patients with severe and moderate chronic pancreatitis cancer was found in 34% while in patients with mild chronic pancreatitis in 4% (p=0.0181). The complications in these patients were: pseudocysts (30.6%), obstructive jaundice (11.1%), diabetes mellitus (2.8%), portal hypertension (2.8%) etc. They were more frequent in the presence of pancreatic cancer. Sensitivity and accuracy of EUS-FNA for the diagnosis of cancer in chronic pancreatitis patients were 50% and 73.7%, respectively.

CONCLUSIONS

Severity of chronic pancreatitis seems to play an important role in cancer development. Other factors associated with pancreatic cancer were increasing age and complications (such as obstructive jaundice). Due to the low sensitivity of EUS-FNA, patients with a strong suspicion of pancreatic cancer based on imaging tests should be submitted to surgery.