Diagnostic performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) based on histopathology

Guru Trikudanathan, Jose Vega-Peralta, Ahmad Malli, Satish Munigala, Yusheng Han, Melena Bellin, Usman Barlass, Srinath Chinnakotla, Ty Dunn, Timothy Pruett, Gregory Beilman, Mustafa Arain, Stuart K. Amateau, Shawn Mallery, Martin L. Freeman, Rajeev Attam

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21 Citations (Scopus)

Abstract

Objectives:Studies correlating endoscopic ultrasound (EUS) with histopathology for chronic pancreatitis (CP) are limited by small sample size, and/or inclusion of many patients without CP, limiting applicability to patients with painful CP. The aim of this study was to assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP).Methods:Adult patients undergoing total pancreatectomy and islet autotransplantation (TPIAT) for NCCP, between 2008 and 2013, with EUS <1 year before surgery. Histology from resected pancreas at the time of TPIAT (from head, body, and tail) was graded by a GI pathologist blinded to the EUS features. A fibrosis score (FS) ≥2 was abnormal, and FS≥6 was considered severe fibrosis. A multivariate regression analysis for the EUS features predicting fibrosis, after taking age, sex, smoking, and body mass index into consideration, was performed. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation co-efficient (r) was calculated.Results:68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61%), specificity (75%), and accuracy (63%). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP.Conclusions:Correlation between standard EUS features and histopathology is poor in NCCP. MPD irregularity is an independent predictor for NCCP.

Original languageEnglish (US)
Pages (from-to)568-574
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume111
Issue number4
DOIs
StatePublished - Apr 1 2016

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Chronic Pancreatitis
Pancreatectomy
Autologous Transplantation
Fibrosis
ROC Curve
Multivariate Analysis
Regression Analysis
Pancreatic Ducts
Sample Size
Pancreas
Histology
Body Mass Index
Smoking
Head
Sensitivity and Specificity

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Diagnostic performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) based on histopathology. / Trikudanathan, Guru; Vega-Peralta, Jose; Malli, Ahmad; Munigala, Satish; Han, Yusheng; Bellin, Melena; Barlass, Usman; Chinnakotla, Srinath; Dunn, Ty; Pruett, Timothy; Beilman, Gregory; Arain, Mustafa; Amateau, Stuart K.; Mallery, Shawn; Freeman, Martin L.; Attam, Rajeev.

In: American Journal of Gastroenterology, Vol. 111, No. 4, 01.04.2016, p. 568-574.

Research output: Contribution to journalArticle

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title = "Diagnostic performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) based on histopathology",
abstract = "Objectives:Studies correlating endoscopic ultrasound (EUS) with histopathology for chronic pancreatitis (CP) are limited by small sample size, and/or inclusion of many patients without CP, limiting applicability to patients with painful CP. The aim of this study was to assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP).Methods:Adult patients undergoing total pancreatectomy and islet autotransplantation (TPIAT) for NCCP, between 2008 and 2013, with EUS <1 year before surgery. Histology from resected pancreas at the time of TPIAT (from head, body, and tail) was graded by a GI pathologist blinded to the EUS features. A fibrosis score (FS) ≥2 was abnormal, and FS≥6 was considered severe fibrosis. A multivariate regression analysis for the EUS features predicting fibrosis, after taking age, sex, smoking, and body mass index into consideration, was performed. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation co-efficient (r) was calculated.Results:68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61{\%}), specificity (75{\%}), and accuracy (63{\%}). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP.Conclusions:Correlation between standard EUS features and histopathology is poor in NCCP. MPD irregularity is an independent predictor for NCCP.",
author = "Guru Trikudanathan and Jose Vega-Peralta and Ahmad Malli and Satish Munigala and Yusheng Han and Melena Bellin and Usman Barlass and Srinath Chinnakotla and Ty Dunn and Timothy Pruett and Gregory Beilman and Mustafa Arain and Amateau, {Stuart K.} and Shawn Mallery and Freeman, {Martin L.} and Rajeev Attam",
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T1 - Diagnostic performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) based on histopathology

AU - Trikudanathan, Guru

AU - Vega-Peralta, Jose

AU - Malli, Ahmad

AU - Munigala, Satish

AU - Han, Yusheng

AU - Bellin, Melena

AU - Barlass, Usman

AU - Chinnakotla, Srinath

AU - Dunn, Ty

AU - Pruett, Timothy

AU - Beilman, Gregory

AU - Arain, Mustafa

AU - Amateau, Stuart K.

AU - Mallery, Shawn

AU - Freeman, Martin L.

AU - Attam, Rajeev

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objectives:Studies correlating endoscopic ultrasound (EUS) with histopathology for chronic pancreatitis (CP) are limited by small sample size, and/or inclusion of many patients without CP, limiting applicability to patients with painful CP. The aim of this study was to assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP).Methods:Adult patients undergoing total pancreatectomy and islet autotransplantation (TPIAT) for NCCP, between 2008 and 2013, with EUS <1 year before surgery. Histology from resected pancreas at the time of TPIAT (from head, body, and tail) was graded by a GI pathologist blinded to the EUS features. A fibrosis score (FS) ≥2 was abnormal, and FS≥6 was considered severe fibrosis. A multivariate regression analysis for the EUS features predicting fibrosis, after taking age, sex, smoking, and body mass index into consideration, was performed. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation co-efficient (r) was calculated.Results:68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61%), specificity (75%), and accuracy (63%). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP.Conclusions:Correlation between standard EUS features and histopathology is poor in NCCP. MPD irregularity is an independent predictor for NCCP.

AB - Objectives:Studies correlating endoscopic ultrasound (EUS) with histopathology for chronic pancreatitis (CP) are limited by small sample size, and/or inclusion of many patients without CP, limiting applicability to patients with painful CP. The aim of this study was to assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP).Methods:Adult patients undergoing total pancreatectomy and islet autotransplantation (TPIAT) for NCCP, between 2008 and 2013, with EUS <1 year before surgery. Histology from resected pancreas at the time of TPIAT (from head, body, and tail) was graded by a GI pathologist blinded to the EUS features. A fibrosis score (FS) ≥2 was abnormal, and FS≥6 was considered severe fibrosis. A multivariate regression analysis for the EUS features predicting fibrosis, after taking age, sex, smoking, and body mass index into consideration, was performed. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation co-efficient (r) was calculated.Results:68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61%), specificity (75%), and accuracy (63%). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP.Conclusions:Correlation between standard EUS features and histopathology is poor in NCCP. MPD irregularity is an independent predictor for NCCP.

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