Endoscopy 2004; 36(5): 385-389
DOI: 10.1055/s-2004-814320
Original Article
© Georg Thieme Verlag Stuttgart · New York

The No Endosonographic Detection of Tumor (NEST) Study: a Case Series of Pancreatic Cancers Missed on Endoscopic Ultrasonography

M.  S.  Bhutani1 , F.  G.  Gress2 , M.  Giovannini3 , R.  A.  Erickson4 , M.  F.  Catalano5 , A.  Chak6 , P.  H.  Deprez7 , D.  O.  Faigel8 , C.  C.  Nguyen9
  • 1Center for Endoscopic Ultrasound, University of Texas Medical Branch, Galveston, Texas, USA
  • 2Winthrop University Hospital, Mineola, New York, USA
  • 3Paoli-Calmette Institute, Marseilles, France
  • 4Scott and White Clinic, Temple, Texas, USA
  • 5St. Luke’s Medical Center, Milwaukee, Wisconsin, USA
  • 6Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  • 7St.-Luc University Hospital, Brussels, Belgium
  • 8Oregon Health and Science University, Portland, Oregon, USA
  • 9Mayo Clinic, Scottsdale, Arizona, USA
Further Information

Publication History

Submitted 20 September 2001

Accepted after Revision 9 November 2003

Publication Date:
21 April 2004 (online)

Background and Study Aims: The purpose of this study was to identify possible associated factors that may have contributed to failure to detect a pancreatic neoplasm during endoscopic ultrasound (EUS) examinations by experienced endosonographers.
Patients and Methods: A multicenter retrospective study was organized, and 20 cases of pancreatic neoplasms missed by nine experienced endosonographers were identified. Careful analysis of each case was carried out to identify the factors that might have led to the missed diagnosis on EUS.
Results: Twelve patients with a missed pancreatic neoplasm had EUS features of chronic pancreatitis. Other factors that might have increased the likelihood of a false-negative EUS examination included a diffusely infiltrating carcinoma (n = 3), a prominent ventral/dorsal split (n = 2), and a recent episode (within the previous 4 weeks) of acute pancreatitis (n = 1). Five patients with a negative initial EUS underwent a follow-up EUS after 2-3 months, with a pancreatic mass being found in all cases. Three patients had a diffusely infiltrating pancreatic adenocarcinoma.
Conclusions: EUS is not a foolproof method of detecting a pancreatic neoplasm. Possible associated factors that may increase the likelihood of a false-negative EUS examination include chronic pancreatitis, a diffusely infiltrating carcinoma, a prominent ventral/dorsal split and a recent episode (< 4 weeks) of acute pancreatitis. If there is a high clinical suspicion of pancreatic neoplasm, if EUS and other imaging methods are negative, and if the patient does not undergo surgery, this study suggests that a repeat EUS after 2-3 months may be useful for detecting an occult pancreatic neoplasm.


M. S. Bhutani, M. D., F.A.C.G., F.A.C.P.

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