VOLUME 56, NO. 5, 2002 GASTROINTESTINAL ENDOSCOPY 701 Intraductal papillary-mucinous tumor (IPMT) of the pancreas is increasingly recognized as a clinical entity since its initial description as a “mucous secreting pancreatic cancer” by Ohhashi et al. 1 in 1982. IPMT is a polypoid tumor that characteristi- cally produces dilation of the main pancreatic duct or its branches, filling defects evident by endoscopic retrograde pancreatography (ERP) corresponding to mucin globules, and swelling of the papilla as a result of excessive intraductal secretion of mucin. 1 These features encompass a wide spectrum of histopathologic disorders ranging from hyperplasia to invasive cancer. 2-4 Because of similarities to mucinous cystic neoplasm including mucin produc- tion and similar epithelial cytopathology, IPMT was grouped under the term mucin-producing pancreat- ic tumor. 2 However, there is growing evidence that IPMT is a separate entity. It is distinct from pancre- atic adenocarcinoma in its intraductal growth, ERP features, and favorable prognosis. 5,6 Hence, clinical recognition of IPMT is important for appropriate management of patients. The most frequent presenting symptom of IPMT is upper abdominal pain and occurs in 45% to 100% of patients, 5-8 with more than half of these patients having elevated levels of serum amylase and/or lipase. 9 Episodes of pancreatitis have also been reported (30%-85% patients). 5,6 Pain and pancreati- tis are both thought to be caused by mucin-induced obstruction of the pancreatic duct (PD). 8,10 Transabdominal US and CT, often used in the evalu- ation of patients with these manifestations, demon- strate nonspecific abnormalities 11 and hence the diagnosis may be overlooked for long periods of time. EUS is being used increasingly in the evaluation of patients with abdominal pain, especially pain thought to be of pancreatic or biliary origin. It is also used for the diagnosis of recurrent and chronic pan- creatitis (CP). 12 A role for EUS in IPMT has not been established. 13 However, EUS is minimally invasive and if effective in detecting IPMT it may be an alter- native to ERP in the initial evaluation of patients. ERP, which is invasive and has a high risk-benefit ratio when used to evaluate patients with recurrent Received July 3, 2001. For revision October 31, 2001. Accepted May 29, 2002. Current affiliations: Digestive Disease Center and Department of Biostatistics, Medical University of South Carolina, Charleston, South Carolina. Reprint requests: Brenda J. Hoffman, MUSC Digestive Disease Center, 96 Jonathan Lucas St., Suite 210 CSB, Charleston, SC 29425. Copyright © 2002 by the American Society for Gastrointestinal Endoscopy 0016-5107/2002/$35.00 + 0 37/1/128542 doi:10.1067/mge.2002.128542 Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas Guruprasad P. Aithal, MD, MRCP, PhD, Robert Y. M. Chen, MD, FRACP, John T. Cunningham, MD, Valerie Durkalski, PhD, MPH, Eun Y. Kim, MD, Rig S. Patel, MD, Michael B. Wallace, MD, MSPH, Robert H. Hawes, MD, Brenda J. Hoffman, MD Charleston, South Carolina Background: Patients with intraductal papillary mucinous tumors of the pancreas (IPMT) present with symptoms similar to those of chronic pancreatitis. This study assessed the accuracy of EUS for detection of IPMT and identified features that discriminate IPMT from chronic pancreatitis. Methods: EUS accuracy for detecting IPMT was determined with characteristic findings by endo- scopic retrograde pancreatography as the reference standard.To determine EUS features charac- teristic of IPMT, EUS images from patients with IPMT were compared with those from patients (similar age, gender) with chronic pancreatitis. Results: Thirty-eight patients (23 men, 15 women; age range 40-90 years) with IPMT were identi- fied between 1994 and 2001. For EUS, the sensitivity was 86%, specificity 99%, positive predictive value 78%, and negative predictive value 99% for detection of IPMT.When compared with patients with chronic pancreatitis, the EUS features of dilation of pancreatic duct (89% vs. 42%, p < 0.0001), cysts (45% vs. 11%, p = 0.002), and pancreatic atrophy (32% vs. 3%, p = 0.002) were more common, whereas parenchymal features of chronic pancreatitis were less common with IPMT (21% vs. 97%, p < 0.0001). By multivariate analysis, the presence of no more than one parenchymal feature of chronic pancreatitis suggested the diagnosis of IPMT (odds ratio 43.84; 95% CI [4.13, 465.74]). Conclusions: EUS may be useful in the initial evaluation of patients suspected to have IPMT. Paucity of parenchymal features of chronic pancreatitis is important in differentiating IPMT from other causes of chronic pancreatitis. (Gastrointest Endosc 2002;56:701-7.)