The importance of endosonography in preoperative management of patients with pancreatic head carcinoma
Authors:
M. Loveček 1; M. Kliment 2; P. Skalický 1; Dušan Klos 1; I. Tozzi Di Angelo 3; P. Kovala 4; R. Havlík 1
Authors‘ workplace:
I. chirurgická klinika FN a LF UP Olomouc
1; Centrum péče o zažívací trakt, Vítkovická nemocnice Ostrava
2; II. interní klinika FN a LF UP Olomouc
3; Interní oddělení, Městská nemocnice Ostrava
4
Published in:
Rozhl. Chir., 2012, roč. 91, č. 11, s. 608-613.
Category:
Original articles
Overview
Introduction:
Pancreatic ductal cancer remains a devastating disease with an urgent need for improved diagnostics and new treatment strategies. It has no early specific symptoms, shows rapid progression and is practically undiagnosable in the early stage. Survival of radically operated patients is rather unsatisfactory. Nonetheless, only radical surgical resection offers potentially curative treatment.
Material and methods:
The authors present a set of 70 patients (2009–2011) who underwent radical surgery – pancreatic head resection – for ductal pancreatic head adenocarcinoma. A retrospective study analyzes the accuracy of T-staging using preoperative CT and EUS.
Results:
In 21 (30%) patients, CT did not prove pathology in the head of the pancreas. Subsequent endosonography revealed a mass in the head of the pancreas in 88% of patients with negative CT scans. The conformity of CT (detection of the mass) with the histopathological finding was detected in 68.2% of cases, 95% CI for compliance: 55.6%–79.1%. The conformity of endosonography (detection of the mass) with the histopathological finding was detected in 96.0% of cases, 95% CI for compliance: 86.3%–99.5%. The conformity between CT and endosonography was found in 68.8% of cases, 95% CI for compliance: 53.8%–81.3%. The conformity of preoperative CT staging and final histopathological staging was observed in 18.2% of cases, 95% CI for compliance: 9.8%–29.6%. The conformity of preoperative endosonography staging and final histopathological staging was seen in 42.0% of cases, 95% CI for compliance: 28.2%–56.8%. The conformity of accuracy of preoperative CT staging and endosonography staging was detected in 37.5% of cases, 95% CI for compliance: 23.9%–52.7%. In 58.3% of cases, endosonography compared with CT findings evaluated higher T stage (p = 0.001).
Conclusion:
Pancreatic head carcinoma presents mostly with obstructive jaundice. CT diagnosis of small tumours often fails. Subsequent endosonography in case of a negative CT usually contributes significantly to the final diagnosis and helps determine the indication for surgery. EUS is more accurate than CT in showing the tumour mass in the pancreatic head. In our group EUS revealed the mass in 96% of patients versus 68% in CT. When evaluating the staging, CT is accurate only in 18.2% of patients, EUS in 42% of patients. Both methods, EUS and particularly CT, underestimate the actual final T-staging of the disease.
Key words:
carcinoma of the head of pancreas – diagnostics – endosonography
Sources
1. Röder C, Trauzold A, Kalthoff H. Impact of death receptor signaling on the malignancy of pancreatic ductal adenocarcinoma. Eur J Cell Biol 2011;90(6–7):450–5. Epub 2010 Dec 3.
2. Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, Kamiyama M, Hruban RH, Eshleman JR, Nowak MA, Velculescu VE, Kinzler KW, Vogelstein B, Iacobuzio-Donahue CA. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature 2010;467:1114–1117.
3. Gürlich R, Oliverius M, Lipár K, Varga M, Špičák J, Stirand P, Valsamis A, Novotný J, Vyhnánek F. Výsledky jednoročního přežití u nemocných po resekci hlavy slinivky břišní s resekcí žil portomesenterické oblasti. Rozhl Chir 2009;88(8):417–21.
4. Gress FG, Howell DA, Travis AC. Endoscopic ultrasound in the staging of exocrine pancreatic cancer. Up To Date 19.3, 2011.
5. Ryska M. Karcinom pankreatu – chirurgická strategie léčby. Onkologie 2010;4(6):333–337.
6. Chari ST. Detecting early pancreatic cancer: Problems and prospects. Semin Oncol 2007;34:284–94.
7. Yasuda I, Iwashita T, Doi S, Nakashima M, Moriwaki H. Role of EUS in the early detection of small pancreatic cancer. Digestive Endoscopy 2011;23,suplement S1:22–25.
8. Dewitt J, Deveraux BM, Lehman GA, Sherman S, Imperiale TF. Comparison of endoscopis ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol 2006;4:717–725.
9. Mertz HR, Sechopoulos P, Delbeke D, Leach SD. EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc 2000;52:367–71.
10. Muller MF, Meyenberger C, Bertschinger P, Schaer R, Marincek B. Pancreatic tumors: Evaluation with endoscopic US, CT, and MR imaging. Radiology 1994;190:745–51.
11. Varadarajulu S, Wallace MB. Application of endoscopic ultrasonography in pancreatic cancer. Cancer Control 2004;11:15–22.
12. Saifuku Y, Yamagata M, Koike T, Hitomi G, Kanke K, Watanabe H, Murohisa T, Tamano M, Iijima M, Kubota K, Hiraishi H. Endoscopic ultrasonography can diagnose distal biliary strictures without a mass on computed tomography. World J Gastroenterol 2010;16(2):237–44.
13. Deerenberg EB, Poley JW, Hermans JJ, Ganesh S, van der Harst E, van Eijck CH. Role of Endoscopic Ultrasonography in Patients Suspected of Pancreatic Cancer with Negative Helical MDCT Scan Dig Surg 2011;28(5–6):398–403. [Epub ahead of print]
14. Puli SR, Singh S, Hagedorn CH, Reddy J, Olyaee M. Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers: a meta-analysis and systematic review. Gastrointest Endosc 2007;65:788–797.
15. DeWitt J, Devereaux B, Chriswell M, McGreevy K, Howard T, Imperiale TF, Ciaccia D, Lane KA, Maglinte D, Kopecky K, LeBlanc J, McHenry L, Madura J, Aisen A, Cramer H, Cummings O, Sherman S. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 2004;141:753–763.
16. Chan M, Scaife C, Thaker HM, Adler DG. Adenocarcinoma of the pancreas undetected by multidetector CT, endoscopic ultrasound, or intraoperative ultrasound. JOP 2009;10(5):554–6.
17. Kliment M, Urban O, Cegan M, Fojtik P, Falt P, Dvorackova J, Lovecek M, Straka M, Jaluvka F. Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients. Scand J Gastroenterol 2010; 45(11):1372–9. Epub 2010 Jul 14.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2012 Issue 11
Most read in this issue
- Repeated surgery for parathyroid carcinoma
- Current microsurgical and neurointerventional therapy of cerebral aneurysms
- Postoperative pancreatic fistula management by gastrofistuloanastomosis – a set of case reports
- The NanoKnife and two successful cases of intracavitary irreversible electroporation of main bronchus tumours