Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography

• Published in: The American journal of surgery Vol. 165; no. 5; p. 600
• Main Authors: Freeny, P C, Traverso, L W, Ryan, J A
• Format: Journal Article
• Language: English
• Published: United States 01-05-1993
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Angiography; Humans; Laparotomy; Liver Neoplasms - secondary; Lymphatic Metastasis; Neoplasm Staging; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - surgery; Predictive Value of Tests; Prospective Studies; Radiographic Image Enhancement; Retrospective Studies; Tomography, X-Ray Computed
• ISSN: 0002-9610
• DOI: 10.1016/S0002-9610(05)80443-X

We assessed the accuracy of dynamic contrast-enhanced computed tomography (CT) in the diagnosis and staging of 213 patients with pancreatic carcinoma and compared it with the accuracy of angiography and surgery. A correct CT diagnosis of pancreatic carcinoma was made in 207 of 213 (97%) patients. Tumors were located in the pancreatic head in 64%, the body in 22%, and the tail in 10%, and enlarged the pancreas diffusely in 4%. CT staged 25 (12%) patients as having potentially resectable tumors and 188 (88%) as having unresectable tumors on the basis of local extension (72%), contiguous organ invasion (43%), vascular invasion (82%), and distant metastases (50%). Compared with angiography in 60 patients, CT detected vascular invasion missed on angiography in 20%, and angiography detected invasion missed by CT in 5%. In these latter cases, other CT criteria of unresectability were present, and angiography provided no significant staging information. Compared with surgery in 71 patients, CT accurately predicted unresectable tumors in 100% of patients and resectable tumors in 72% of patients. Eleven of the patients with CT-resectable tumors underwent resection. Median survival was 22.7 months, with four patients alive at a median of 15.5 months postoperatively. Palliative resections were performed in six patients, and median survival was 14.4 months.