title: Assessment of resectability of pancreatic head and periampullary tumors by color flow Doppler sonography.
abstract: OBJECTIVE
  To examine the sensitivity of color flow Doppler ultrasonography in assessing resectability of pancreatic head and periampullary tumors.
  
  
  METHODS
  Validation cohort study.
  
  
  METHODS
  Tertiary care public hospital.
  
  
  METHODS
  Thirty-seven patients with pancreatic head or periampullary cancer were studied by color flow Doppler examination of the relevant blood vessels.
  
  
  METHODS
  A pancreatic Doppler score (PDS) was defined as the closest circumferential contact of the tumor to the superior mesenteric vein, superior mesenteric artery, or portal vein. A PDS of 1 indicated no contact (n = 9); PDS 2, less than 50% contact (n = 10); PDS 3, 50% to 99% contact (n = 7); and PDS 4, encasement (n = 11). The PDS was compared with operative and histologic resection margins.
  
  
  RESULTS
  The lack of vascular invasion was confirmed operatively in 7 of 7 patients with a PDS of 1, and 6 patients who underwent resection had clear histologic margins. Nine (90%) of 10 patients with a PDS of 2 were confirmed to have no vascular invasion, and 3 (43%) of 7 patients who underwent resection had clear margins. Five (83%) of 6 patients with a PDS of 3 had correct operative findings, and both patients who underwent resection had positive margins. Operative confirmation of encasement was found in all 7 patients with a PDS of 4 who had operative exploration, and none underwent resection.
  
  
  CONCLUSIONS
  Color flow Doppler sonography and PDS predicted resectability and the histologic margin status (positive predictive value, 97%). Patients with a PDS of 1 are predicted to have clear histologic margins after resection. Patients with a PDS of 4 have unresectable tumors, and nonoperative palliation should be considered. Patients with a PDS of 2 or 3 have a high likelihood of positive histologic margins after resection and may be candidates for neoadjuvant chemotherapy.
authors.affiliation: Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Wren
authors.forename: P W
authors.initials: PW
authors.lastname: Ralls
authors.forename: S C
authors.initials: SC
authors.lastname: Stain
authors.forename: A
authors.initials: A
authors.lastname: Kasiraman
authors.forename: C L
authors.initials: CL
authors.lastname: Carpenter
authors.forename: D
authors.initials: D
authors.lastname: Parekh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018579:Patient Selection; D011300:Preoperative Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color