Preoperative diagnostics in pancreatic carcinoma: would less be better?
OBJECTIVE
The objective of this study was to investigate the value of preoperative diagnostics in patients with pancreatic carcinoma in terms of tumor diagnosis and evaluation of resectability.


METHODS
From 1 September 1985 to 31 December 1997, 408 patients shown by histology to have a ductal (n=330) or periampullary carcinoma (n=78) were treated at our hospital.


RESULTS
In determining the presence of tumor, ultrasonography and computed tomography (CT) had a sensitivity of 88.3% and 94.0%, respectively; combined, they had a sensitivity of 96.2%. Endoscopic retrograde cholangiopancreatography (ERCP) had a sensitivity of 96.2%. Preoperative aspiration biopsy cytology had a sensitivity of 71.4%. No correlation was found in the patients undergoing surgery between the preoperative level of serum CA 19-9 and the presence of distant metastases. Tumor infiltration of the portal vein was shown with a sensitivity of 33.3%, 24.3%, and 76.5% and a specificity of 93.9%, 98.9%, and 65.6% by ultrasonography, CT, and angiography, respectively. Ultrasonography and CT detected liver metastases or peritoneal carcinomatosis with a sensitivity of 35.9% each and a specificity of 91.9% and 91.7%, respectively.


CONCLUSIONS
This study shows that, in 96% of patients with pancreatic carcinoma, ultrasonography and CT are adequate for diagnosis and for the evaluation of resectability. ERCP is not the method of choice in the diagnosis of pancreatic carcinoma due to its invasiveness and to the fact that it fails to demonstrate the pathological anatomical location of the tumor; it should only be used if a tumor is suspected despite negative results on ultrasonography and CT or as an additional diagnostic method to differentiate between chronic pancreatitis and carcinoma. On account of the low sensitivity of percutaneous aspiration biopsy cytology, this method is not necessary preoperatively and may even lead to the spread of tumor cells. In 7% of patients, routine laparoscopy would additionally show liver metastases or peritoneal carcinomatosis not demonstrated using the imaging techniques.
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz, Germany.
T
T
Böttger
R
R
Engelman
J K
JK
Seifert
R
R
Löw
T
T
Junginger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000032:analysis; D002277:Carcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D018395:CA-19-9 Antigen