Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography.
OBJECTIVE
The objective of this study was to evaluate prospectively the efficacy of different strategies based on endoscopic ultrasonography (EUS), helical computed tomography (CT), magnetic resonance imaging (MRI), and angiography (A) in the staging and tumor resectability assessment of pancreatic cancer.


METHODS
All consecutive patients with pancreatic carcinoma judged fit for laparotomy were studied by EUS, CT, MRI, and A. Results of each of the imaging techniques regarding primary tumor, locoregional extension, lymph-node involvement, vascular invasion, distant metastases, tumor TNM stage, and tumor resectability were compared with the surgical findings. Univariate, logistic regression, decision, and cost minimization analyses were performed.


RESULTS
Sixty-two patients with pancreatic cancer were included. Helical CT had the highest accuracy in assessing extent of primary tumor (73%), locoregional extension (74%), vascular invasion (83%), distant metastases (88%), tumor TNM stage (46%), and tumor resectability (83%), whereas EUS had the highest accuracy in assessing tumor size (r = 0.85) and lymph node involvement (65%). The decision analysis demonstrated that the best strategy to assess tumor resectability was based on CT or EUS as initial test, followed by the alternative technique in those potentially resectable cases. Cost minimization analysis favored the sequential strategy in which EUS was used as a confirmatory technique in those patients in whom helical CT suggested resectability of the tumor.


CONCLUSIONS
Helical CT and EUS are the most useful individual imaging techniques in the staging of pancreatic cancer. In those cases with potentially resectable tumors a sequential approach consisting of helical CT as an initial test and EUS as a confirmatory technique seems to be the most reliable and cost minimization strategy.
Soriano
Antonio
A
Department of Gastroenterology, Institut de Malalties Digestives, University of Barcelona, Barcelona, Catalonia, Spain.
Castells
Antoni
A
Ayuso
Carmen
C
Ayuso
Juan Ramón
JR
de Caralt
Maria Teresa
MT
Ginès
Maria Angels
MA
Real
Maria Isabel
MI
Gilabert
Rosa
R
Quintó
Llorenç
L
Trilla
Antoni
A
Feu
Faust
F
Montanyà
Xavier
X
Fernández-Cruz
Laureano
L
Navarro
Salvador
S
D000368:Aged; D000792:Angiography; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D019043:Vascular Neoplasms / Q000556:secondary