Predicting resectability of pancreatic head cancer with multi-detector CT. Surgical and pathologic correlation.
BACKGROUND
Computed tomography is widely used to pre-operatively evaluate patients with ductal carcinoma of the pancreas.


OBJECTIVE
To prospectively evaluate the ability of multi-detector computed tomography to predict resectability of pancreatic head cancer.


METHODS
Ninety-one consecutive patients (53 men, 38 women; mean age, 61 years) referred to our department with a diagnosis of cancer of the head of the pancreas underwent a preoperative contrast enhanced triphasic 16-slice multi-detector computed tomography. Sixty-three were considered inoperable because of advanced local disease, metastatic disease, or poor surgical risk.


METHODS
Of the remaining 28 patients, 23 underwent a Whipple procedure, whereas 5 patients underwent a palliative procedure.


METHODS
Surgical and pathologic reports were reviewed and compared to CT results.


RESULTS
Of the 91 patients evaluated, 25% had successful resection of pancreatic head carcinoma; while only 5% had a palliative procedure. When compared to surgical outcome, the positive predictive value of multi-detector computed tomography for resectability was 100%. On the basis of pathologic results, the positive predictive value of multi-detector computed tomography for resectability fell to 83%, Four patients deemed resectable following multi-detector computed tomography had positive margins at pathology.


CONCLUSIONS
The positive predictive value of multi-detector computed tomography for resectable disease is lower when pathologic correlation, as opposed to surgical correlation, is used as the gold standard. Compared to previous studies, there was a lower rate of palliative surgery in our cohort.
Olivié
Damien
D
Department of Radiology, University of Rennes Medical Centre, Rennes, France.
Lepanto
Luigi
L
Billiard
Jean Sébastien
JS
Audet
Pascale
P
Lavallée
Jessica Murphy
JM
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*