title: A novel scoring system for arterial invasion of pancreatic body and tail cancer based on multidetector row computed tomography and biomarkers.
abstract: OBJECTIVE
  The absence of major-vessel involvement is a crucial factor in the resectability and prognosis of pancreatic cancer. However, arterial invasion cannot be evaluated adequately using imaging findings alone. We therefore developed a scoring system to assess arterial invasion by pancreatic adenocarcinoma using multidetector row computed tomography (MDCT) and serum tumor markers.
  
  
  METHODS
  Twenty patients who underwent distal pancreatectomy and splenectomy for pancreatic adenocarcinoma were examined retrospectively using 4-, 16- or 64-row MDCT and serum tumor markers. Splenic arterial invasion was evaluated in terms of length of tumor contact, circumferential involvement (<180° or ≥180°) and deformity of vascular diameter. Preoperative expression of carbohydrate antigen 19-9 (CA19-9), DUPAN-2 and S-Pancreas-1 antigen (SPan-1) were also evaluated. The presence or absence of arterial invasion was confirmed histopathologically in all 20 cases.
  
  
  RESULTS
  In 11 of 20 cases invasion into splenic arteries was observed histopathologically, mostly involving the external elastic lamina and periarterial nerves. Sensitivity, specificity and accuracy were 100%, 88.9% and 95%, respectively, for length of tumor contact (<16 mm or ≥16 mm), 90.9%, 77.8% and 85% for circumferential involvement (<180° or ≥180°), and 100%, 66.7% and 85% for deformity of vascular diameter. Furthermore, the sensitivity, specificity and accuracy were all increased to 100% when tumor markers were included in the score.
  
  
  CONCLUSIONS
  MDCT is a useful technique for diagnosing arterial invasion of pancreatic body and tail cancer, even in comparison with pathological examination; however, this new scoring system can be further complemented and made more reliable by measurements of serous tumor markers.
authors.affiliation: Division of Gastroenterology, Yokohama City University School of Medicine, 3-9 Fukuura, Yokohama 236-0004, Japan. t096063c@yokohama-cu.ac.jp
authors.forename: Seitaro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sato
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor