title: Absence of a Periampullary Mass on Cross-sectional Imaging Delays Diagnosis and Time to Pancreatoduodenectomy But Does Not Impair Outcome.
abstract: The aim of this study was to assess whether the lack of a radiological mass in patients with periampullary malignancies led to protracted diagnosis, delayed resection, and an inferior outcome.
  
  
  
  The departmental database was interrogated to identify all patients undergoing pancreatoduodenectomy during the period 2000-2014. The absence of a mass on cross-sectional and endoscopic ultrasound was noted. The interval between imaging and surgery was evaluated and related to the absence of a mass. The relationship between mass/no mass and the pathological profile was also assessed.
  
  
  
  Among 490 patients who underwent pancreatoduodenectomy for periampullary malignancies, masses were detected in 299 patients. Patients with undetected mass on either endoscopic ultrasonography (EUS) or computed tomography (CT)/magnetic resonance imaging (MRI) had a longer median interval from initial imaging to resection than detected mass with no difference in survival (66 vs. 41 days, p = 0.001). The absence of a mass was more common in cholangiocarcinomas (p < 0.001). The absence of a mass on imaging was associated with smaller size on final histopathology (2.4 vs. 2.8 cm; p < 0.001).
  
  
  
  The absence of a mass with all modalities in patients with a periampullary malignancy leads to a delayed diagnosis without a significant effect on survival.
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA. takahah@ccf.org.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA.
authors.forename: Maitham A
authors.initials: MA
authors.lastname: Moslim
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA.
authors.forename: Naftali
authors.initials: N
authors.lastname: Presser
authors.affiliation: Section of Biostatistics, Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Wey
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA.
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Walsh
authors.affiliation: Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH, 44195, USA.
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D057210:Delayed Diagnosis; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Endoscopic ultrasound; Pancreatic neoplasms; Pancreatoduodenectomy