Abstract
Background
Pancreatic cancer is a devastating disease whose early detection remains difficult. There is no 100% reliable imaging test to diagnose and stage pancreatic cancer. We assessed the surgical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival rates of patients who had pancreatic head cancer.
Methods
Eighty-nine patients who had pancreatic head cancer were investigated with spiral CT. Based on the preoperative CT results, we assigned patients to one of three CT groups based on resectability.
Results
A correlation between classification of CT resectability and intraoperative finding was found in 83% of patients. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of spiral CT in identifying predictive unresectability were 79%, 82%, 91%, 62%, and 81%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosis of vascular invasion were 94%, 84.2%, 94%, 84%, and 91.3%, respectively.
Conclusion
The use of CT in the evaluation of pancreatic tumors provides valuable preoperative assessment of surgical resectability and should be performed for clinical examination. Classifying patients by tumor resectability on CT helps to estimate more precisely the tumor stage and to prognosticate survival rates of these patients.
Similar content being viewed by others
References
JH Balcom CF Castillo AL Warshaw (2001) Staging of adenocarcinoma of the pancreas John L Cameron DegreesMD FACS (Eds) American Cancer Society atlas of clinical oncology pancreatic cancer chapter 6 BC Decker Inc Hamilton—London 87–97
CJ Yeo JL Cameron (1999) ArticleTitleImproving results of pancreaticoduodenectomy for pancreatic cancer World J Surg 23 907–912 Occurrence Handle10.1007/s002689900598 Occurrence Handle10449819
A Alberti A Dattola A Parisi et al. (2000) ArticleTitlePeriampullar tumors: role of intraoperative color-Doppler ultrasonography in the evaluation of vascular invasion. Methods available to the surgeon and personal experience Ann Ital Chir 71 669–676 Occurrence Handle11347319
M Yamamoto (1999) ArticleTitleA general view of pancreatic cancer in Japan and a proposal for a more practical staging system Int J Clin Oncol 4 267–272 Occurrence Handle10.1007/s101470050066
VK Mehta G Fisher JA Ford et al. (2001) ArticleTitlePreoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas J Gastrointest Surg 5 27–35 Occurrence Handle10.1016/S1091-255X(01)80010-X Occurrence Handle11309645
S Pedrazzoli C Pasquali C Sperti (1999) ArticleTitleGeneral aspects of surgical treatment of pancreatic cancer Dig Surg 16 265–275 Occurrence Handle10.1159/000018735 Occurrence Handle10449970
H Obertop S Pedrazzoli (1999) ArticleTitleCurrent views on surgical treatment of pancreatic cancer Dig Surg 16 263–264 Occurrence Handle10.1159/000018734 Occurrence Handle10847759
CF Castillo AL Warshaw (1998) Pancreatic cancer: indications for resection HG, et al. Begger (Eds) The pancreas, chapter 109 Blackwell Scientific Publications United Kingdom London 1021–1027
LW Traverso (1998) ArticleTitleWhat are the problems associated with the surgical treatment of patients with pancreatic cancer? J Hepatobiliary Pancreat Surg 5 138–142 Occurrence Handle10.1007/s005340050024 Occurrence Handle9745079
M Bouvet KF Binmoeller AR Moossa (2001) Diagnosis of adenocarcinoma of the pancreas John L Cameron DegreesMD FACS (Eds) American Cancer Society atlas of clinical oncology pancreatic cancer BC Decker Inc Hamilton—London 67–85
T Bottger J Boddin C Duber et al. (1998) ArticleTitleDiagnosing and staging of pancreatic carcinoma—what is necessary? Oncology 55 122–129 Occurrence Handle10.1159/000011846 Occurrence Handle9499186
T Bottger R Engelmann JK Seifert et al. (1998) ArticleTitlePreoperative diagnostics in pancreatic carcinoma: would less be better? Langenbeck Arch Surg 383 243–248 Occurrence Handle10.1007/s004230050126
PC Freeny (2001) ArticleTitlePancreatic carcinoma: what is the best imaging test? Pancreatology 1 604–609 Occurrence Handle10.1159/000055870 Occurrence Handle12120243
A Haycox M Lombard J Neoptolemons T Walley (1998) ArticleTitleReview article: current practice and future perspectives in detection and diagnosis of pancreatic cancer Aliment Pharmacol Ther 12 937–948 Occurrence Handle10.1046/j.1365-2036.1998.00393.x Occurrence Handle9798798
H Irie H Honda K Kaneko et al. (1997) ArticleTitleComparison of helical CT and MR imaging in detecting and staging small pancreatic adenocarcinoma Abdom Imaging 22 429–433 Occurrence Handle10.1007/s002619900226 Occurrence Handle9157866
JA Spencer J Ward JA Guthrie et al. (1998) ArticleTitleAssessment of resectability of pancreatic cancer with dynamic contrast-enhanced MR imaging: technique, surgical correlation and patient outcome Eur Radiol 8 23–29 Occurrence Handle10.1007/s003300050331 Occurrence Handle9442123
MJ Wiersema (2001) ArticleTitleAccuracy of endoscopic ultrasound in diagnosing and staging pancreatic carcinoma Pancreatology 1 625–632 Occurrence Handle10.1159/000055872 Occurrence Handle12120245
MJ Menack JD Spitz ME Arregui (2001) ArticleTitleStaging of pancreatic and ampullary cancers for resectability using laparoscopy with laparoscopic ultrasound Surg Endosc 15 1129–1134 Occurrence Handle10.1007/s00464-001-0030-6 Occurrence Handle11727085
MJ Wiersema (2002) ArticleTitleIdentifying contraindications to resection in patients with pancreatic carcinoma: the role of endoscopic ultrasound Can J Gastroenterol 16 109–114 Occurrence Handle11875595
FG Gress RH Hawes TJ Savides et al. (1999) ArticleTitleRole of EUS in the preoperative staging of pancreatic cancer: a large single-center experience Gastrointest Endosc 50 786–791 Occurrence Handle10570337
P Innocenti M Falchini A Stecco (1999) ArticleTitleUltrasonography of pancreatic neoplasms Tumori 85 IssueIDsuppl 1 S11–S13 Occurrence Handle10235073
PC Freeny WM Marks JA Ryan LW Traverso (1988) ArticleTitlePancreatic ductal adenocarcinoma: diagnosis, staging with dynamic CT Radiology 166 IssueID1 pt 1 125–133 Occurrence Handle2827228
AJ Megibow XH Zhou H Rotterdam et al. (1995) ArticleTitlePancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability—report of the Radiology Diagnostic Oncology Group Radiology 195 327–332 Occurrence Handle7724748
C Procacci C Biasiutti G Carbognin et al. (2002) ArticleTitleSpiral computed tomography assessment of resectability of pancreatic ductal adenocarcinoma: analysis of results Dig Liver Dis 34 739–747 Occurrence Handle10.1016/S1590-8658(02)80026-3 Occurrence Handle12469802
CB Ross KW Sharp AJ Kaufman et al. (1988) ArticleTitleEfficacy of computerized tomography in the preoperative staging of pancreatic carcinoma Am J Surg 54 221–226
VA Kubyshkin VA Vishnevsky AT Airapetian et al. (2000) ArticleTitleDifferential diagnosis of pancreatic head cancer [in Russian] Khirurgiia (Mosk) 11 19–23
PC Freeny LW Traverso JA Ryan (1993) ArticleTitleDiagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography Am J Surg 165 600–606 Occurrence Handle8488945
SC Coley NH Strickland JD Walker RC Williamson (1997) ArticleTitleSpiral CT and the pre-operative assessment of pancreatic adenocarcinoma Clin Radiol 52 24–30 Occurrence Handle10.1016/S0009-9260(97)80301-7 Occurrence Handle9022576
BI Choi MJ Chung JK Han et al. (1997) ArticleTitleDetection of pancreatic adenocarcinoma: relative value of arterial and late phases of spiral CT Abdom Imaging 22 199–203 Occurrence Handle10.1007/s002619900172 Occurrence Handle9013535
H Taoka E Hauptmann LW Traverso et al. (1999) ArticleTitleHow accurate is helical computed tomography for clinical staging of pancreatic cancer? Am J Surg 177 428–432 Occurrence Handle10.1016/S0002-9610(99)00077-X Occurrence Handle10365885
S Vedantham DS Lu HA Reber B Kadell (1998) ArticleTitleSmall peripancreatic veins: improved assessment in pancreatic cancer patients using thin-section pancreatic phase helical CT AJR 170 377–383 Occurrence Handle9456949
DI Park JK Lee JE Kim et al. (2001) ArticleTitleThe analysis of resectability and survival in pancreatic cancer patients with vascular invasion J Clin Gastroenterol 32 231–234 Occurrence Handle10.1097/00004836-200103000-00011 Occurrence Handle11246351
KJ Lehmann SJ Diehl R Lachmann M Georgi (1998) ArticleTitleValue of dual-phase-helical CT in the preoperative diagnosis of pancreatic cancer-a prospective study [in German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 168 211–216 Occurrence Handle9551105
Z Jin X Li L Cai (2001) ArticleTitleAssessing the resectability of pancreatic ductal adenocarcinoma: comparison of dual-phase helical CT arterial portography with conventional angiography Chin Med Sci J 16 40–45 Occurrence Handle12899347
M Imbriaco AJ Megibow L Camera et al. (2002) ArticleTitleDual-phase versus single-phase helical CT to detect and assess resectability of pancreatic carcinoma AJR 178 1473–1479 Occurrence Handle12034622
L Fernandez-Cruz C Johnson C Dervenis (1999) ArticleTitleLocoregional dissemination and extended lymphadenectomy in pancreatic cancer Dig Surg 16 313–320 Occurrence Handle10.1159/000018741 Occurrence Handle10449976
SP Monig W Schroder SE Baldus AH Holscher (2002) ArticleTitlePreoperative lymph-node staging in gastrointestinal cancer—correlation between size and tumor stage Onkologie 25 342–344 Occurrence Handle10.1159/000066051 Occurrence Handle12232485
D Birk C Bassi HG Beger (1999) ArticleTitleNeed for a standard report and future directions in pancreatic resections for cancer Dig Surg 16 276–280 Occurrence Handle10.1159/000018736 Occurrence Handle10449971
DA Bluemke JL Cameron RH Hruban et al. (1995) ArticleTitlePotentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation Radiology 197 381–385 Occurrence Handle7480681
A Alberti P Dattola F Littori et al. (2002) ArticleTitleIntraoperative ultrasonography in the staging of pancreatic head neoplasms [in Italian] Chir Ital 54 59–64 Occurrence Handle11942011
V Raptopoulos ML Steer RG Sheiman et al. (1997) ArticleTitleThe use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery AJR 168 971–977 Occurrence Handle9124153
MG Lentschig P Reimer E Rummeny et al. (1996) ArticleTitleThe value of 3-phase spiral CT and magnetic resonance tomography in preoperative diagnosis of pancreatic carcinoma [in German] Radiologe 36 406–412 Occurrence Handle10.1007/s001170050089 Occurrence Handle8778925
AB Gorelick JM Scheiman AM Fendrick (1998) ArticleTitleIdentification of patients with resectable pancreatic cancer: at what stage are we? Am J Gastroenterol 93 1995–1996 Occurrence Handle9772077
R Vargas M Nino-Murcia W Trueblood RB Jeffrey SuffixJr (2004) ArticleTitleMDCT in pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations AJR 182 419–425 Occurrence Handle14736675
TJ Hough V Raptopoulos B Siewert JB Matthews (1999) ArticleTitleTeardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas AJR 173 1509–1512 Occurrence Handle10584793
AJ Megibow MA Bosniak MA Ambos et al. (1981) ArticleTitleThickening of the celiac axis and/or superior mesenteric artery: a sign of pancreatic carcinoma on computed tomography Radiology 141 449–453 Occurrence Handle7291572
EM Loyer CL David RA Dubrow et al. (1996) ArticleTitleVascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT Abdom Imaging 21 202–206 Occurrence Handle10.1007/s002619900046 Occurrence Handle8661548
LH Sobin C, Wittekind (Eds) (1997) UICC: TNM classification of malignant tumors EditionNumber5 John Wiley & Sons New York
VD Fedorov GG Karmazanovsky EB Guzeeva VV Tsvirkoun (2003) Virtual surgery modeling on the base CT data [in Russian] Vidar-M Moscow 184
GG Karmazanovsky VD Fedorov EB Guzeeva GB Marina (2002) Radiology investigations of abdomen cavity after pancreaticoduodenal resections [in Russian] Russian Doctor Moscow 126
InstitutionalAuthorNameJapanese Pancreas Society (1986) General rules for cancer of the pancreas, 3rd ed [in Japanese] Kanehara Publishing Tokyo
F Griffanti-Bartoli GB Arnone P Ceppa et al. (1994) ArticleTitleMalignant tumors in the head of the pancreas and the periampullary region. Diagnostic and prognostic aspects Anticancer Res 14 IssueID2B 657–666 Occurrence Handle8010724
T Hatori K Takasaki T Imaizumi et al. (1997) ArticleTitleDiagnosis of tumor extension of ductal adenocarcinoma of the pancreas based on histological findings [in Japanese] Nippon Geka Gakkai Zasshi 98 604–609 Occurrence Handle9276866
S Pauls R Sokiranski M Schwarz et al. (2003) ArticleTitleValue of spiral CT and MRI (1.5 T) in preoperative diagnosis of tumors of the head of the pancreas [in German] Rontgenpraxis 55 3–15 Occurrence Handle12650033
RK Zeman C Cooper AS Zeiberg et al. (1997) ArticleTitleTNM staging of pancreatic carcinoma using helical CT AJR 169 459–464 Occurrence Handle9242754
R White C Lee M Anscher et al. (1999) ArticleTitlePreoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas Ann Surg Oncol 6 38–45 Occurrence Handle10.1007/s10434-999-0038-z Occurrence Handle10030414
F Chen W Fu X Xu (1997) ArticleTitleCombined resection of the pancreas and portal vein replaced by blood vessel prosthesis for pancreatic head carcinoma: report of two cases [in Chinese] Zhonghua Wai Ke Za Zhi 35 147–149 Occurrence Handle10374520
JE Niederhuber MF Brennan R Menck (1995) ArticleTitleThe National Cancer Database report on pancreatic cancer Cancer 76 1671– 1677 Occurrence Handle8635074
M Trede B Rumstadt K Wendl et al. (1997) ArticleTitleUltrafast magnetic resonance imaging improves the staging of pancreatic tumors Ann Surg 226 393–405 Occurrence Handle10.1097/00000658-199710000-00001 Occurrence Handle9351708
T Rosch R Lorenz C Braig et al. (1991) ArticleTitleEndoscopic ultrasound in pancreatic tumor diagnosis Gastrointest Endosc 37 347–352 Occurrence Handle2070987
P Legmann O Vignaux B Dousset et al. (1998) ArticleTitlePancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography Am J Radiol 170 1315–1322
GM Richter C Simon V Hoffmann et al. (1996) ArticleTitleHydrospiral CT of the pancreas in thin section technique [in German] Radiologe 36 397–405 Occurrence Handle10.1007/s001170050088 Occurrence Handle8778924
MG House CJ Yeo JL Cameron et al. (2004) ArticleTitlePredicting resectability of periampullary cancer with three-dimensional computed tomography J Gastrointest Surg 8 280–288 Occurrence Handle10.1016/j.gassur.2003.12.011 Occurrence Handle15019924
L Kopka P Rogalla B Hamm (2002) ArticleTitleMultislice CT of the abdomen-current indications and future trends [in German] Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174 273–282 Occurrence Handle10.1055/s-2002-20599 Occurrence Handle11885002
RW Prokesch LC Chow CF Beaulieu et al. (2002) ArticleTitleLocal staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience Radiology 225 759–765 Occurrence Handle12461258
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Karmazanovsky, G., Fedorov, V., Kubyshkin, V. et al. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging 30, 488–500 (2005). https://doi.org/10.1007/s00261-004-0279-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-004-0279-z