THE CT CRITERIA OF UNRESECTABILITY FOR PANCREATIC CARCINOMA

Mahnoor Hafeez Ur Rehman; Ateeque Ahmed Khan

THE CT CRITERIA OF UNRESECTABILITY FOR PANCREATIC CARCINOMA

Mahnoor Hafeez Ur Rehman, Ateeque Ahmed Khan

Abstract

Objectives: The objective of our study was to determine the accuracy of CT using pancreatic protocol for detecting vascular invasion in patients with pancreatic carcinoma.

Study Design: Cross -Sectional prospective study

Place and Duration of Study: Department of Diagnostic Radiology and imaging, Civil Hospital Karachi, from October 2015 to December 2016,

Methods: Thirty consecutive male and female patients having obstructive jaundice with age range of 40-75 undergoing MDCT were included in this study. All patients selected were ERCP guided biopsy proven cases of pancreatic adenocarcinoma. Based on vessel invasion, we assigned patients to one of two CT groups: Vascular invasion & Vascular sparing. The vessels studied were coeliac trunk, common hepatic artery, and superior mesenteric artery. At Civil Hospital, pancreatic adenocarcinoma is considered to be unresectable on MDCT if vascular invasion is present which is defined as tumor-to-vessel contiguity > 50% in the peripancreatic vessel. Other studied factors were age, gender and size of the tumor. The radiologic findings were correlated with per-operative findings at exploratory laparotomy, which were taken as gold standard. Descriptive statistics were calculated and Chi square test was used to determine the correlation between the variables. All findings were analyzed using SPSS 20.0 software. Those patients whose MDCT meets the CT criteria of unresectability underwent palliative Common Bile Duct stenting and those who meet don’t meet the CT criteria subsequently underwent Whipple’s Procedure.

Results: There were 86.6% male and 13.4% female patients in the study. The mean age was 58 ±9.2years and mean size of the tumor was 5.2 cm. The results showed that by MDCT scan positive findings were observed in 61.2% cases and per-operative positive findings were observed in 62.3% cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of spiral CT in identifying non resectability of pancreatic carcinoma were 91.6%, 83.3%, 95.6%, 71.4% and 90.0% respectively.

Conclusion: MDCT has a high positive predictive value for vascular invasion and good accuracy for determining overall tumor non resectability in patients with pancreatic carcinoma.

KEY WORDS: Pancreatic Carcinoma, pancreas, unresectability, vascular invasion, CT.

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