Diagnosing and Staging of Pancreatic Carcinoma – What Is Necessary?

Abstract

The aim of the present prospective observational study was to diagnose and stage pancreatic carcinoma with a minimum of diagnostic procedures. Our experiences in 307 patients with a histologically confirmed pancreatic carcinoma show that for diagnosing pancreatic carcinoma sonography and computed tomography are sufficient in 95% of the cases. The combination of both has a sensitivity equal to that of endoscopic retrograde cholangiopancreatography (ERCP; 96.8 vs. 98.7%; n.s., χ² test). ERCP is only indicated in cases with negative sonography and computed tomography, and suspicion of pancreatic cancer. For tumor staging, the routine performance of angiography cannot be recommended in view of the fact that although it provides greater sensitivity for the evaluation of an infiltration of the portal vein (80% for angiography vs. 22% for sonography or computed tomography), it is associated with a lower positive predictive value (56.4 vs. 68 and 72%) which results in a lower accuracy. Despite recent advantages in diagnostic technology, less than 50% of unresectable tumors were identified preoperatively at a 10% false-positive rate. The major reason for unresectability is infiltration into the mesenteric axis, which cannot be identified laparoscopically. Laparoscopy or percutaneous biopsy is recommended only in the presence of a tumor with suspicion of distant metastasis detected by radiological imaging and requiring histological confirmation. In conclusion, sonography and computed tomography as the only diagnostic images are sufficient for diagnosing and staging of pancreatic carcinoma in more than 95% of the patients. Only a small number of patients needs further diagnostic procedures.

Endoscopic Ultrasound for Solid and Cystic Neoplasms of the Pancreas

“…Its sensitivity ranges between 48% 8 and 89% 20 with accuracy between 46% 8 and 64% 21 . Small tumors measuring less than 1cm are detected by US in only 50% of cases while the sensitivity increases to 95.8% for tumors larger than 3 cm 20 .…”

“…Its sensitivity ranges between 48% 8 and 89% 20 with accuracy between 46% 8 and 64% 21 . Small tumors measuring less than 1cm are detected by US in only 50% of cases while the sensitivity increases to 95.8% for tumors larger than 3 cm 20 . US has a relatively low performance profile for staging of pancreatic tumors as its sensitivity for lymph nodes involvement ranges only between 8 17 to 57 % 20 .…”

“…In addition, the deep position of the pancreas and the interposition of other organs such as the stomach and the transverse colon limit the capacity of US to identify small PCLs. The overall sensitivity of US in detecting pancreatic lesions ranges from 48% 8 to 89% 20 . The majority of studies describing the role of CT and MRI in the diagnosis of PCLs have been small and retrospective.…”

Staging Laparoscopy and Its Indications in Pancreatic Cancer Patients

“…The clinical findings from other clinical centers support our results. Böttger et al [26]reported reliable staging in 95% in a series of 307 patients with pancreatic cancer using CT scan and ultrasonography. The use of ERCP was recommended as an additional diagnostic tool if necessary.…”

Improved Targeting of Pancreatic Cancer

“…In addition to in vitro screening technologies, noninvasive imaging procedures currently in use provide additional support for an accurate diagnosis, as well as provide data regarding localization and staging to determine whether resection is an option. Computed tomography (12)(13)(14) and ultrasonography (15)(16)(17) are the most widely used technologies for imaging pancreatic cancer; however, detection of small tumors is problematic. Research is proceeding with magnetic resonance imaging as well as magnetic resonance cholangiopancreatography (18 -20) and positron emission tomography (PET; Refs.…”