State‐of‐the‐art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

Abstract

AbbreviationsCT, computed tomography; CTA, computed tomographic angiography; PV, portal vein; SMA, superior mesenteric artery; SMV, superior mesenteric vein; SV, splenic vein Article Objective. To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullary cancer is unresectable because of either distant metastasis or local vascular involvement. The advent of gray scale and color Doppler ultrasonography has improved the ability of ultrasonography to detect vascular involvement. Methods. Twenty-three consecutive patients with periampullary cancer were enrolled for prospective staging of their disease by comparing helical computed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesenteric vein, splenic vein, and superior mesenteric artery involvement was graded 0 to 4, grade 0 being no vascular involvement and grade 4 being total occlusion of the vessel. Agreement between ultrasonography and computed tomographic angiography for determining vascular involvement was measured by χ 2 analysis. Results. Two patients (9%) were excluded because excessive overlying bowel gas hampered the ability of ultrasonography to visualize the pancreas. For the remaining 21 patients, there was significant agreement between ultrasonography and computed tomographic angiography for detecting vascular involvement in all vessels (P < .001; portal vein, κ = 0.67; superior mesenteric vein, κ = 0.67; splenic vein, κ = 0.85; and superior mesenteric artery, κ = 0.59). Ultrasonography was in agreement with computed tomographic angiography in all cases of unresectability. Both modalities were equally poor in preoperatively showing lymphadenopathy and metastases. Conclusions. Provided that there is adequate visualization on ultrasonography of the head of the pancreas in the periampullary region, then state-of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detecting the unresectability of periampullary cancer. If performed as the initial investigation and the region of the pancreatic head is clearly shown, and if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.

Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma

“…5,10,12,14,15,[18][19][20]22,23,25 In particular, these authors claim that compared with sonography, helical CT gives a better depiction of the tumor and that the results are less dependent on the radiologist's experience and the patient's body habitus. 14,15,25 However, the mean sensitivity of helical CT in identifying pancreatic tumors, as calculated from data reported in 10 recent studies, 5,10,12,[18][19][20]22,23,25,31 is only 87% (range, 84-96%). This mean sensitivity is slightly lower than that reported for sonography, which is about 90%, 27,31,32 although it is possible that the authors using sonography tended to exclude from their series those patients who were difficult to examine.…”

“…14,15,25 However, the mean sensitivity of helical CT in identifying pancreatic tumors, as calculated from data reported in 10 recent studies, 5,10,12,[18][19][20]22,23,25,31 is only 87% (range, 84-96%). This mean sensitivity is slightly lower than that reported for sonography, which is about 90%, 27,31,32 although it is possible that the authors using sonography tended to exclude from their series those patients who were difficult to examine. 31 Nevertheless, with technologic progress and increasing experience of sonographers, the incidence of nondiagnostic sonographic investigations has decreased considerably worldwide in recent years.…”

Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer

“…96 The use of color Doppler TUS has improved the accuracy for detection of the vascular involvement, with a correct assessment of the spatial relationship between tumors and vessels, especially if contrast sonography is used. 97 TUS is not accurate enough for the prediction of resectability, and other modalities should be used for accurate staging. 18,98 A large meta-analysis including 68 articles was recently published and also confirmed the low accuracy of TUS for staging and determination of resectability, in comparison with CT and MR. 99 Helical CT had the highest sensitivity for the diagnosis as compared to TUS (93% versus 76%), but also the highest specificity for assessing resectability (82% versus 63%), and it is the preferred modality for staging.…”

Imaging in Staging and Management of Pancreatic Ductal Adenocarcinoma

“…Ultrasound is largely operator dependent and the experience of one center may not be reproducible in others. However, in advanced and metastatic disease, they may be comparable to CT in their accuracy [18]. On ultrasound, pancreatic ductal adenocarcinoma is usually seen as a hypo echoic mass with ill defined borders (Fig.…”

“…There are several heritable disorders which are associated with an increased incidence of pancreatic ductal adenocarcinoma such as Peutz-Jeghers syndrome (132 times increased risk), hereditary pancreatitis (53 times increased relative risk); familial atypical multiple mole melanoma syndrome (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) times increased risk); familial pancreatic cancer syndrome (9-32 times increased risk) and hereditary breast and ovarian cancer syndrome-BRCA mutation (2-10 times increased risk) [4,5].…”