PREOPERATIVE ASSESSMENT OF LOCALLY INVASIVE PANCREATIC TUMOR BY COMPUTED TOMOGRAPHY AND ENDOSCOPIC ULTRASOUND

Zainab Kamil Majeed, Kassim Amir Hadi Taj Al-Dean

 

College of Medicine, University of Babylon. Babylon, Iraq.

P

ancreatic cancer is the 5th most common reason of cancer-related deaths in Asian countries and the 4th leading reason of cancer-related deaths in Western countries. Computed tomography (CT) show excellent spatial and temporal resolution with wide anatomic coverage for evaluation of pancreatic lesions. Endoscopic Ultrasound (EUS) is used for radiology evaluation in symptomatic or asymptomatic cases with pancreatic lesions.

Purpose. To assess the radiological findings and to find the accuracy between CT and EUS in preoperative assessment of locally invasion pancreatic tumors.

Materials and methods. A retrospective study of 22 patients proven with pancreatic adenocarcinoma were studied at a period from 26th July 2023 to 29th May 2024. Data collected include age of patient, sex, Location of pancreas mass. CT scan findings included: max tumor dimension, attenuation, dilatation, invasion, arterial contact and venous. EUS findings included: appearance, echogenisty and dilatation. EUS (fugifilm linear EUS, Japan), was done under GA. CT scan was performed used the Siemens system.

Results. In this study, mean age of patients was 40.68±10.45 yrs (median =45.5 yrs). Females were predominant in 14 cases (63.6%). Head of pancreas represented the common site of mass location in 13 of cases (59.1%). The maximum tumor dimension measured by CT was most belonged between 2 to cm in 13 patients (59.1%). The Hypo-attenuated mass visualized in 19 cases (86.4%). In relation to dilatation, the pancreatic duct dilated in seven cases (31.8%) while CBD dilated in 15 cases (68.2%). Regarding to the invasion to adjacent organs, the duodenum was the common organ invaded in six patients. Arterial contact to celiac artery seen in four patients and also for mesenteric artery. Venous content visualized in nine patients at portal vein, two in IVC and the most of patients with mesenteric vein (n=11; 50%). Most of mass appearance by EUS was infiltrative in 14 cases (63.6%). 16 of 22 patients (72.7%) showed hypo-echoic mass. CT showed higher sensitivity and specificity, respectively with accuracy rate reached to 81% in diagnosis of max tumor dimension among other tests. Furthermore, EUS sensitivity, specificity and accuracy for echogenisty were greater among other parameter (75%; 66%; 60%, respectively).

Discussion. In this study, the maximum tumor dimension measured was most belonged between 2 to 4 cm in 13 patients (59.1%). Those with dimension more than 4 cm were 7 cases (31.8%). The Hypo-attenuated mass visualized in 19 cases (86.4%). The iso-attenuated mass detected in three cases. In relation to dilatation, the pancreatic duct dilated in seven cases (31.8%) while CBD dilated in 15 cases (68.2%). Regarding to the invasion to adjacent organs, the duodenum was the common organ invaded in six patients. Arterial contact to celiac artery seen in four patients and also for mesenteric artery. Venous content visualized in nine patients at portal vein, two in IVC and the most of patients with mesenteric vein (n=11; 50%). Disagree with the findings of Dickinson et al. found 22 cases (13%)  had tumors that were not measurable (≤ 2 cm), 125 (74%) had tumor > 2 - ≤ 4 cm, and 21 (12%) had tumors > 4 cm. Tumors were present in 116 cases (69%) within the head, in 19 cases (11%) – neck  and body or tail in 33patients (20%). Tumor arterial contacting was presented in 47 cases and venous contacting was presented in 136 cases. They classified 25% of tumor as iso-attenuating. These data differ from our findings. The discordances are probably because of the differences in study designs including difference in patients selecting criteria, CT scan evaluation at different stages of management, vascular involvement assessment via intra-operative radiology and inclusion of subjects with different primer resect-ability classifications.

Conclusions. Head of pancreas represented the common site of pancreatic cancer. The large maximum tumor dimension measured, Hypo-attenuated mass, dilatation of the pancreatic and CBD, invasion to adjacent organs encasement of vessels are features of pancreatic carcinoma detect by CT scan. Infiltrative, hypo-echoic mass and dilatation of ducts are features of pancreatic carcinoma detect by CT scan. CT have higher sensitivity and specificity, respectively among EUS, with no significant difference.

 

Keywords: pancreatic cancer, computed tomography, endoscopic ultrasound, portal vein, CT scan attenuation.

 

Corresponding author: Zainab Kamil Majeed, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Zainab Kamil Majeed, Kassim Amir Hadi Taj Al-Dean. Preoperative assessment of locally invasive pancreatic tumor by computed tomography and endoscopic ultrasound. REJR 2024; 14(3):58-68. DOI: 10.21569/2222-7415-2024-14-3-58-68.

Received:        13.07.24 Accepted:       04.09.24