Procacci C, Biasiutti C, Carbognin G, Bicego E, Graziani R, Franzoso F, Pesci A, Megibow A J
Department of Radiology, University Hospital G.B. Rossi, Verona, Italy.
Dig Liver Dis. 2002 Oct;34(10):739-47. doi: 10.1016/s1590-8658(02)80026-3.
Despite more recent technical advances, single detector spiral computed tomography is still the most widely used imaging technique for the detection and staging of pancreatic adenocarcinoma. Many reports have recently focused on single detector spiral computed tomography imaging findings indicative of unresectability
To evaluate the ability of single detector spiral computed tomography in the pre-operative staging of ductal adenocarcinoma of the pancreas in selecting surgically resectable versus unresectable cases, considering different parameters (vascular and local infiltration, liver metastases, lymphadenopathy, and peritoneal carcinomatosis).
A total of 100 patients diagnosed with ductal adenocarcinoma of the pancreas, pathologically verified, and examined with single detector spiral computed tomography were considered. Of these, 63 underwent surgery; 37 were excluded (imaging evidence of unresectability in biopsy-proven adenocarcinomas). Single detector spiral computed tomography studies, performed at the time of surgery, were retrospectively reviewed by two radiologists. The final results were reached by consensus, without being aware of the operation. All prospective clinical readings were also considered, and tabulated.
In the patients undergoing surgery, 44 proved to be unresectable and 19 resectable. Considering the above-mentioned parameters, the prospective assessment of resectability demonstrated a rather low sensitivity (68%), with high specificity (95%). Accordingly, a high positive predictive value (97%) was achieved, while the negative predictive value was 56%. After the retrospective evaluation, the value of sensitivity increased (84%) to the expense of the specificity (84%). Moreover, a positive predictive value of 92.5%, and a negative predictive value of 69.5% were obtained.
The demonstration of many signs of unresectability of pancreatic ductal adenocarcinoma reported in the literature yields a better sensitivity in the diagnosis, but unfortunately, is associated with an inevitable reduction in specificity.
尽管近年来技术有所进步，但单排螺旋计算机断层扫描仍是检测和分期胰腺腺癌最广泛使用的成像技术。最近许多报告都集中在提示不可切除性的单排螺旋计算机断层扫描成像结果上。
考虑不同参数（血管和局部浸润、肝转移、淋巴结病和腹膜癌），评估单排螺旋计算机断层扫描在胰腺导管腺癌术前分期中区分可手术切除与不可手术切除病例的能力。
共纳入100例经病理证实诊断为胰腺导管腺癌并接受单排螺旋计算机断层扫描检查的患者。其中，63例接受了手术；37例被排除（活检证实为腺癌但有不可切除成像证据）。两名放射科医生对手术时进行的单排螺旋计算机断层扫描研究进行了回顾性分析。最终结果通过共识得出，且不知晓手术情况。还考虑并列表了所有前瞻性临床读片结果。
接受手术的患者中，44例被证明不可切除，19例可切除。考虑上述参数，可切除性的前瞻性评估显示敏感性较低（68%），但特异性较高（95%）。因此，阳性预测值较高（97%），而阴性预测值为56%。回顾性评估后，敏感性值增加（84%），但特异性降低（84%）。此外，阳性预测值为92.5%，阴性预测值为69.5%。
文献中报道的胰腺导管腺癌许多不可切除征象的显示在诊断中具有更高的敏感性，但不幸的是，与特异性不可避免的降低相关。
