Işcanlı Esra, Türkvatan Aysel, Bostancı Erdal Birol, Sakaoğulları Zişan
Department of Radiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
Turk J Gastroenterol. 2014 Aug;25(4):416-23. doi: 10.5152/tjg.2014.4973.
BACKGROUND/AIMS: To investigate the accuracy of multidetector computed tomography (MDCT) in preoperatively determining the surgical resectability of pancreatic adenocarcinomas.
Multidetector computed tomography, surgery, and pathological results of 274 patients with pancreatic adenocarcinoma were evaluated retrospectively. MDCT findings were compared with surgical and pathological findings to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MDCT in determining surgical resectability.
A total of 124 of 274 (56%) patients (83 males, mean age: 60 years) underwent laparoscopy and/or laparotomy. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in determining the surgical resectability of pancreatic adenocarcinomas were 100%, 72%, 78%, 100%, and 86%, respectively. Liver metastases in 9 cases, peritoneal metastases in 3 cases, and vascular invasion in 5 cases, which were determined during surgery, were not reported by MDCT. On re-review of the MDCT images of these 17 patients, no metastatic lesions could be seen in 9 patients with liver metastases and in 2 of 3 patients with peritoneal metastases. In 1 patient, a peritoneal implant of a diameter of 8 mm was missed on MDCT. There was no vascular invasion according to Lu criteria on the MDCT images in the 5 cases that had vascular invasion in the surgical exploration.
The accuracy of MDCT is high in the preoperative determination of surgical resectability of pancreatic adenocarcinomas, but the detection of small liver and peritoneal metastases and accurate determination of vascular invasion are still major problems. Surgeons should be aware of the limitations of preoperative MDCT.
背景/目的：探讨多排螺旋计算机断层扫描（MDCT）术前判定胰腺腺癌手术可切除性的准确性。
回顾性分析274例胰腺腺癌患者的多排螺旋计算机断层扫描、手术及病理结果。将MDCT表现与手术及病理结果进行比较，以确定MDCT在判定手术可切除性方面的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及准确性。
274例患者中共有124例（56%）（83例男性，平均年龄60岁）接受了腹腔镜检查和/或剖腹手术。MDCT在判定胰腺腺癌手术可切除性方面的敏感性、特异性、PPV、NPV及准确性分别为100%、72%、78%、100%和86%。手术中确定的9例肝转移、3例腹膜转移和5例血管侵犯，MDCT均未报告。再次查看这17例患者的MDCT图像时，9例肝转移患者及3例腹膜转移患者中的2例未见转移灶。1例患者MDCT漏诊了直径8 mm的腹膜种植灶。手术探查发现有血管侵犯的5例患者，其MDCT图像根据Lu标准未显示血管侵犯。
MDCT在术前判定胰腺腺癌手术可切除性方面准确性较高，但小肝转移和腹膜转移的检测及血管侵犯的准确判定仍是主要问题。外科医生应了解术前MDCT的局限性。
