Systematic evaluation of radiological findings in the assessment of resectability of peri-ampullary cancer by CT using different contrast phase protocols

Dentro del amplio espectro de los tumores pancreáticos, el adenocarcinoma es el que presenta mayor frecuencia. A pesar de los avances de los métodos imagenológicos y de las técnicas quirúrgicas, el carcinoma de páncreas sigue siendo uno de los tumores más agresivos. Su diagnóstico oportuno, y sobre todo la determinación de su resecabilidad, sirven para sectorizar aquellos pacientes candidatos a cirugía de aquellos en quienes esta no resultaría beneficiosa, sumando además los riesgos adicionales que dicho tratamiento implica. En el presente trabajo queremos mencionar los aspectos clínico-epidemiológicos fundamentales del carcinoma de páncreas y describir sus características imagenológicas y criterios de resecabilidad utilizando la tomografía computada multidetector (TCMD) con protocolo específico para glándula pancreática.

show abstract

“…4), la atrofia de la glándula distal a la lesión (Fig. 5) y la deformidad del contorno pancreático [11][12][13] .…”

Section: Aspectos Clínicosunclassified

Adenocarcinoma de páncreas: evaluación mediante tomografía computada multidetector

Perroni¹,

Larrañaga²,

Prado-Zárate³

et al. 2023

RAR

View full text Add to dashboard Cite

show abstract

“…While DA represent over 50% of small bowel adenocarcinoma, they differ from other small bowel tumors: the resection rate of 41-57% for DA is substantially lower than the 83-95% resection rate for jejunal and ileal cancer, and the median overall survival (OS) of 13-40 months for DA compares unfavorable to 19-63 months for jejunal and ileal cancer [2,3,6,7]. Because DA is a rare disease, the majority of publications that are available discuss all small bowel tumors as one group or include DA in the analysis of periampullary tumors [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Routine contrast-enhanced CT is insufficient for TNM-staging of duodenal adenocarcinoma

Litjens¹,

Laarhoven²,

Prokop³

et al. 2022

Abdom Radiol

View full text Add to dashboard Cite

Purpose Adequate TNM-staging is important to determine prognosis and treatment planning of duodenal adenocarcinoma. Although current guidelines advise contrast-enhanced CT (CECT) for staging of duodenal adenocarcinoma, literature about diagnostic tests is sparse. Methods In this retrospective single-center cohort study, we analyzed the real life performance of routine CECT for TNM-staging and the assessment of resectability of duodenal adenocarcinoma. Intraoperative findings and pathological staging served as reference standard for resectability, T-, and N-staging. Biopsies, 18FDG-PET-CT, and follow-up were used as the reference standard for M-staging. Results Fifty-two consecutive patients with duodenal adenocarcinoma were included, 26 patients underwent resection. Half of the tumors were isodense to normal duodenum on CECT. The tumor was initially missed in 7/52 patients (13%) on CECT. The correct T-stage was assigned with CECT in 14/26 patients (54%), N-stage in 11/26 (42%), and the M-stage in 42/52 (81%). T-stage was underestimated in (27%). The sensitivity for detecting lymph node metastases was only 24%, specificity was 78%. Seventeen percent of patients had indeterminate liver or lung lesions on CECT. Surgery with curative intent was started in 32 patients, but six patients (19%) could not be resected due to unexpected local invasion or metastases. Conclusion Radiologists and clinicians have to be aware that routine CECT is insufficient for staging and determining resectability in patients with duodenal adenocarcinoma. CECT underestimates T-stage and N-stage, and M-stage is often unclear, resulting in futile surgery in 19% of patients. Alternative strategies are required to improve staging of duodenal adenocarcinoma. We propose to combine multiphase hypotonic duodenography CT with MRI.

show abstract

Proposed nomogram predicting neoplastic ampullary obstruction in patients with a suspected ampulla of Vater lesion on CT

et al. 2021

View full text Add to dashboard Cite

Systematic evaluation of radiological findings in the assessment of resectability of peri-ampullary cancer by CT using different contrast phase protocols

Cited by 5 publications

References 23 publications

Adenocarcinoma de páncreas: evaluación mediante tomografía computada multidetector

Adenocarcinoma de páncreas: evaluación mediante tomografía computada multidetector

Routine contrast-enhanced CT is insufficient for TNM-staging of duodenal adenocarcinoma

Proposed nomogram predicting neoplastic ampullary obstruction in patients with a suspected ampulla of Vater lesion on CT

Contact Info

Product

Resources

About