Vascular involvement in pancreatic adenocarcinoma:reassessment by thin-section CT

Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours

“…In the report of Loyer and co-workers, there was an increased likelihood of detection of unresectable disease with increasing CT grades of vascular involvement (Loyer et al, 1996). All of the 22 patients with grade A and B tumours were resectable with only one patient requiring venous resection.…”

“…In the remaining 152 patients there were 83 (55%) males and 69 (45%) females with a median age of 64 years (range 35 -83 years). The eventual pathological diagnosis was pancreatic adenocarcinoma in 93 (61%), presumed pancreatic (but not Normal parenchyma separates the hypodense tumour from adjacent vessels Grade C Hypodense tumour is inseparable from adjacent vessels, and the points of contact form a convexity against the vessels Grade D Hypodense tumour is inseparable from adjacent vessels, and the points of contact form a concavity against the vessels or partially encircle the vessels Grade E Hypodense tumour encircles adjacent vessels, and no fat plane is identifiable between the tumour and the vessels Grade F Tumour occludes the vessels Based on the classification of vascular involvement described by Loyer et al (1996). biopsy proven) in 18 (12%), ampullary cancer in 17 (11%), benign in eight (5%), cholangiocarcinoma in seven (5%), neuroendocrine in five (3%) and four other diagnoses (3%).…”

“…Each tumour was given a CT grade of vascular involvement based on that described by Loyer et al (1996). This grading system examines the relationship between the tumour and the major vessels (superior mesenteric vein, portal vein, superior mesenteric artery and hepatic artery).…”

“…This grading system examines the relationship between the tumour and the major vessels (superior mesenteric vein, portal vein, superior mesenteric artery and hepatic artery). Patients with grade A to D tumours are considered potentially resectable while those with grade E or F tumours are invariably not resectable (Loyer et al, 1996). In addition a grade O was added to this grading system for those patients with pancreatic and biliary duct dilatation without the presence of a pancreatic mass.…”

“…Loyer et al (1996) have described a grading system of vascular involvement based on a dynamic series of 1.5 mm thickness scans in patients with pancreatic adenocarcinoma (Table 1). Along with other groups, they have reported a decreasing rate of resectability with increasing grades of vascular involvement (Loyer et al, 1996;Phoa et al, 1999;Saldinger et al, 2000).…”