Accuracy of Multislice Detector Computed Tomography in Staging Borderline Resectable Periampullary Pancreatic Carcinoma

Document Type : Original Article

Authors

1 Department of General Surgery, Prince Charles Hospital, Merthyr Tydfil, Cardiff, UK

2 Department of General Surgery, Cairo University Hospitals, Egypt

Abstract

Introduction: Periampullary malignancies have poor outcomes. Thus, identifying patients who can benefit from
surgery while avoiding risks and possible complications is crucial. This study was designed to determine the
accuracy of MDCT in diagnosing resectable tumors.
Methodology and results: This retrospective case-control study included 28 randomly selected patients. Patients
were divided into group A (preoperative staging via MDCT) and group B (control; staging via laparoscopy and
MDCT).MDCT had a 100% sensitivity and accuracy in identifying signs of irresectability. For borderline staging,
MDCT had an accuracy of 62.5% and 71% for groups A and B, respectively. MDCT had an overall accuracy of
75%, which decreased to 68.1% for borderline lesions. Laparoscopy was able to identify occult findings missed by
radiological imaging. Three cases in group A and one in group B underwent unnecessary laparotomy, resulting in
a false-negative rate of 21% and 7%, respectively, with an overall rate of 14.2%. The mean predictive value of CT
was 100% and 68.1% in irresectable and resectable cancers, respectively.
Conclusion: Although MDCT is highly accurate for high-stage cancers, in potentially resectable tumors, it’s less
accurate. We recommend adding other adjuncts to avoid unindicated laparotomies.

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