4565 Value of preoperative staging for pancreatic masses suspicious of malignancy.

Abstract

Introduction: Imaging studies of pancreatic cancer have been reported to be accurate in the preoperative staging of pancreatic cancer. Systematic assessment of imaging studies regardless of a positive (malignancy) or negative (benign) Whipple or other surgical procedure has not been carefully assessed. We therefore retrospectively reviewed the results of preoperative imaging of pancreatic masses suspicious of cancer com of the histology of resection specimen and/or surgery. Methods: Between 10/96 and 10/99 CT, ERCP and EUS was performed approximately 2-4 weeks prior to surgery in 62 patients with suspected pancreatic cancer. The results of imaging were correlated with that of the histology of resection specimen or surgical findings. Results: Table summarizes the results of CT, ERCP, and EUS 38 patients underwent a Whipple procedure (36 adenocarcinomas; 1 pancreatic Crohn s disease, 1 pancreatitis with abscess); 9 patients underwent non Whipple surgery, and 15 were found to be unresectable at exploratorty laparotomy. Adenocarcinoma of the pancreas was found in 52 (84%) patients and benign pathology was found in 10 patients(16%). The accuracy for both CT , ERCP and EUS were 84%; 84% and 87% respectively. The positive predictive value (PPV) of CT, ERCP and EUS were of 84%,90.% and 87%, respectively. Of all patients deemed unresectable at surgery (n= 15), all had evidence of vascular invasion at the time of EUS. Conclusions: 1- CT, ERCP and EUS for preoperative staging do not show any significant difference in predicting malignancy. 2- In this series, 16% of cases had false positive imaging studies. 3- Surgery is still recommended in cases of positive imaging studies. 4- Pre-operative tissue diagnosis may be helpful to avoid unnecessary surgery.