Preoperative staging accuracy of multidetector computed tomography in pancreatic head adenocarcinoma.

Objective: To compare the preoperative computed tomography (CT) findings in patients with potentially operable pancreatic malignancy with findings at surgery.

Methods: In a retrospective analysis, 140 consecutive patients with carcinoma of the pancreatic head were studied. All were imaged using a standardized multidetector CT (MDCT) protocol. Patients with disease that was clearly inoperable were excluded. The remaining patients had their CT studies double-reported using a standard method. Images were scored for vascular involvement, tumor size, nodal disease, pancreatic duct diameter, and size of the gastrocolic trunk. Preoperative staging was compared with findings at surgery.

Results: One hundred forty patients presented with pancreatic head tumors. One hundred were not suitable for surgery. Forty patients were considered for curative surgery. For assessing preoperative operability, MDCT has an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 72.7, 81.8, 68.2, 56, and 88.2%, respectively. Subjects with inoperable tumors tended to have larger tumors and more dilated pancreatic ducts (P = 0.04).

Conclusions: There remains a group of patients with small pancreatic tumors that show early local dissemination, undetectable with high-resolution anatomical imaging.