[The importance of endosonography in preoperative management of patients with pancreatic head carcinoma].

Introduction: Pancreatic ductal cancer remains a devastating disease with an urgent need for improved diagnostics and new treatment strategies. It has no early specific symptoms, shows rapid progression and is practically undiagnosable in the early stage. Survival of radically operated patients is rather unsatisfactory. Nonetheless, only radical surgical resection offers potentially curative treatment.

Material And Methods: The authors present a set of 70 patients (2009-2011) who underwent radical surgery - pancreatic head resection - for ductal pancreatic head adenocarcinoma. A retrospective study analyzes the accuracy of T-staging using preoperative CT and EUS.

Results: In 21 (30%) patients, CT did not prove pathology in the head of the pancreas. Subsequent endosonography revealed a mass in the head of the pancreas in 88% of patients with negative CT scans. The conformity of CT (detection of the mass) with the histopathological finding was detected in 68.2% of cases, 95% CI for compliance: 55.6%-79.1%. The conformity of endosonography (detection of the mass) with the histopathological finding was detected in 96.0% of cases, 95% CI for compliance: 86.3%-99.5%. The conformity between CT and endosonography was found in 68.8% of cases, 95% CI for compliance: 53.8%-81.3%. The conformity of preoperative CT staging and final histopathological staging was observed in 18.2% of cases, 95% CI for compliance: 9.8%-29.6%. The conformity of preoperative endosonography staging and final histopathological staging was seen in 42.0% of cases, 95% CI for compliance: 28.2%-56.8%. The conformity of accuracy of preoperative CT staging and endosonography staging was detected in 37.5% of cases, 95% CI for compliance: 23.9%-52.7%. In 58.3% of cases, endosonography compared with CT findings evaluated higher T stage (p = 0.001).

Conclusion: Pancreatic head carcinoma presents mostly with obstructive jaundice. CT diagnosis of small tumours often fails. Subsequent endosonography in case of a negative CT usually contributes significantly to the final diagnosis and helps determine the indication for surgery. EUS is more accurate than CT in showing the tumour mass in the pancreatic head. In our group EUS revealed the mass in 96% of patients versus 68% in CT. When evaluating the staging, CT is accurate only in 18.2% of patients, EUS in 42% of patients. Both methods, EUS and particularly CT, underestimate the actual final T-staging of the disease.