ancreatic cancer is associated with an extremely poor
prognosis with less than 5% of patients surviving 5 years after the diagnosis.
Current preoperative staging modalities include various crosssectional
imaging techniques, including spiral CT and endoscopic ultrasound
(EUS). Aim of the work: This prospective study aimed at demonstrating
the role of spiral CT and endoscopic ultrasonography in early diagnosis
staging and assessment of operability of periampullary tumors.
Patients and Methods: Sixty-two patients with periampullary tumors
were included in this study. All cases were subjected to abdominal ultrasound,
Spiral CT, ERCP, EUS and operative inteiference. Surgical findings
were considered the gold standard for assessing the sensitivity of
spiral CT and EUS in diagnosing, staging and estimating resectability of
periampullary tumors. Results: Endoscopic Ultrasonography was very
sensitive in detecting periampullary masses (93.5%) especially masses
smaller than 20mm while the sensitivity of spiral CT was 71%. EUS was
also very sensitive in detecting arnpullary masses (100%) in contrast to
spiral CT that missed the diagnosis of the 14 ampullary masses found in
our work. EUS was more sensitive than Spiral CT in detecting malignant
vascular invasion (95% versus 75%) while it was slightly less specific
than spiral CT in that context (74 versus 80%). The predictive value of spiral CT was 60% for tumor resectability while it was 100% for tumor
unresectability. The predictive value of EUS was 73.5% for tumor resectabatty
while it was 96.4% for tumor unresectability. When combining both
techniques the predictive value for tumor resectabtlity was 65% while it
was 100% for tumor unresectability. No complications were encountered
in both techniques. Conclusions: We concluded that EUS is more sensitive
than spiral CT in detection and staging of periampullary masses. Also,
the non-invasive spiral CT and the Minimally invasive EUS are very valuable
tools in predicting unresectability of periampullary masses while
EUS is slightly more valuable in detecting tumor resectability. |
