review of literature on clinical pancreatology - The Pancreapedia

show how this imaging modality helps to differentiate between focal fatty infiltration <strong>of</strong> thepancreas and actual pancreatic tumors [430].EUS versus CTTo compare the performances <strong>of</strong> EUS to helical CT in the diagnosis and staging <strong>of</strong>pancreatic adenocarcinoma 42 consecutive patients (mean age 63 years; 25 men) who hadsurgical exploration and histologically proved pancreatic cancer were retrospectivelyincluded. All the patients underwent with endoscopic ultrasonography (EUS) and helicalcomputed tomography (CT). Data analysis compared helical CT, EUS with the surgical datawith or without histological study in diagnosis, staging and resectability <strong>of</strong> pancreatic cancer.Surgical findings were used as gold standard. For positive diagnosis EUS was moresensitive 100 percent (95 % confidence interval 93 to 100) than helical CT 88 percent (77 to95). However, helical CT was more specific 89 percent (64 to 98) than EUS 83 percent (58 to96) for small tumors whose diameter is below 2.5 cm in witch EUS was more sensitive intheir detection (100 % vs 83 %). In evaluating venous involvement EUS was significantlymore sensitive than helical CT (96 % vs 50 %), while CT was significantly more specific (81% vs 75 %). Regarding lymph nodes invasion, the two imaging technique had the samesensibility (56 %) with better specificity for helical CT (83 % vs 75 %). The accuracy <strong>of</strong> EUSin identifying the T and N stages were 80 and 67 percent, respectively, while helical CT havean accuracy <strong>of</strong> 50 and 71 percent, respectively. EUS and helical CT correctly identified allresectable tumors while EUS was more accurate than helical CT in detecting non resectabletumors 94 percent versus 69 percent. It was concluded that EUS remains superior to helicalCT in positive diagnosis <strong>of</strong> pancreatic adenocarcinoma especially for small tumors and als<strong>of</strong>or the diagnosis <strong>of</strong> venous invasion and in identifying non resectable tumors. The twotechniques have the same accuracy in the detection <strong>of</strong> lymph node involvement [431].For evaluation <strong>of</strong> cytotoxic treatmentResponse Evaluation Criteria in Solid Tumors (RECIST) guidelines assume spherical shape<strong>of</strong> tumors. Morphology <strong>of</strong> pancreatic adenocarcinoma (PAC) on multidetector row computedtomography was investigated to evaluate the applicability <strong>of</strong> RECIST guidelines. Studypopulation comprised 16 patients with histologically confirmed localized PAC enrolled in aphase II clinical trial <strong>of</strong> chemoradiation. Pancreatic adenocarcinomas were segmented onbaseline and follow-up multidetector row computed tomography with commercially availables<strong>of</strong>tware. Tumor volumes (mL), RECIST diameter (mm), volume equivalent sphere diameter(VESD, mm), maximum 3-dimensional diameter (M3DD, mm), and elongation value wereobtained. RECIST diameter, VESD and M3DD <strong>of</strong> the tumors at baseline and follow-up werecompared to determine differences. Elongation values were analyzed. Mean volume,RECIST diameter, VESD, M3DD, and elongation for baseline versus follow-up studies were23.12 mL versus 19.43 mL, 41.86 mm versus 39.35 mm, 33.14 mm versus 32.1 mm, 51.76mm versus 51.73 mm, and 0.67 versus 0.76, respectively. There was a significant differenceat baseline and follow-up between RECIST diameter, VESD, and M3DD. The results suggestthat pancreatic cancers are not spherical in shape. Evaluation <strong>of</strong> PAC treatment responsebased on RECIST guidelines may not be accurate [432].A prospective study to determine the value <strong>of</strong> multidetector CT (MD-CT) in assessing thecourse <strong>of</strong> nonresectable pancreatic carcinoma during therapy was performed in 26 patientswith nonresectable pancreatic carcinoma underwent MD-CT before and after therapy. Theexaminations were evaluated with regard to tumor size and vascular invasion using aninvasion score (IS) by 2 radiologists independently. Diagnosis was confirmed surgically, bybiopsy or clinical course. Sensitivity for the assessment <strong>of</strong> irresectability was 100 percent.Following therapy, 54 percent <strong>of</strong> all the tumors were smaller (14/26), 42 percent hadincreased in volume (11/26), and one tumor remained stable (1/26). The IS (veins) duringfollow-up changed in 26 patients (portal vein: 5 higher, 4 lower; superior mesenteric vein: 12higher, 5 lower). The IS (arteries) changed in 13 patients (celiac trunk: 3 higher; hepaticartery: 4 higher, 3 lower; superior mesenteric artery: 2 higher, 1 lower). It was concluded that