Endosonography in the T-staging of pancreatic cancer

Close metadata

Pancreatic cancer is the sixth among all oncologic diseases and takes the 4th place on cancer mortality in the world. Pancreatic cancer has poor prognosis. Survival for the 5 years after diagnosis is less than 5%. The objective was the evaluation of endosonography diagnostic significance in identification of tumor vascular invasion and tumor resectability. The treatment results of 82 patients with pancreas adenocarcinoma, technique of endosonography, the types of echo-endoscopes and ultrasonic criteria of vascular invasion are presented in the article. Tumor invasion was suspected in 48 patients (58.5%) during endosonography. Tumor invasion into the blood vessels of the upper abdomen was observed in 51 patients (62.2%). Endosonography sensitivity for detection of tumor invasion was 90.2%, specificity - 93.5%, accuracy - 91.5%. In view of modern criteria of pancreatic cancer resectability endosonography is leading method for selection of patients for surgical treatment.

Keywords:

pancreatic cancer

endosonography

tumor invasion

Authors:

Solodinina E.N.

Institut khirurgii im. A.V. Vishnevskogo, Moskva

Starkov Iu.G.

Institut khirurgii im. A.V. Vishnevskogo Ministerstva zdravookhraneniia i sotsial'nogo razvitiia RF

Kurushkina N.A.

Moscow Clinical Scientific Center, Moscow, Russia

Egorov V.I.

Chuvashskiĭ gosudarstvennyĭ universitet im. I.N. Ul'ianova, Vtoraia gorodskaia bol'nitsa, Cheboksary

List of references:

Sobin L.KH., Gospodarovich M.K., Vittekind K. TNM klassifikatsiya zlokachestvennykh opukholej [TNM classification of malignant tumors]. M: Logosfera 2011; 118-121. (in Russian)
Ahmad N.A., Lewis J.D., Ginsberg G.G., Haller D.G., Morris J.B., Williams N.N. et al. Long term survival after pancreatic resection for pancreatic adenocarcinoma. Am J Gastroenterol 2001; 96: 2609-2615.
Ahmad N.A., Lewis J.D., Ginsberg G.G., Rosato E.F., Morris J.B., Kochman M.L. EUS in preoperative staging of pancreatic cancer. Gastrointest Endosc 2000; 52: 463-468.
Brügel M., Rummeny E.J., Dobritz M. Vascular invasion in pancreatic cancer: value of multislice helical CT. Abdom Imaging 2004; 29: 239-245.
Buchs N.C., Chilcott M., Poletti P.-A., Buhler L.H., Morel P. Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management World J Gastroenterol 2010; 16: 7: 818-831.
Buscail L., Pages P., Berthelemy P., Fourtanier G., Frexinos J., Escourrou J. Role of EUS in the management of pancreatic and ampullary carcinoma: a prospective study assessing resectability and prognosis. Gastrointest Endosc 1999; 50: 34-40.
Cannon M.E., Carpenter S.L., Elta G.H., Nostrant T.T., Kochman M.L., Ginsberg G.G. et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 1999; 50: 27-33.
DeWitt J., Devereaux B., Chriswell M., McGreevy K., Howard T., Imperiale T.F., Ciaccia D., Lane K.A., Maglinte D., Kopecky K., LeBlanc J., McHenry L., Madura J., Aisen A., Cramer H., Cummings O., Sherman S. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 2004; 141: 753-763.
Evans D.B., Abbruzzese J.L., Rich T.A. Cancer of the pancreas. In: V.T.Jr. DeVita, S. Hellman, S.A. Rosenberg, eds.: Cancer: Principles and Practice of Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed. 1997; 1054-1087.
Evans D.B., Farnell M.B., Lillemoe K.D., Vollmer C.Jr., Strasberg S.M., Schulick R.D. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 2009; 16: 7: 1736-1744.
Fuhrman G.M., Leach S.D., Staley C.A., Cusack J.C., Charnsangavej C., Cleary K.R., El-Naggar A.K., Fenoglio C.J., Lee J.E., Evans D.B. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg 1996; 223: 154-162.
Hermanek P., Sobin L.N. editors. International Union Against Cancer (UICC). TNM classification of malignant tumors, 4th edn. Berlin: Springer-Verlag 1987; 62-67.
Howlader N., Noone A., Krapcho M., Neyman N., Aminou R. et al. SEER Cancer Statistics Review, 1975-2008. National Cancer Institute. Bethesd MD 2011.
Hunt G.C., Faigel D.O. Аssessment of EUS for diagnosing, staging, and determining respectability of pancreatic cancer: a review. Gastrointest Endosc 2002; 55: 2: 232-237.
Imamura M., Doi R. Treatment of locally advanced pancreatic cancer: should we resect when resectable? Pancreas 2004; 28: 293-295.
Lepanto L., Arzoumanian Y., Gianfelice D., Perreault P., Dagenais M., Lapointe R., Létourneau R., Roy A. Helical CT with CT angiography in assessing periampullary neoplasms: identification of vascular invasion. Radiology 2002; 222: 347-352.
Makary M.A., Fishman E.K., Cameron J.L. Resection of the celiac axis for invasive pancreatic cancer. J Gastrointest Surg 2005; 9: 503-507.
Mansfield S.D., Scott J., Oppong K., Richardson D.L., Sen G., Jaques B.C. et al. Comparison of multislice computed tomography and endoscopic ultrasonography with operative and histological findings in suspected pancreatic and periampullary malignancy. Br J Surg 2008; 95: 12: 1512-1520.
Mertz H.R., Sechopolous P., Delbeke D., Leach S.D. EUS, PET, and CT scanning for evaluation of pancreatic adenocarcinoma. Gastrointest Endosc 2000; 52: 367-371.
Nawaz H., Yi-Fan Ch., Kloke J., Khalid A., McGrath K., Landsittel D., Papachristou G. Performance Characteristics of Endoscopic Ultrasound in the Staging of Pancreatic Cancer: A Meta-Analysis JOP. J Pancreas 2013; 14: 5: 484-497.
Rivadeneira D.E., Pochapin M., Grobmyer S.R. et al. Comparison of linear array endoscopic ultrasound and helical computed tomography for the staging of periampullary malignancies. Ann Surg Oncol 2003; 10: 890-897.
Rosch T., Braig C., Gain T. et al. Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Gastroenterology 1992; 102: 188-199.
Rösch T.P., Dittler H.J., Strobel K., Meining A., Schusdziarra V., Lorenz R. et al. Endoscopic ultrasound criteria for vascular invasion in the staging of cancer of the head of the pancreas: a blind reevaluation of videotapes. Gastrointest Endosc 2000; 52: 469-47.
Seicean A., Badea R., Mocan T., Iancu C., Pop T., Seicean R., Moşteanu O., Bălă O., Pascu O. Radial Endoscopic Ultrasonography in the Preoperative Staging of Pancreatic Cancer. J Gastrointestin Liver Dis September 2008; 17: 3: 273-278.
Snady H. EUS criteria for vascular invasion: analyzing the meta-analysis. Gastrointest Endosc 2007; 65: 6: 798-807.
Soriano A., Castells A., Ayuso C., Ayuso J.R., de Caralt M.T., Ginès M.A., Real M.I., Gilabert R., Quintó L., Trilla A., Feu F., Montanyà X., Fernández-Cruz L., Navarro S. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 2004; 99: 492-501.
Squillaci E., Fanucci E., Sciuto F., Masala S., Sodani G., Carlani M., Simonetti G. Vascular involvement in pancreatic neoplasm: a comparison between spiral CT and DSA. Dig Dis Sci 2003; 48: 449-458.
Takhar A.S., Palaniappan P., Dhingsa R., Lobo D.N. Recent developments in diagnosis of pancreatic cancer. BMJ 2004; 329: 668-673.
Tierney W.M., Francis K., Eckhauser F., Elta G.H., Nostrant T.T., Scheiman I. The accuracy of EUS and helical CT in the assessment of vascular invasion by peripapillary tumor. Gastrointest Endosc 2001; 53: 182-188.
Tio T.L., Sie L.H., Kallimanis G. et al. Staging of ampullary and pancreatic carcinoma: comparison between endosonography and surgery. Gastrointest Endosc 1996: 44: 706-713.
Winter J.M., Cameron J.L., Campbell K.A., Arnold M.A., Chang D.C. et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006; 10: 1199-1210; discussion 1210-1191.

Close metadata