MSCT proves acceptable for selecting pancreatic cancer patients for surgery

Multislice CT is an acceptable alternative to endoscopic ultrasound for identifying which pancreatic lesions can be treated surgically, according to a study from Indiana University.

Four-slice CT showed accuracy comparable to endoscopic ultrasound in detecting resectable pancreatic tumors, said lead author Dr. John DeWitt, an assistant professor of medicine at the IU School of Medicine.

In fact, a person having a high-quality CT scan showing a completely resectable mass can forgo endoscopic ultrasound for confirmation altogether, DeWitt said.

In a prospective study, DeWitt and colleagues examined 120 patients with confirmed or suspected pancreatic cancer. The subjects underwent endoscopic ultrasound followed by quadslice CT with dual-phase imaging. Results were published in the November issue of the Annals of Internal Medicine.

Of 80 patients with confirmed cancer, 66% qualified for surgery. Although endoscopic ultrasound was generally more accurate than MSCT for detection and staging, the differences were not significant enough to win DeWitt's support for the modality for assessing disease resectability.

Ultrasound scored a 98% accuracy rate for detecting pancreatic tumors, compared with 86% accuracy for MSCT, and ultrasound staging was 67% accurate, compared with a dismal 41% for MSCT. However, only four percentage points separated ultrasound's 92% accuracy rate for identifying viable tumor candidates and the 88% rate for MSCT. Additionally, MSCT correctly identified 64% of the 28 unresectable tumors compared with 68% for ultrasound.

The noninvasiveness of MSCT is a big advantage, according to DeWitt. It does not require sedation or the insertion of an endoscope, making the technique less invasive than endoscopic ultrasound and more attractive for determining lesion resectability.

"MSCT should be the initial test of choice in patients with suspected pancreatic cancer," he said.

Some of the limitations of the study included a small sample size and the fact that radiologists and sonographers were not blinded to previous radiographic information. Further comparative studies using 32- or 64-slice scanners with multiplanar reconstruction are needed, according to DeWitt.

For more information from the online Diagnostic Imaging archives:

MDCT boosts staging of pancreatic cancer

Pancreatic MR defines ducts, pinpoints disease

Fast spiral CT has edge in imaging pancreatic cancer