COMPARISON OF HELICAL-CT AND ENDOSCOPIC U LTRASONOGRAPHY IN DIAGNOSISAND STAGING OF PANCREATIC-CARCINOMA - A CLINICAL PRELIMINARY-STUDY

Objective. - To determine in a retrospective clinical study the benefi t of helical-CT for the diagnosis and staging of pancreatic carcinoma compared with endoscopic ultrasonography. Method - Results of helical- CT and endoscopic ultrasonographic investigations relative to 24 cases of histologically proven adenocarinoma were reviewed. The criteria st udied were : a) existence of a pancreatic mass, bl diagnosis of malign ancy, c) existence of vascular involvement, d) lymph node involvement. Statistical analysis (binomial test) was performed in 24 patients for the assessment of mass and malignancy and in 10 patients for the asse ssment of vascular involvement (9 patients who under-went surgery and one patient with a positive arteriography), Results. - Fur diagnosis o f pancreatic mass both methods were equivalent: 91.5 % (22 cases out o f 24) for helical-CT and 87.5 % (21 cases out of 24) Sol endoscopic ul trasonography. Two pancreatic masses were seen only,vith endoscopic ul trasonography. Their size was under 3 cm. Two of the 3 masses not seen with endoscopic ultrasonography ere infiltrative lesions measuring mo re than 3 cm. Helical-CT was significantly superior to endoscopic ultr asonography for the diagnosis of malignancy (96 % vs 71 %) (P = 0.035) . The accuracy of helical-CT for vascular involvement was significant superior to endoscopic ultrasonography (90 % vs 40 %) (P = 0.031). End oscopic ultrasonography underestimated vascular involvement in 5 cases : mesenterico-portal confluence (3 cases), superior mesenteric artery (2 cases). In the 6 cases with histologically proved lymph node involv ement, endoscopic ultrasonography (6 correct assessments) was superior to helical-CT (3 con ect assessments). Conclusion. - This study confi rms the complementarity of helical-CT and endoscopic ultrasonography f or the diagnosis of pancreatic carcinoma. II suggests that helical-CT is superior to endoscopic ultrasonography for diagnosis of malignancy and assessment of vascular involvement and endoscopic ultrasonography is superior to helical-CT for diagnosis of lymph node involvement. The se preliminary results have to be confirmed by a prospective study inc luding a large number of patients with surgical correlation.