DIAGNOSING AND STAGING OF PANCREATIC-CARCINOMA - WHAT IS NECESSARY

The aim of the present prospective observational study was to diagnose and stage pancreatic carcinoma with a minimum of diagnostic procedure s. Our experiences in 307 patients with a histologically confirmed pan creatic carcinoma show that for diagnosing pancreatic carcinoma sonogr aphy and computed tomography are sufficient in 95% of the cases. The c ombination of both has a sensitivity equal to that of endoscopic retro grade cholangiopancreatography (ERCP; 96.8 vs. 98.7%; n.s., chi(2) tes t). ERCP is only indicated in cases with negative sonography and compu ted tomography, and suspicion of pancreatic cancer. For tumor staging, the routine performance of angiography cannot be recommended in view of the fact that although it provides greater sensitivity for the eval uation of an infiltration of the portal vein (80% for angiography vs. 22% for sonography or computed tomography), it is associated with a lo wer positive predictive value (56.4 vs. 68 and 72%) which results in a lower accuracy. Despite recent advantages in diagnostic technology, l ess than 50% of unresectable tumors were identified preoperatively at a 10% false-positive rate. The major reason for unresectability is inf iltration into the mesenteric axis, which cannot be identified laparos copically. Laparoscopy or percutaneous biopsy is recommended only in t he presence of a tumor with suspicion of distant metastasis detected b y radiological imaging and requiring histological confirmation. In con clusion, sonography and computed tomography as the only diagnostic ima ges are sufficient for diagnosing and staging of pancreatic carcinoma in more than 95% of the patients. Only a small number of patients need s further diagnostic procedures.