PREDICTION OF RESECTABILITY OF PANCREATIC MALIGNANCY BY COMPUTED-TOMOGRAPHY

Background The accuracy of computed tomography (CT) in predicting rese ctability of pancreatic malignancy has been questioned recently and al ternative methods have been recommended. Methods To determine the accu racy of CT for predicting resectability and its influence on survival, a standard protocol for performing CT and reporting the results was d eveloped and then compared retrospectively with the ability of one sur geon to perform a resection during 1989-1994. Postoperative survival w as determined. Results Of 88 consecutive patients 35 (40 per cent) had CT-resectable disease and 53 (60 per cent) had CT-irresectable diseas e. Twenty-one patients were excluded because of advanced disease or po or performance status. Of the remaining 67 patients, 47 (70 per cent) had pancreatic ductal adenocarcinoma and 20 (30 per cent) had ampullar y adenocarcinoma, of whom 32 had a resection, 32 had a palliative bypa ss and three had only a staging laparoscopy. The sensitivity and speci ficity for computed tomographic prediction of resectability were 72 an d 80 per cent respectively. The positive predictive value was 77 per c ent and the negative predictive value 76 per cent. There were seven fa lse-positive and nine false-negative findings. Survival was more depen dent on whether or not resection was performed than on computed tomogr aphic predictability of resection. Conclusion CT was reasonably accura te in predicting resectability but cannot be relied on entirely, requi ring an improvement in staging methods for pancreatic malignancy.