Spiral computed tomography for preoperative staging of potentially resectable carcinoma of the pancreatic head

Background: Pancreatic cancer is often locally invasive. Preoperative stagi ng attempts to identify patients suitable for resection, in order to minimi ze unnecessary operations. The aim of this study was to assess the improved imaging provided by spiral computed tomography (CT) in the preoperative st aging of potentially resectable pancreatic head carcinoma. Methods: In 56 consecutive patients with pancreatic head carcinoma spiral C T findings were correlated prospectively with operative and histopathologic al findings. Criteria for irresectability at CT were infiltration of the pe ripancreatic fat and vascular ingrowth grade D, on a scale from A to F. Results: At operation 27 (48 per cent) of 56 tumours were irresectable. Sma ll metastases were found in seven patients (12 per cent). Ingrowth (adheren ce) to the portal or mesenteric vein was present in 19 patients (34 per cen t). The sensitivity and specificity of CT for irresectability were 78 and 7 6 per cent respectively. Resection rates with a vascular margin free of tum our were 100 per cent for grade A, 63 per cent for grade B, 44 per cent for grade C, 15 per cent for grade D and 0 per cent for grade E, with a predic tive value for ingrowth of 88 per cent for grades D or higher. The resectab ility rate was 11 per cent (one of nine) when infiltration of the anterior peripancreatic fat was present and 67 per cent when infiltration was absent (P < 0.01). Conclusion: Spiral CT with thin slices seems to improve detection of distan t metastases and vascular ingrowth in patients with pancreatic head carcino ma.