COLOR-FLOW SONOGRAPHY IN EVALUATING THE RESECTABILITY OF PERIAMPULLARY AND PANCREATIC TUMORS

Over the past several years, we have developed a technique to assess t he resectability of periampullary and pancreatic tumors using color fl ow sonography. This is a feasibility study to determine if sonography with color flow imaging can play a role in evaluating patients with pe riampullary and pancreatic tumors. This study comprises a retrospectiv e analysis of 51 patients referred for color flow sonographic evaluati on of resectability of periampullary and pancreatic neoplasm. Scanning was performed with state-of-the-art color flow sonographic systems. V essels that were touched or occluded by tumor were categorized accordi ng to a Pancreatic Color Doppler Score. Other factors affecting resect ability (metastasis, enlarged nodes) were recorded. Sonographic findin gs were correlated with surgical resectability and pathologic findings regarding tumor margins. The color flow study was complete technicall y (all index vessels visualized) in 49 of 51. patients (96%). In all, 643 of 647 vessels (99.4%) were imaged. Forty-five patients had suffic ient surgical, pathologic, or clinical proof to be included in the res ectability analysis. All 18 patients with circumferential tumor or vas cular occlusion (Pancreatic Color Doppler Score 4 and 5) were found to have unresectable disease. All 10 patients in whom tumor did not touc h (Pancreatic Color Doppler Score 0) had negative margins. All 30 pati ents considered to have unresectable tumors sonographically could not be resected. Patients in. this category had one or more of the followi ng: positive pathologic margins, positive nodes, liver metastasis, or not clinically resectable. Six of 15 considered resectable sonographic ally (40%) were unresectable for cure. Surgeons believed that color fl ow sonography influenced management in 10 of 45 patients (22% overall) . Color flow sonography, a painless, noninvasive, and relatively inexp ensive examination, may be an effective screening tool to evaluate per iampullary and pancreatic neoplasms for resectability. Our data show t hat color flow sonography can correctly predict unresectability of per iampullary and pancreatic neoplasms. Any future evaluation of imaging and management of periampullary and pancreatic tumors should include c olor flow sonography.