Abstracts
1997 Digestive Disease Week

Can spiral CT replace angiography in the staging of patients with pancreatic cancer?

KP Murray, HA Pitt, DA Bluemke, EK Fishman, AC Venbrux, J Geschwind, RP Liddell, MA Talamini, KD Lillemoe, CA Yeo, JL Cameron. Departments of Surgery and Radiology, The Johns Hopkins Medical Institutions, Baltimore, MD.

The role of angiography in the preoperative staging of patients with pancreatic cancer remains controversial. Proponents argue that angiography is the gold standard for detecting vessel encasement, aberrant anatomy, and celiac artery stenosis. However, newer thin-section spiral computerized tomography (CT) also can detect vascular abnormalities and has the potential advantages of improved ability to diagnose liver metastases and reduce costs. Therefore, the aim of this analysis was to determine whether spiral CT was as accurate as angiography in predicting resectablity in patients with pancreatic cancer. To achieve this aim, we reviewed the mesenteric angiograms, spiral CT scans and operative findings in 78 surgically staged patients with pancreatic cancer. The mean age of the patients was 66 years, 50% were female, and 91% were Caucasian. Thirty-eight patients (49%) were resected while 40 underwent palliative procedures because of encasement (27%) or metastatic disease (24%). Angiograms and spiral CT scans were evaluated for vascular encasement or occlusion, aberrant vessels, celiac stenosis and metastatic disease as well as accuracy in predicting resection. No significant differences were noted between angiography and CT with respect to their detection of venous encasement or occlusion (32% vs 33%), celiac stenosis ( 6% vs 3%), or hepatic metastases (1% vs 7%). However, angiography was more accurate at predicting arterial encasement (28% vs 13%, p < 0.05) and aberrant vessels ( 14% vs 4%, p <0.05). Results for predicting resectability were:

                            Predictive Value            Overall
                       Positive          Negative       Accuracy
 Angiography             89%               79%            63%
 Spiral CT               84%               77%            67%

These data suggest that (1) angiography provides better arterial data, but (2) spiral CT is equivalent to angiography in predicting resectability of patients with pancreatic cancer. Since staging algorithms that employ spiral CT and avoid angiography are more cost- effective, we conclude that spiral CT should replace angiography in the staging of most patients with pancreatic cancer.