A novel scoring system for arterial invasion of pancreatic body and tail cancer based on multidetector row computed tomography and biomarkers

作者：Watanabe Seitaro^*; Kobayashi Noritoshi; Kubota Kensuke; Sato Takamitsu; Kato Shingo; Hosono Kunihiro; Shimamura Takeshi; Inayama Yoshiaki; Nakajima Atsushi; Endo Itaru

来源：Pancreatology, 2013, 13(2): 161-169.

DOI：10.1016/j.pan.2012.12.364

• Pancreatic carcinoma
• Arterial invasion
• MDCT

Background/objectives: The absence of major-vessel involvement is a crucial factor in the resectability and prognosis of pancreatic cancer. However, arterial invasion cannot be evaluated adequately using imaging findings alone. We therefore developed a scoring system to assess arterial invasion by pancreatic adenocarcinoma using multidetector row computed tomography (MDCT) and serum tumor markers. %26lt;br%26gt;Methods: Twenty patients who underwent distal pancreatectomy and splenectomy for pancreatic adenocarcinoma were examined retrospectively using 4-, 16- or 64-row MDCT and serum tumor markers. Splenic arterial invasion was evaluated in terms of length of tumor contact, circumferential involvement (%26lt;180 degrees or %26gt;= 180 degrees) and deformity of vascular diameter. Preoperative expression of carbohydrate antigen 19-9 (CA19-9), DUPAN-2 and S-Pancreas-1 antigen (Span-1) were also evaluated. The presence or absence of arterial invasion was confirmed histopathologically in all 20 cases. %26lt;br%26gt;Results: In 11 of 20 cases invasion into splenic arteries was observed histopathologically, mostly involving the external elastic lamina and periarterial nerves. Sensitivity, specificity and accuracy were 100%, 88.9% and 95%, respectively, for length of tumor contact (%26lt;16 mm or %26gt;= 16 mm), 90.9%, 77.8% and 85% for circumferential involvement (%26lt;180 degrees or %26gt;= 180 degrees), and 100%, 66.7% and 85% for deformity of vascular diameter. Furthermore, the sensitivity, specificity and accuracy were all increased to 100% when tumor markers were included in the score. %26lt;br%26gt;Conclusions: MDCT is a useful technique for diagnosing arterial invasion of pancreatic body and tail cancer, even in comparison with pathological examination; however, this new scoring system can be further complemented and made more reliable by measurements of serous tumor markers.

• 出版日期2013-4