ISSN: 2578-482X
Authors: Reza J, Sanders J, Westrick E, Coombs K, Harutyunyan H, Simunich T and Mesropyan L*
Background: In patients with pancreatic adenocarcinoma, the accuracy of identifying vascular involvement via EUS and MDCT remains unclear, especially in the setting of neoadjuvant therapy. Methods: We conducted a retrospective analysis of patients who underwent a pancreaticoduodenectomy between 2012 and 2016 at Advent Health Orland Hospital. Sensitivity, specificity, positive predictive value and negative predictive value of MDCT and EUS with respect to vessel involvement (SMV, PV, SMA) in a given treatment setting (no treatment, neoadjuvant chemotherapy, neoadjuvant chemotherapy/radiation) were analyzed. Results: In the setting of no treatment, MDCT has the highest sensitivity, specificity, PPV, NPV in the evaluation of the SMA: 22%, 94%, 50%, and 83% respectively. In the setting of no treatment, EUS has the highest sensitivity, specificity, PPV, NPV in the evaluation of the SMV: 33%, 95%, 33% and 95% respectively. The modality with the highest specificity in the assessment of PV involvement is intra-operative evaluation regardless of treatment setting. In the setting of neoadjuvant therapy, either EUS or intra-operative evaluation is preferred over MDCT for the evaluation of the SMA, SMV and PV. Discussion: In the setting of no treatment, the SMA is best evaluated via MDCT, the SMV via EUS, and the PV is best evaluated intra-operatively.
Keywords: Pancreaticoduodenectomy; Neoadjuvant Chemotherapy; Diagnosis
