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Article |

Assessment of Resectability of Pancreatic Head and Periampullary Tumors by Color Flow Doppler Sonography

Sherry M. Wren, MD; Philip W. Rails, MD; Steven C. Stain, MD; A. Kasiraman, MD; Catherine L. Carpenter, PhD; Dilipkumar Parekh, MD
Arch Surg. 1996;131(8):812-818. doi:10.1001/archsurg.1996.01430200022004.
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Objective:  To examine the sensitivity of color flow Doppler ultrasonography in assessing resectability of pancreatic head and periampullary tumors.

Design:  Validation cohort study.

Setting:  Tertiary care public hospital.

Patients:  Thirty-seven patients with pancreatic head or periampullary cancer were studied by color flow Doppler examination of the relevant blood vessels.

Main Outcome Measure:  A pancreatic Doppler score (PDS) was defined as the closest circumferential contact of the tumor to the superior mesenteric vein, superior mesenteric artery, or portal vein. A PDS of 1 indicated no contact (n=9); PDS 2, less than 50% contact (n=10); PDS 3, 50% to 99% contact (n=7); and PDS 4, encasement (n=11). The PDS was compared with operative and histologic resection margins.

Results:  The lack of vascular invasion was confirmed operatively in 7 of 7 patients with a PDS of 1, and 6 patients who underwent resection had clear histologic margins. Nine (90%) of 10 patients with a PDS of 2 were confirmed to have no vascular invasion, and 3 (43%) of 7 patients who underwent resection had clear margins. Five (83%) of 6 patients with a PDS of 3 had correct operative findings, and both patients who underwent resection had positive margins. Operative confirmation of encasement was found in all 7 patients with a PDS of 4 who had operative exploration, and none underwent resection.

Conclusions:  Color flow Doppler sonography and PDS predicted resectability and the histologic margin status (positive predictive value, 97%). Patients with a PDS of 1 are predicted to have clear histologic margins after resection. Patients with a PDS of 4 have unresectable tumors, and nonoperative palliation should be considered. Patients with a PDS of 2 or 3 have a high likelihood of positive histologic margins after resection and may be candidates for neoadjuvant chemotherapy.Arch Surg. 1996;131:812-818


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