42 The Accuracy of the Multi-Slice Detector CT scan (MDCT) in Staging Borderline Respectable Periampullary Carcinoma. (28th February 2022)

• Record Type: Journal Article
• Authors: Issa, M.; Noureldin, K.; Jones, L.
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 1
• Publication Date: 2022-02-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac039.022
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aim: Assess MDCT accuracy in staging cancers periampullary cancers. Method: Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple's resection and who can avoid. RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. Liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%. Conclusion: MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumours with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy.