RELEVANCE OF DUPLEX DOPPLER ULTRASONOGRAPHY IN ASSESSMENT OF PANCREATIC CARCINOMA VASCULAR INVASION

Purpose: It is highly desirable to achieve the most accurate diagnostic information possible with more noninvasive technology. By defining tumor involvement of blood vessels Doppler ultrasonography has been increasingly reported as an effective screening tool for clinical staging and treatment decisions in patients with pancreatic neoplasm.

Our study aims to analyze sensitivity and specificity of data gathered by duplex Doppler ultrasonography in patients with pancreatic neoplasm that are important for treatment decisions.

Methods and Materials: In presurgical assessment of patients with pancreatic neoplasm, we applied duplex Doppler ultrasonography and correlate the results with surgical findings of vascular invasion. We examined 43 patients who underwent surgery. We measured maximal flow velocity, resistance index, pulsatility index in the portal vein, celiac artery, superior mesenteric artery and vein and splenic artery and vein. Also, we performed color Doppler examination. Patients with metastasis of pancreatic neoplasm were excluded from this study.

Results: There were 32 male and 11 female patients, aged from 39 to 79 years (mean age 62,33yrs.). Of the 43 patients, 29 patients underwent a radical surgical procedure, while the rest had palliative operation. Tumor invasion of blood vessels was critical in decision-making process for the type of surgical treatment. Comparison of color Doppler sonograms and operative findings show that sensitivity and specificity of duplex Doppler ultrasonography. For maximal flow velocity the sensitivity ranges between 71 and 79%, and specificity between 76 and 93%. Resistance index shows sensitivity between 86 and 93% in vascular invasion detection, and specificity between 76 and 83%. Pulsatility index shows sensitivity between 79 and 93%, and specificity between 76 and 90%. Color Doppler ultrasonography has sensitivity between 79 and 93% and specificity 83 and 93% in vascular invasion detection.

Conclusions: In comparison to the surgical findings for prediction of pancreatic, neoplasm resectability duplex Doppler ultrasonography shows satisfactory rate of sensitivity and specificity. Since duplex Doppler ultrasonography is noninvasive and inexpensive technique, and considering results of our study and other similar studies, it appears that duplex Doppler ultrasonography should be used as initial method for detection of vascular invasion in preoperative assessment of patients with pancreatic neoplasm.