Staging of Abdominal Metastases in Pancreatic Carcinoma by Diagnostic Laparoscopy and Magnetic Resonance Imaging

Abstract

Background: Different noninvasive and invasive techniques are available for the detection of abdominal metastases in pancreatic carcinoma. Since small hepatic or peritoneal metastases are a crucial problem which precludes resection, accurate detection is mandatory. We compared laparoscopic staging of abdominal metastases in adenocarcinoma of the pancreas with MRI.

Methods: 55 patients with pancreatic adenocarcinoma had been screened and 49 entered the retrospective study. All patients had undergone MRI of the upper abdomen with concomitant MR-cholangiopancreatography (MRCP) and diagnostic laparoscopy under conscious sedation. Patients without histologic proof of abdominal metastases underwent laparotomy.

Results: In 6/10 patients, metastases were correctly detected by laparoscopy, yielding a sensitivity of 60 % and a specificity of 92 %. MRI predicted metastases in 6/10 patients with 60 % sensitivity and 100 % specificity. Laparoscopy showed metastases in 3 patients that were missed by MRI, but failed to identify metastases in 3 of 6 patients with metastases on MRI. Though only one patient showed previously undetected metastases during laparotomy, 3 patients with abdominal metastases underwent unnecessary laparotomy due to a lack of histologic proof of malignancy.

Conclusions: Whereas diagnostic laparoscopy is sensitive for the detection of small metastases and offers histologic verification, intrahepatic alterations are not detectable by sole visual inspection. MRI may compensate for this deficiency, but histologic proof of malignancy may be problematic. To date, no definite decision in favor of one of the presented procedures for the staging of abdominal metastases can be given.

Zusammenfassung

Einleitung: Für das Staging abdomineller Metastasen von Pankreaskarzinomen werden verschiedene nicht invasive als auch invasive Verfahren angewendet. Eine Herausforderung stellt der Nachweis auch kleiner Leber- oder Peritonealmetastasen dar, da diese eine kurative Resektion verhindern. Wir berichten über den Vergleich von diagnostischer Laparoskopie des Internisten mit der Magnetresonanztomographie (MRT) für das Staging abdomineller Metastasen von Adenokarzinomen des Pankreas.

Methoden: 49 von 55 untersuchten Patienten mit einem Adenokarzinom des Pankreas konnten in die retrospektive Studie eingeschlossen werden. Alle Patienten waren mit einer MRT der Oberbauchorgane, ergänzt durch eine MR-Cholangiopankreatikographie, sowie einer diagnostischen Laparoskopie unter Sedoanalgesie untersucht worden. Patienten ohne histologischen Nachweis einer Metastasierung wurden laparotomiert.

Ergebnisse: Die Laparoskopie identifizierte abdominelle Metastasen mit 60 % Sensitivität und 92 % Spezifität. Durch die MRT gelang der Metastasennachweis mit einer Sensitivität von 60 % und einer Spezifität von 100 %. Während die diagnostische Laparoskopie Metastasen bei 3 Patienten mit unauffälliger MRT darstellen konnte, entgingen der Methode 3/6 Patienten mit positivem MRT-Befund. Im Rahmen der Laparotomie wurden nur bei einem Patienten zuvor nicht bekannte Metastasen gefunden. Bei 3 Patienten wurde jedoch eine Probelaparotomie aufgrund der fehlenden histologischen Bestätigung von Metastasen durchgeführt.

Diskussion: Obwohl die diagnostische Laparoskopie kleine abdominelle Metastasen nachweisen und histologisch bestätigen kann, entgehen intrahepatische Veränderungen einer alleinigen Inspektion. Die MRT kann diese Lücke zum Teil schließen, ermöglicht jedoch keine histologische Bestätigung. Eine definitive Entscheidung für eine der beiden Methoden bei dieser Fragestellung kann somit zum jetzigen Zeitpunkt nicht gegeben werden.

Key words

Pancreatic carcinoma - staging - laparoscopy - MRI

Schlüsselwörter

Pankreaskarzinom - Staging - Laparoskopie - MRT

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