The Role of Intraoperative Ultrasonography in Pancreatic Solid Tumor Staging

Significant advances in preoperative diagnostic techniques have slightly reduced the value of intraoperative ultrasonography (IOUS, sonography) for pancreatic tumor diagnosis. However, tumor extension degree is finally determined during intraoperative revision. IOUS is a technique, which enables to assess a tumor process extension degree and perform minimally invasive surgeries for morphological verification of the changes revealed.

The aim of the investigation was to assess the capabilities of intraoperative ultrasound investigation to determine the degree of pancreatic tumor extension.

Materials and Methods. 53 patients with morphologically verified diagnosis of pancreatic tumor underwent IOUS. We assessed if the tumor extended beyond the pancreatic capsule involving the surrounding cellular tissue, magistral vessels, and revealed metastases in lymph nodes and liver. If there were N3 (according to JPS, Japan Pancreatic Society) metastases in lymph nodes or in liver, they were needled.

Results. 10 patients underwent test laparotomy following IOUS. Laparotomy resulted from: the involvement of the superior mesenteric vein up to the inflows (4 patients), liver metastases (2 patients), peritoneal dissemination (3 patients), liver metastases and peritoneal dissemination (1 patient). IOUS accuracy in determining the tumor extension beyond the pancreatic capsule was 98%. We distinguished two types of surrounding cellular tissue infiltrated by the tumor: focal and diffuse. IOUS sensitivity, specificity and accuracy in vascular invasion determination were 96, 93.3 and 95% respectively. Lymph gland metastases (N3 according to JPS) were detected in 5 patients; the lymph nodes being needled for morphological verification of tumor changes. Liver metastases were found in 3 patients. Paracentesis was performed for morphological verification of a tumor.

Conclusion. Intraoperative ultrasonography is a highly informative diagnostic technique used to determine the degree of pancreatic tumor extension. Moreover, IOUS enables to perform morphological verification to detect distant metastases (primarily, in liver and distant lymph nodes) with low complication rate.

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Prozorova E.V., Kazakevitch V.I., Sidorov D.V., Mitina L.А., Stepanov S.О. The Role of Intraoperative Ultrasonography in Pancreatic Solid Tumor Staging. Sovremennye tehnologii v medicine 2014; 6(2): 68