Suade Özlem BADAK, Hakan YÜCEYAR, Elmas KASAP, Gökhan PEKİNDİL

Periampuller Tümörlerde Batın Tomografisi, Dinamik Manyetik Rezonans Görüntüleme ve Endoskopik Retrograd Kolanjiopankreatografinin Rolü

GİRİŞ ve AMAÇ: Pankreatik ve periampuller kanserler mortalite oranları oldukça yüksek düzeylerde seyreden kanserlerdir. Bütün gastrointestinal kanserlerin %5’ini, tüm kanserlerin yaklaşık %2’sini oluştururlar. Periampuller bölge neoplazmlarının cerrahi tedavisinin uygulanabilmesi için erken tanı ve tümör rezektabilitesinin değerlendirilmesi esas teşkil etmektedir. Bu çalışmanın amacı periampuller tümörlü olgularda; Batın Tomografisi, Dinamik Manyetik Rezonans Görüntüleme ve Endoskopik Retrograd Kolanjio Pankreatografinin rolünü karşılaştırmaktır. YÖNTEM ve GEREÇLER: 2009-2011 yılları arasında periampuller tümör ön tanısı ile izlenen ve ERCP, BT, MRG tetkikleri yapılan 20 olgu dahil edilmiştir. BULGULAR: Çalışmamızda periampuller bölge tümörlerini saptamada BT’nin duyarlılığını %75, MRG’nin duyarlılığını %85, ERCP'nin duyarlılığını ise %100 olarak saptadık. ERCP’nin, BT ve MRG ile karşılaştırıldığında en büyük saptama üstünlüğünün, ampulla vateri tümörlerinde olduğu görüldü. TARTIŞMA ve SONUÇ: Periampuller tümörü saptamada ERCP’nin, BT ve MRG’den; MRG’nin tespit oranının ise BT’ye göre biraz daha fazla olduğu görüldü. MRG ve BT’nin hastalık bulgularının yaygınlığı ile evrelemesinde; ERCP’nin ise safra yolu obstrüksiyon seviyesi ve nedenini belirlemede, sitolojik örnek alma ve aynı seansta terapötik yaklaşımda bulunma gibi avantajları bulunmaktadır.

The Role of Abdominal Tomography, Dynamic Magnetic Resonance İmaging and Endoscopic Retrograde Cholangiopancreatography in Periampullary Tumors

INTRODUCTION: The incidence of pancreatic and periampullary cancers have been increasing since the mid 20th century and the mortality of these cancers have remained high levels. Pancreatic and periampullary cancers are five percent of gasrointestinal cancers and two percent of all the cancers. Evaluation of early diagnosis and the probability of tumor resection is important in these cancers; because the only chance of cure in periampullary zone neoplasms are surgery. The target of our study is to determine the differences between abdominal CT, Dynamic magnetic resonance and retrograde cholangiopancreatography roles in periampullar zone tumors. METHODS: : 20 periampullary zone tumor patients which are diagnosed and followed between 2009 and 2011 are included in our study. RESULTS: In our study, we detected 75% sensitivity of CT, 85% sensitivity of MRI and 100% sensitivity of ERCP in detecting periampullary tumors. Compared with CT and MRI, ERCP had the highest detection superiority in ampulla wattled tumors. DISCUSSION AND CONCLUSION: Our study shows that ERCP is more successful in detecting periampullar tumors than CT and MR also MR’s ability of detecting periampullary cancers is more than CT. Besides MR and CT is beneficial to determine staging and spreading of tumor. But ERCP has the advantage in to define the level of bile duct obstruction and the cause of the obstruction. Also ERCP gives us the advantage of to collect cytologic specimen and the cure chance at the same seance.

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1- Fontham ET, Correa P. Epidemiology of pancreatic cancer. Surg Clin North Am. 1989;69:551-67.
2- Fortner JG. Recent advances in pancreatic cancer. Surg Clin of North Am. 1974; 54(4):854-63.
3- Gold EB, Goldin SB. Epidemiology of and risk factors for pancreatic cancer. Surg Oncol Clin N Am. 1998;7(1): 67-91.
4- Farley DR, Sarr MG. Management of the apparent periampullary malignancy: preoperative evaluation and operative treatment. In Surgery for Gastrointestinal Cancer: a Multidisciplinary Approach. Edited by HJ Wanebo. Philadelphia, Lippincott- Raven Publishers, 1997, 383-92.
5- Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med. 1992;326(7):455-65.
6- Cameron JL, Crist DW, et al. Factors influencing survival after pancreaticoduedonecomy for pancreatic cancer. Am J surg. 1991;161:120- 4.
7- Jemal A, Thomas A, Murray T, Thun M. Cancer statistics 2002. CA Cancer J Clin. 2002;52(1): 23-47.
8- Di Bello MG, Giacinti I, Marzano PF, et al. Ampullary and periampullary tumors. G Chir. 1997;18(10):541-3.
9- Johnson CD, Özmen MM. Pankreas kanseri. Temel Cerrahi. Sayek İ (ed). Üçüncü baskı. Ankara. Güneş Kitabevi, 2004:1429-36.
10- Filiz G, Yerci O, Adim SB, et al. Periampullary carcinomas. Hepatogastroenterology. 2007;54(76):1247-9.
11- Chen XP, Liu J, Zhou J, Zhou PC, Shu J, Xu LL, Li B, Su S. Combination of CEUS and MRI for the diagnosis of periampullary space-occupying lesions: a retrospective analysis. BMC Med Imaging. 2019 Sep 2;19(1):77. doi: 10.1186/s12880-019-0376-7. PMID: 31477041; PMCID: PMC6719361.
12- Fitzgerald PJ, Fortner JG, Watson RC, et al. The value of diagnostic aids in detecting pancreas cancer. Cancer. 1978;41(3):868-79.
13- Shoup M, Hodul P, Aranha GV, et al. Defining a role for endoscopic ultrasound in staging periampullary tumors. Am J Surg. 2000;179(6):453-6.
14- Andersen HB, Efferse H, Tjalve E, Burcharth F. CT for assessment of pancreatic and periampullary cancer. Acta Radiol. 1993;34(6):569- 72.
15- Bolog N, Constantinescu G, Oancea I, et al. Magnetic resonance imaging of bile and pancreatic ducts: a retrospective study. Rom J Gastroenterol. 2004;13(2):91-7.
16- Sugita R, Furuta A, Ito K, et al. Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens. Radiology. 2004; 231(3):767-74.
17- Hall TJ, Blackstone MO, Cooper MJ, Hughes RG, Moossa AR. Prospective evaluation of endoscopic retrograde cholangiopancreatography in the diagnosis of periampullary cancers. Ann Surg. 1978;187(3):313-7.
18- Coppola R, Riccioni ME, Ciletti S, et al. Periampullary tumors. Analysis of 319 consecutive cases submitted to preoperative endoscopic biliary drainage. Surg Endosc. 2001;15(10):1135-9.
19- Güitrón A, Macías M, Abalid R, GómezMejía A, Torres F. The endoscopic treatment of carcinoma of Vater's ampulla. Rev Gastroenterol Mex. 1995;60(2):7883.
20- Albert J, Breer H, Weitz M, et al. Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. The Lancet. 2000;356:190-3.
21- Okada K, Yagi A, Tamio T, et al. Diagnostic evaluation of CT and ERCP based on a retrospective analysis of hepato-biliary and pancreatic diseases. Japanese Journal Of Surgery. 1981;11:277-82.
22- Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48(1):1-10.
23- Karmazanovsky G, Fedorov V, Kubyshkin V, Kotchatkov A. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging. 2005;30(4):488-500.
24- Park HS, Lee JM, Choi HK, et al. Preoperative evaluation of pancreatic cancer: Comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. Journal Of Magnetıc Resonance Imagıng. 2009;30(3):586-95.
25-Taimr P, Jongerius VL, Pek CJ, Krak NC, Hansen BE, Janssen HL, Metselaar HJ, van Eijck CH. Liver Contrast-Enhanced Ultrasound Improves Detection of Liver Metastases in Patients with Pancreatic or Periampullary Cancer. Ultrasound Med Biol. 2015 Dec;41(12):3063-9. doi: 10.1016/j.ultrasmedbio.2015.06.019. Epub 2015 Oct 1. PMID: 26427339.