Pankreatik Duktal Adenokarsinom Evrelemesi: Bilgisayarlı Tomografide Segmentasyon Yöntemi ile Ölçülen Tümör Hacmi ve Dansitesinin Histopatolojik Bulgular ile İlişkisi

Amaç: Multidetektör Bilgisayarlı Tomografi (MDBT) Pankreatik duktal adenokarsinom (PDA) tanı ve evrelemesinde en yaygın olarak kullanılan görüntüleme yöntemidir. Çalışmamızın amacı PDA’da radyolojik evreleme ile histopatolojik evrelemeyi karşılaştırmak, tümör BT dansitesi ve hacmi ile histopatolojik parametrelerin ilişkisini araştırmaktır. Materyal ve Metod: Çalışmamıza 2012- 2019 tarihleri arasında opere pankreas başı/unsinat proçes yerleşimli postoperatif histopatolojik tanısı PDA olan ve preoperatif intravenöz kontrastlı abdomen BT’si olan olgular dahil edildi (n=17). Radyolojik ve histopatolojik TNM evrelemesi, kitlenin duodenal ve peripankreatik yağ doku invazyon değerlendirilmesi karşılaştırıldı. Tümör hacim ve dansitesi segmentasyon yöntemi ile hesap edildi. Bulgular: Her iki cinsiyet arasında (nerkek=12, nkadın=5) yaş, tümör hacmi veya tümör dansitesi açısından anlamlı farklılık saptanmadı (p>0,05). Histopatolojik ve radyolojik T, N evreleme arasında anlamlı korelasyon ve uyum bulundu (sırasıyla, r=0,90, ĸ=0,86; p<0,001, r=0,67, ĸ=0,53; p:0,003). Tümör dansitesi ortalama değeri 68,49±18,76 (43-121) HU olup tümör dansitesi ile tümör hacmi (r=-0,58, p:0,01) ve N (r=-0,57, p:0,02) arasında anlamlı ilişki bulundu. MDBT’nin duodenum invazyonunu saptama duyarlılığı %50, özgüllüğü %100, doğruluk oranı %71 bulundu. Yağ doku invazyonu için duyarlılık %83, özgüllük %60, doğruluk oranı %77 bulundu. Sonuç: Pankreas başı/unsinat proçes yerleşimli PDA tanılı hastalarda MDBT duodenum ve peripankreatik yağ doku invazyonu tespitinde doğruluk oranı yüksek, evrelemede başarılı bir görüntüleme yöntemidir. Tümör hacim ve evreleme parametreleri arasında anlamlı ilişki mevcuttur. Tümör dansitesi ise tümör hacmi ve N evrelemesi ile anlamlı ilişki göstermektedir. Preoperatif değerlendirmede bu bilgilerin bilinmesi cerrahi yaklaşım ve tedavi yöntemi seçiminde rol oynayabilir.

Anahtar Kelimeler:

Histopatoloji, Bilgisayarlı Tomografi, Pankreatik Duktal Adenokarsinom, Evreleme

Pancreatic Ductal Adenocarcinoma Staging: The Relationship between Histopathological Findings and Computed Tomography Segmentation Method-Measured Tumor Volume and Density

Objective: Multidetector Computed Tomographyy (MDCT) is the primarily preferred imaging method for the diagnosis and staging of the pancreatic ductal adenocarcinoma (PDA). The aim of this study is to compare the radiological and histopathological staging of PDA and evaluate the relationship between histopathological parameters and tumor CT density and volume. Material ve Method: Patients with histopathologically diagnosed, pancreatic head/uncinate process localized PDA who have ungergone pancreaticoduodenectomy and preoperative contras-enhanced abdomen CT between 2012-2019 were included. Radiological and histopathological evaluation of TNM staging, duodenal, and peripancreatic fat invasion were compared. Tumor volume and density were calculated by the segmentation method. Results: There was no significant difference in age, tumor volume, and density between the genders (nmale=12, nfemale=5) (p>0.05). A significant correlation and aggreement was found between histopathological and radiological T, N staging (r=0.90, ĸ=0.86; p<0.001, r=0.67, ĸ=0.53; p:0.003, respectively). The mean of tumor density was 68.49±18.76 (43-121) HU. A significant correlation was found between tumor density vs volume (r=-0.58, p:0.01) and N (r=-0.57, p:0.02). The sensitivity, specificity, and accuracy of MDCT to detect duodenum invasion was 50%, 100%, and 71%, respectively. The sensitivity, specificity, and accuracy of MDCT to detect peripancreatic fat invasion was 83%, 60%, and 77%, respectively. Conclusion: MDCT of pancreatic head/uncinate process localized PDA is a successful imaging method for staging with a high accuracy for the detection of duodenum and peripancreatic fat invasion. There is a significant relationship between tumor volume and staging. Tumor density shows a signifcant relationship with tumor volume and N. Preoperative evaluation of these findings may play a role in decision making of surgical approach or treatment method.

Keywords:

Histopathology, Computed Tomography, Pancreatic Ductal Adenocarcinoma, Staging,

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