Abstract
Background
Neoplastic infiltration of the retroportal fat tissue is a critical parameter in tumor staging and in surgical planning because it frequently represents a site of persistence and recurrence of disease.
Method
We evaluated 64 patients affected by ductal adenocarcinoma of the pancreatic head/uncinate process, submitted to curative surgery. Suspicion of infiltration (micro or macroinfiltration) of the retroportal margin arose at MDCT in cases of obliteration, irregularity, or abnormal density of the fatty layer localized between the medial surface of the pancreatic head/uncinate process and the mesenteric artery.
Results
CT suggested the infiltration of the retroportal tissue in 27 cases (10 microinfiltration, 17 macroinfiltration). At histopathology, the presence of infiltration was confirmed in 21/27 (78%) cases. In all CT cases of microinfiltration, the retroperitoneal resection margin was not infiltrated, while all cases (6) with infiltration of the retroperitoneal margin were macroinfiltrated at CT. The sensitivity of CT was 80%, specificity of 84% with an overall diagnostic accuracy of 82%.
Conclusion
MDCT is accurate in the assessment of the neoplastic infiltration of the retroportal fat tissue.
Similar content being viewed by others
References
Seiki M, Katsusuke S. Pancreatic cancer in Japan, 2004. Pancreas 2004; 28(3):219–230.
Shaib Y, Davila J et al. the impact of curative intent surgery on the survival of pancreatic cancer patients: a U.S. population-based study. Am J Gastroenterol 2007; 102:1377–1382.
Valls C, Andia E et al. Dual phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. Am J Roentgenol 2002; 178(4):821–826.
Lüttges J, Vogel I et al. The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Virchows Arch 1998;433:237–242.
Imaizumi T, Hanyu F et al. Extended radical Whipple resection of the pancreatic head: operative procedure and results. Dig Surg 1998;15(4):299–307
Westgard A, Tafjord S et al. Resectable adenocarcinoma in the pancreatic head: the retroperitonal resection margin is an independent prognostic factor. BMC Cancer, 2008, 8:5.
Wayne J, Abdalla E, et al. Localized adenocarcinoma of the pancreas: the rationale for chemoradiation. Oncologist 2002; 7:34–45.
Henkie P. Tan, Smith J. et al. Pancreatic adenocarcinoma: an update. J Am Coll Surg 1996;183:164–184.
Westerdhal J, Andren-Sandberg A, Ihse I. Recurrence of exocrine pancreatic cancerlocal or hepatic? Hepato-Gastroenterol 1993, 40:384–387.
Furukawa H, Mukai K et al. Non functioning islet cell tumors of the pancreas: clinical aspects in 16 patients. Jpn J Clin Oncol, 1998. 28;4:255-261.
Traverso LW, Longmire WP et al. Preservation of the pylorus in pancreaticoduodenectomy. Ann Surg 1980;105:645-653.
Sohn TA, Yeo CJ et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes and prognostic indicators. J Gastroint Surg 2000,4:567–579.
Willett CG, Lewandrowski K, Warshaw AL et al. Resection margins in carcinoma of the head of the pancreas. Implications for radiation theraphy. Ann Surg 1993;217:144–148.
Balci NC, Semelka RC et al. Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. Eur J Rad 2001;38:105–112.
Soriano A, Castells A et al. Preoperative staging and tumor resectabiity assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical ct, magnetic resonance imaging, and angiography. Am J Gastroent 2004; 99(3): 492.
Legmann P, Vignaux O, Dousset B, Baraza AJ, Palazzo L et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol. 1998;170(5):1315-22.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mazzeo, S., Cappelli, C., Battaglia, V. et al. Multidetector CT in the evaluation of retroperitoneal fat tissue infiltration in ductal adenocarcinoma of the pancreatic head: correlation with histopathological findings. Abdom Imaging 35, 465–470 (2010). https://doi.org/10.1007/s00261-009-9548-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-009-9548-1