| Background:Pancreatic cancer, known as "the king of cancer", is the most common malignant neoplasm of the pancreas, which is refractory to surgical resection. Early diagnosis, accurate preoperative staging and surgical resection are prominent to treat pancreatic cancer successfully. In general, radiological techniques, particularly ultrasound and spiral CT, have preference in preoperative diagnosis and staging of pancreatic cancer. Nevertheless, these radiological approaches also remain some limits. The diagnostic accuracy of ultrasound is bound by the operator, patient's body form and gastrointestinal gas. Meanwhile, electromagnetic emission, contrast allergy and poor resolution of soft tissue also have effects in spiral CT examination. In recent years, as the development of high-speed magnetic resonance (MR) imaging, it's potential to combine multiple MR imaging technologies such as fat-suppressed technique, dynamic contrast, MRCP and MRA, which ultimately provides a safe, simple and non-invasive way to diagnosis and evaluation of pancreatic cancer. In the current study, we compared the differences of preoperative diagnosis and staging by MRI and postoperative diagnosis and staging by clinic criteria in pancreatic cancer patients. By exploring how to make accurate diagnosis and staging by MRI preoperatively, which may contribute to effective evaluation of surgical resection rate as well as reasonable strategy for surgical treatment, pancreatic cancer patients could be treated rationally.Objectives:(1) To analyze clinical data, imaging findings, pathological manifestations and prognosis of 35 pancreatic cancer patients in Changhai Hospital from 2007 to 2009, and to provide important references for accurate clinical diagnosis and rational treatment thereafter.(2) To analyze the differences between preoperative diagnosis and staging by MRI and postoperative diagnosis and staging by clinic criteria, and to increase the accurate rate of diagnosis by preoperative MRI. Provide accurate and reasonable diagnosis and treatment programs.(3) To prospect for the development of modern surgical treatment of pancreas tumor and to improve the cure rate of pancreatic cancer.Materials and methods:Thirty-five patients who prepared for surgical resection of pancreatic cancer had been selected,2 cases refused surgery,1 cases had accepted surgery (but did not leave specimens) in the third general surgery department of Changhai Hospital. In these 32 patients who accepted surgical treatment, cases of pancreatic ductal adenocarcinoma is 16, cases of pancreas intraductal papillary mucinous tumors is 4, cases of pancreatic adenosquamous carcinoma is 1, case of solid-pseudopapillary tumor is 1, cases of pancreatic endocrine tumors is 1, cases of pancreatic cystadenoma is 2, cases of pancreatitis mass is 7. All cases were pathologically confirmed and the information is complete.(1) The clinical data of 35 patients was collected completely, using basic statistical methods to analyze 35 cases of patients in general, clinical manifestations, treatment, laboratory examinations, pathological features, etc. Then, it will provide information on further studies of diagnosis and staging of pancreatic cancer (pre-and post operation).(2) These 35 pancreatic cancer patients had gotten preoperative MRI diagnosis and staging according to the Japanese staging of pancreatic cancer with the help of medical imaging specialists. The detail of the growth of tumor had been recorded in the patient's surgery record. Differential diagnosis and post-operative stage had been made out contact with the results of pathological diagnosis, and preoperative and postoperative tumor staging of patients have been approached in this reasonable control study. Results:(1) In this group of patients, pancreatic head carcinoma is 23 cases (65.7%), pancreatic body and tail carcinoma are 5 cases (14.3%); the average age of patients is about 51.7 year; 22 were male and 13 cases were female. In this group of cases, 15 cases (42.8%) had smoking history,6 patients (17.1%) had a long history of heavy drinking,4 cases (11.4%) had pancreatitis history,5 patients (14.3%) had diabetes mellitus, of which 2 cases (5.7%) was a new diabetes mellitus. In this group,31 patients were cured a complete resection,3 cases (8.6%) underwent pancreatic-fetching stones+pancreatic ojejunostomy,2 cases (5.7%) underwent palliative surgery. Pancreatic bile duct adenocarcinoma is the highest degree of malignancy, in 32 cases of surgical specimens, pancreatic ductal adenocarcinoma were 16 cases (45.7%), other tumors had intraductal papillary mucinous tumors (IPMT) 4 cases (11.4%), pancreas gland squamous cell carcinoma 1 cases (2.9%), solid-pseudopapillary tumor (SPT) 1 case (2.9%), pancreatic endocrine tumor 1 case (2.9%), pancreatic cystadenoma 2 cases (5.7%). It is difficult to distinguish pancreatic cancer from mass-type pancreatitis,7 cases (20.0%) were misdiagnosed as mass pancreatitis.(2) The group of 35 cases was diagnosed with pancreatic cancer according to preoperative MRI,2 cases refused surgery, pathological diagnosis of pancreatic cancer were 25 cases, intraoperative clinical diagnosis of cancer was 1 case, and accuracy rate was 78.79%(26/33).(3) In this group, the phaseâ… ,â…¡,â…¢had significant differences between the preoperative staging and postoperative staging, accuracy rate was 28.57%(2/7), 31.58%(6/19),42.86%(6/14), while theâ…£had a higher accuracy rate,75% (3/4). The difference in theâ… phase was caused by the misdiagnosis, in which five cases were pancreatitis; andâ…¡phase,â…¢phase also had differences, due to the highly malignant of the pancreatic cancer, Preoperativeâ…¡period in which there were 2 cases of pancreatitis,10 cases of postoperativeâ…¢phase,1 case of postoperativeâ…£phase. In this group,8 preoperative cases were found swollen lymph nodes. But, in the operation,18 cases were found swollen lymph nodes, the accuracy was 44.44%(8/18), in which pathologically confirmed that 9 cases lymph node metastasized, accounting for 50%(9/18).4 patients found distant metastasis after the operation, because intra-abdominal metastasis of pancreatic cancer is small, and it is difficult to detect by the MRI imaging.Conclusions:(1) Pancreatic cancer is a malignant tumor in pancreas, in which ductal adenocarcinoma is of most malignance. The tumor is located preferentially in the head of pancreas, and secondly the local part of pancreatic body. The whole pancreas is least involved. Patients aged 40-65 are of highest incidence. Pancreatic cancer, the presence of which is higher among men compared to women, is associated with several factors such as cigarette smoking, alcohol use, diabetes, diet, environment and inheritance, however, its etiology is still elusive. Operation is still regarded as the major treatment and surgical resection is the only approach for the cure of pancreatic cancer, but palliative surgery is also an important part of the management of pancreatic cancer.(2) Compared with preoperative staging, the resulting postoperative stageâ…¡(31.58%) andâ…¢(42.86%) are of most difference. The reasons are included a correction of the stage on MRI, site, size and fat around the focus, lymph node. There were nothing on MRI but the metastases, lymph node swelling were probably found during the surgical operation.(3) The differential diagnosis of pancreatic mass was complicated. In this group of 35 patients,7 cases of chronic pancreatitis are diagnosed with cancer by histopathology; misdiagnosis rate was 21.21%(7/33). Because that pancreatic mass and cancer not only have similar symptoms, but also have many similarities in the MRI imaging and other radiological signs, and sometimes surgical exploration or biopsy is difficult to diagnosis, so pancreatic cancer and mass-type pancreatitis which is difficult to diagnosis has been a clinical problem.(4) Along with development of the MRI technology and pancreatic surgery, accuracy rate of MRI preoperative diagnosis and the success rate of surgical resection will enhance continually. |
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