Abstract
While computed tomography provides an excellent non-invasive evaluation of the pancreas, its utilization should be restricted to selected clinical problems in patients with suspected pancreatic malignancy. Computed tomography is the preferred initial examination in the nonjaundiced patient because of its high specificity and sensitivity and its capacity for providing valuable staging information. Furthermore, computed tomographically guided percutaneous biopsy will establish a pathologic diagnosis in 85% of patients, thereby avoiding exploratory surgery in the majority of patients. Alternatively, this examination has far less utility in the patient with jaundice since alternative noninvasive and/or invasive radiologic tests provide comparable accuracy and greater functional flexibility. In this group of patients, computed tomography plays only a limited role in defining the incurability of some malignant tumors.
Résumé
Si la tomodensitométrie représente une excellente méthode d'exploration du pancréas dénuée de danger, son emploi doit être limité à certains cas cliniques particuliers évoquant l'existence d'un processus malin. Chez le malade anictérique elle constitue l'examen initial de choix en raison de sa grande spécificité, de sa grande sensibilité et aussi de sa capacité de déterminer le stade évolutif des lésions. Plus encore la méthode permet de diriger la biopsie percutanée et aussi d'établir le diagnostic dans 85% des cas, évitant de ce fait la laparotomie exploratrice. En revanche, la tomodensitométrie est de moins grande utilité chez le sujet ictérique puisque d'autres explorations radiologiques sont d'une précision aussi grande et sont plus faciles à mettre en oeuvre. En fait chez le malade jaune la tomodensitométrie a seulement pour rôle éventuel de dépister les lésions inopérables.
Resumen
Aunque la tomografía computadorizada permite una excelente evaluación no invasiva del páncreas, su utilización debe ser restringida al estudio de problemas clínicos seleccionados en pacientes en quienes se sospecha neoplasia maligna del páncreas. La tomografía computadorizada es el examen inicial de preferencia en el paciente no ictérico en virtud de su elevada especificidad y sensibilidad y de la capacidad para proveer valiosa información para la clasificación del estado clínico (staging). Además, la biopsia percutánea guiada por tomografía computadorizada es capaz de establecer el diagnóstico patológico en 85% de los pacientes, con lo cual se evita la cirugía exploratoria en la mayoría de los casos. Alternativamente, este examen tiene mucha menor utilidad en el paciente con ictericia, puesto que otros exámenes radiológicos poseen precisión comparable y una mayor flexibilidad funcional. En este grupo de pacientes la tomografía computadorizada juega apenas un papel limitado en la definición del estado de incurabilidad de algunos tumores malignos.
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Wittenberg, J., Ferrucci, J.T. & Warshaw, A.L. Contribution of computed tomography to patients with pancreatic adenocarcinoma. World J. Surg. 8, 831–838 (1984). https://doi.org/10.1007/BF01656022
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DOI: https://doi.org/10.1007/BF01656022