Stellenwert der transkutanen B-Bild-Sonographie im Staging von metastasierten Pankreaskarzinomen: Eine retrospektive Studie mit n= 58 Patient*innen.
Abstract
Pancreatic carcinoma, an oncological disease with a lethality rate nearly equivalent to its
incidence, accounts for approximately 4% of cancer-related deaths worldwide (Bray et al.,
2018). Due to its aggressive local growth and early hematogenous metastasis, the diagnosis is
often made at a stage when curative treatment is no longer feasible. A variety of imaging
modalities are employed to assess the stage of the disease.
In the present study, all diagnostic procedures used for staging patients with suspected
metastatic pancreatic carcinoma who presented at the University Hospital of Marburg between
January 2017 and January 2022 and underwent at least one sonographic examination were
analyzed.
The objective of the study was to determine the role of sonography in staging this patient cohort
in comparison to other imaging modalities and to evaluate the diagnostic and economic impact
of all procedures.
The findings indicate that computed tomography (CT) is superior to sonography in detecting
primary pancreatic lesions (CT sensitivity: 96.5% vs. sonography sensitivity: 79.3%). However,
sonography is comparable to, or even superior to, CT in identifying and characterizing distant
metastases (CT sensitivity: 92.6% vs. sonography sensitivity: 90.1%), particularly liver
metastases (CT sensitivity: 91.8% vs. sonography sensitivity: 94%). When sonography and CT
are combined, the detection of distant metastases (sensitivity: 96.3%) and liver metastases
(sensitivity: 95.9%) is more accurate. Consequently, the combined application of sonography
and CT is deemed appropriate and sufficient in most cases for diagnosing suspected metastatic
pancreatic carcinoma.
Moreover, this study demonstrates that a significant number of diagnostic procedures
performed during the staging of metastatic pancreatic carcinoma do not influence therapeutic
decision-making. By implementing a diagnostic algorithm, as illustrated in Figure 4,
overdiagnosis can be minimized, conserving resources and enabling a more patient-centered
diagnostic approach. We found that this approach could reduce overall staging costs by 61%
and overall radiation by 70% in a cohort of 55 patients with confirmed metastatic disease.
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