Pancreatic Tumors: a Multicentre Study of Multidetector Computed Tomography Findings and Histopathologic Correlation in Nairobi, Kenya.
Abstract
Background: Pancreatic tumours have variable morbidities and mortalities dependent on the
histological subtype, tumour grade and stage. These influence management strategies. Triple
phase Multi-Detector Computed Tomography (MDCT) imaging has a role in tumour detection,
staging, prognostication and treatment response assessment. There are limited studies on
pancreatic tumour imaging characteristics and histologic types in Kenya and in Africa as a
whole. Knowledge of MDCT imaging characteristics of different tumour types encountered in
Kenya will impact on patient management strategies.
Objective: To analyse the MDCT imaging spectrum and histopathologic correlation of patients
with pancreatic tumours at Kenyatta National Hospital, Plaza Imaging Solutions and German
Medical Centre.
Methodology: This was a cross sectional study done at the radiology departments of KNH,
Plaza Imaging Solutions and German Medical Centre in Nairobi, Kenya. Thirty-nine
consenting patients found to have pancreatic tumours on triple phase pancreatic protocol
MDCT imaging and who obtained histopathology results after tumour tissue sampling were
recruited. A structured data collection tool was used to document the demographic data and
MDCT pancreatic tumour imaging characteristics of the study participants. The most likely
tumour type from evaluation of the MDCT imaging characteristics was documented as well as
the histopathological diagnosis. Data analysis was done using the Statistical Package for Social
Scientists software (version 25). The results were presented in tables, pie carts, and bar charts.
Results: A total of 39 participants were recruited into the study. The mean age of patients with
pancreatic tumours was 58.4±13.9 years with 59% of them being female. Pancreatic ductal
adenocarcinoma was the most prevalent tumour subtype at 87.2%. Pancreatic neuroendocrine
tumour, solid pseudopapillary neoplasm and paraganglioma constituted 2.6% each while other
pancreatic tumour subtypes were not represented. PDAs were mostly poorly circumscribed
(91.2%), solid (85.3%), and located in the pancreatic head (55.9%). All the PDAs were
hypovascular in the arterial and portovenous phases. Main pancreatic duct dilatation and distal
pancreatic atrophy was seen in 61.8% and 58.8% of PDAs respectively. The double duct sign
was only seen in 29.4%. Distant metastases were found in 47.1% of the tumours at presentation.
The diagnostic accuracy of MDCT imaging for pancreatic ductal carcinoma was 94.9%.
Sensitivity and specificity were 100% and 60% respectively, while the PPV and NPV were
94.4% and 100%.
Conclusion: This study has shown that pancreatic ductal adenocarcinoma is the most prevalent
of the pancreatic tumour subtypes in Kenya. MDCT imaging using the pancreatic protocol had
high accuracy consistent with studies conducted elsewhere and is therefore reliable in the
diagnosis and exclusion of pancreatic ductal adenocarcinoma.
Recommendation: We recommend larger multicentre studies to evaluate the less commonly
occurring pancreatic tumour subtypes. Retrospective studies focusing on the less common
subtypes can be done to determine MDCT imaging features and diagnostic accuracy.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
The following license files are associated with this item: