Duodenal neoplasms: predictive value of CT for determining malignancy and tumor resectability

CT examinations of 25 patients with proved primary or metastatic duodenal neoplasms were retrospectively reviewed to determine if morphologic features seen on CT scans could be used to predict the benign or malignant nature of these neoplasms and to assess the effectiveness of using CT findings to predict tumor resectability. We studied 19 malignant and six benign tumors. Histologic proof was obtained by means of surgery in 20 patients and by endoscopic biopsy in five. CT features of tumor morphology were assessed in the 22 cases in which a duodenal tumor was seen on CT. These features included central necrosis, ulceration or excavation, and the location of the tumor with respect to the bowel wall. The specific morphologic features used to predict that a tumor was malignant included the presence of an exophytic or intramural mass, central necrosis, and ulceration. The only criterion used to predict that a tumor was benign was that the mass be entirely intraluminal. Whenever vascular encasement, invasion of contiguous organs other than the head of the pancreas, distant lymphadenopathy, or metastases were present, the tumor was predicted to be unresectable for cure. With the exception of three benign smooth muscle tumors, all tumors with one or more CT morphologic features indicative of a malignant neoplasm were malignant (n = 16). Three of four intraluminal masses were benign. In three cases of polypoid tumors smaller than 2 cm, a duodenal tumor was not seen on CT. Whenever extraduodenal disease was found (15 cases), the neoplasms were malignant. In the 22 cases in which a tumor was detected on CT, the sensitivity of using the presence of one or more morphologic features associated with a malignant neoplasm as a predictor was 94%; the specificity was 50%, and the accuracy was 82%. If the presence of any morphologic feature indicative of a malignant neoplasm was combined with the presence of any finding of extraduodenal disease, CT was 100% sensitive and 86% accurate for predicting that the tumor was malignant. CT appears to be reliable for predicting duodenal tumor resectability. On the basis of CT findings, 10 tumors were correctly predicted as being unresectable for cure, and 12 were predicted as being resectable; no surgery was performed in the remaining three cases. In conclusion, evaluation of the morphologic features of duodenal neoplasms is a sensitive, but nonspecific, method for predicting that a tumor is malignant.(ABSTRACT TRUNCATED AT 400 WORDS)