Are Staging Computed Tomography (CT) Scans of the Chest Necessary in Pancreatic Adenocarcinoma?

Mehtsun, Winta T.; Chipidza, Fallon E.; Castillo, Carlos Fernández‐del; Hemingway, Katherine; Fong, Zhi Ven; Chang, David C.; Pandharipande, Pari V.; Clark, Jeffrey W.; Allen, Jill N.; Hong, Theodore S.; Wo, Jennifer Y.; Warshaw, Andrew L.; Lillemoe, Keith D.; Ferrone, Cristina R.

doi:10.1245/s10434-018-6764-3

Cited by 9 publications

(24 citation statements)

References 16 publications

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“…However, the actual incidence of lung metastases is believed to be underestimated due to nonspecific symptoms in the early phase of lung metastases and lack of consensus among physicians for the comprehensive lung filed image study as tumor staging for PC. Although PC staging with computed tomography (CT) scan, including abdomen and whole lung field, is recommended by the 8th version of the AJCC cancer staging manual [18], the clinical utility of CT scan including the whole lung field is still debated [19]. Firstly, isolated lung metastasis is a relatively rare entity, accounting for 3.4% of 623 patients with pancreatic cancer in a study by Mehtsun et al [20] and 3.4% of current study.…”

Section: Discussionmentioning

confidence: 99%

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Liu

Hung

Hsueh

et al. 2019

JCM

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The aim of this study was to evaluate the prevalence, the clinicopathological variables associated with probability of lung metastases, and the impact of lung metastases on survival outcome in patients with stage IV pancreatic cancer (PC) treated with palliative chemotherapy. A total of 654 patients with stage IV PC who underwent palliative chemotherapy from 2010–2016 were retrospectively enrolled in this study. Possible clinical variables associated with lung metastases and survival outcome were examined by univariate and multivariate analysis. Lung metastases were detected in 15.0% (3.4% with isolated lung metastases and 11.6% with synchronic metastases to lung and other organs). Female gender, poorly differentiated tumor grade, and large primary tumor size were independent risk factor in multivariate analysis. The median overall survival (OS) time was 6.5 months in the entire cohort, while the median OS was 11.8, 6.9, 7.7, 10.1, and 5.0 months for patients with isolated lung, isolated liver, isolated peritoneum, isolated distant lymph nodes, and multiple sites metastases, respectively. Isolated lung metastases were a better prognosticator for OS in univariate and multivariate analysis. This study utilized real-world clinical practice data to assess the prevalence, risk factors, and survival impact of lung metastases in patients with stage IV pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Liu

Hung

Hsueh

et al. 2019

JCM

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“…Emphasis is placed on the importance of surveillance postresection because the progression of IPN can be detected early and a subgroup of patients could undergo treatment, which may be potentially curable. Of the patients who developed pulmonary metastases, a few were treated with pulmonary resection with intent to cure, which demonstrated a survival benefit [12,13,15]. In the first ever reported study, Arnaoutakis et al showed that isolated lung metastases in PDAC can be considered for pulmonary resection with curative intent in a small number of selected patients [28].…”

Section: Discussionmentioning

confidence: 99%

“…Median survival was comparable among patients who did (15.6 months) or did not (18.0 months) have IPN (p = 0.66) [12]. Patients with lungonly recurrence had a median survival after recurrence of .37], p = 0.42) [13]. Malignancy was associated with the number of IPN in one of the studies; the presence of more than IPN was associated with the development of lung metastasis (relative risk 1.58, 95% CI 1.03-2.4; p = 0.05) [12].…”

Section: Follow-up and Recurrencementioning

confidence: 92%

“…The cut-off size of IPN used by Chang et al [11] and Mehtsun et al [13] was under 1 cm; however, Poruk et al [12] used a range of over 1 cm but less than 3 cm. The other studies did not report the definition of IPN used in their analysis.…”

Section: Size Of Ipnmentioning

confidence: 99%

“…Poruk et al reported that 29 (16%) of patients with pre-op IPN subsequently progressed to have clinically recognizable metastatic lung disease at the location of the prior IPN based on radiological assessment [12]. Mehtsun et al reported the total population of patients which had IPN (n = 451); 19 (4%) developed lung-only metastases, and 109 (24%) developed both lung and abdominal metastases, whereas of the 269 resected patients, 7.8% developed lung metastasis only [13]. Chang et al reported the lowest incidence of lung metastases from IPN, 5 (1.5%) [11].…”

Section: Progression Of Ipn To Metastatic Lung Diseasementioning

confidence: 99%

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Significance of indeterminate pulmonary nodules in resectable pancreatic adenocarcinoma—a review

Kuan

Dennison

Garcea

2021

Langenbecks Arch Surg

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Background The clinical significance of indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma (PDAC) is unknown. The rate of detection on IPN has risen due to enhanced staging investigations to determine resectability. IPNs detected on preoperative imaging represent a clinical dilemma and complicate decision-making. Currently, there are no recommendations on the management of IPN. This review provides a comprehensive overview of the current knowledge on the natural history of IPN detected among patients with resectable PDAC. Methods A systematic review based on a search in Medline and Embase databases was performed. All clinical studies evaluating the significance of IPN in patients with resectable PDAC were included. PRISMA guidelines were followed. Results Five studies met the inclusion criteria. The total patient population was 761. The prevalence of IPN reported ranged from 18 to 71%. The median follow-up duration was 17 months. The median overall survival was 19 months. Patients with pre-operative IPN which subsequently progressed to clinically recognizable pulmonary metastases, ranged from 1.5 to 16%. Four studies found that there was no significant difference in median overall survival in patients with or without IPNs. Conclusion This is a first review on the significance of IPN in patients with resectable PDAC. The preoperative presence of IPN does not demonstrate an association with overall survival after surgery. The identification of IPN is a significant finding however it should not preclude patients with resectable PDAC from undergoing curative resection.

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The yield of chest computed tomography in patients with locally advanced pancreatic cancer

Suker

Koerkamp

Nuyttens

et al. 2020

Journal of Surgical Oncology

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Objective To evaluate the incidence of pulmonary metastases on chest computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC). Methods All patients diagnosed with LAPC in a single tertiary center (Erasmus MC) between October 2011 and December 2017 were reviewed. The staging chest CT scan and follow‐up chest CT scans were evaluated. Pulmonary nodules were divided into three categories: apparent benign, too small to characterize, and apparent malignant. Results In 124 consecutive patients diagnosed with LAPC, 119 (96%) patients underwent a staging chest CT scan at the initial presentation. In 88 (74%) patients no pulmonary nodules were found; in 16 (13%) patients an apparent benign pulmonary nodule was found, and in 15 (13%) patients a pulmonary nodule too small to characterize was found. Follow‐up chest CT scan(s) were performed in 111 (93%) patients. In one patient with either no pulmonary nodule or an apparent benign pulmonary nodule at initial staging, an apparent malignant pulmonary nodule was found on a follow‐up chest CT scan. However, a biopsy of the nodule was inconclusive. Of 15 patients in whom a pulmonary nodule too small to characterize was found at staging, 12 (80%) patients underwent a follow‐up CT scan; in 4 (33%) of these patients, an apparent malignant pulmonary nodule was found. Conclusion In patients with LAPC in whom at diagnosis a chest CT scan revealed either no pulmonary nodules or apparent benign pulmonary nodules, routine follow‐up chest CT scans is not recommended. Patients with pulmonary nodules too small to characterize are at risk to develop apparent malignant pulmonary nodules during follow‐up.

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Are Staging Computed Tomography (CT) Scans of the Chest Necessary in Pancreatic Adenocarcinoma?

Cited by 9 publications

References 16 publications

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

Significance of indeterminate pulmonary nodules in resectable pancreatic adenocarcinoma—a review

The yield of chest computed tomography in patients with locally advanced pancreatic cancer

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