Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Somers, Inne; Bipat, Shandra

doi:10.1007/s00330-016-4708-5

Cited by 52 publications

(28 citation statements)

References 48 publications

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“…The third and main limitation of multidetector CT for initial PDA staging is inadequate sensitivity for detecting small liver metastases (55,56). For achieving this goal, MR imaging performs better than does multidetector CT.…”

Section: Limitations Of Imaging Studies For Initial Stagingmentioning

confidence: 99%

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

2018

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Pancreatic ductal adenocarcinoma (PDA) remains among the most challenging malignancies to treat. At diagnosis, the tumor often already extends beyond the confines of the pancreas, spreading to an extent such that primary surgery with curative intent is very rarely feasible. Considerable momentum is now being given to a treatment strategy involving neoadjuvant chemotherapy or chemotherapy and radiation therapy in patients with nonmetastatic PDA. The main advantage of this strategy is better selection of patients likely to benefit from curative-intent surgery through the achievement of negative resection margins. Patients with rapidly progressive disease are identified and are spared ineffective surgery with its attendant morbidity. Neoadjuvant therapy can downstage tumors classified as locally advanced at initial imaging studies to resectable tumors. However, the imaging study evaluation of the response to neoadjuvant therapy is extremely complex. Thus, the diagnostic performance of imaging studies is not sufficient to ensure the accurate selection of patients in whom negative-margin resection is likely to be achieved. More specifically, standard criteria for predicting vascular invasion, based on the amount of tumor-vessel contact, are not valid after neoadjuvant therapy.

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Section: Limitations Of Imaging Studies For Initial Stagingmentioning

confidence: 99%

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

2018

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“…Patients are falsely determined to have resectable disease mostly because of missed distant metastases rather than underestimated major vascular invasion . Missed distant metastasis can be mainly attributed to metastatic lesions that are too small to be detected by any currently available imaging modalities including CT.…”

Section: Introductionmentioning

confidence: 99%

“…Patients are falsely determined to have resectable disease mostly because of missed distant metastases rather than underestimated major vascular invasion. 7 Missed distant metastasis can be mainly attributed to metastatic lesions that are too small to be detected by any currently available imaging modalities including CT. However, as the presence or absence of distant metastasis is likely to be associated with factors related to tumor burden such as primary tumor extent or serum tumor marker level, we hypothesized that we may preoperatively predict the presence of radiologically undetectable metastasis with a model incorporating various radiologic and clinical factors.…”

Section: Introductionmentioning

confidence: 99%

Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Lee

Hwang

et al. 2019

J of Gastro and Hepatol

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Background and Aim The aim of this study is to identify the predictive factors for futile surgery in patients with radiologically resectable or borderline resectable pancreatic cancer and to develop a prediction model. Methods This retrospective study included patients who underwent pancreatic surgery for pancreatic cancer between 2006 and 2017. To identify independent risk factors for futile surgery, logistic regression and random forest analyses were performed in the training cohort, based on which a nomogram was established. The predictive accuracy and discriminative ability of the nomogram were validated in the validation cohort. Results Of 389 patients who underwent pancreatic surgery, the laparotomy was futile in 40 patients (10.3%). In the training cohort, the univariate and multivariate logistic regression analyses revealed that serum carbohydrate antigen 19‐9 level of ≥ 150 U/mL (P = 0.003), the presence of suspicious lymph node (P = 0.013), and more extensive peripancreatic tumor infiltration (P < 0.001) were independent predictive factors for futile surgery. The bootstrap‐corrected concordance index of the nomogram was high in the training cohort, 0.826 with a 95% confidence interval of 0.745–0.907. This model also showed a good discriminative performance in the validation cohort, with a concordance index of 0.831. Conclusions We established and validated a novel nomogram that predicts the risk of futile surgery due to occult distant metastasis in patients with radiologically resectable or borderline resectable pancreatic cancer.

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“…Among the various criteria for imaging-based resectability assessment of pancreatic cancer (12)(13)(14), those proposed by the National Comprehensive Cancer Network (NCCN) (11) are the most widely used and serve to classify pancreatic cancer as resectable, borderline resectable, or unresectable. Although CT is widely used in this respect, the possibility of R0 resection according to CT resectability status is poorly understood, since most previous evaluations focused on prediction of surgical resectability without considering pathologic resection margin status (15)(16)(17)(18)(19)(20)(21). Surgical resections in these studies were mostly limited to standard pancreatic resection and excluded tumors that required extended pancreatectomy.…”

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confidence: 99%

Pancreatic Cancer CT: Prediction of Resectability according to NCCN Criteria

Hong¹,

Lee²,

Kim³

et al. 2018

Radiology

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To evaluate the diagnostic performance of CT in the determination of pancreatic cancer resectability according to the National Comprehensive Cancer Network (NCCN) criteria to predict R0 resection. Materials and Methods: Structured reports of pancreatic CT clinically prepared by board-certified abdominal radiologists from January 2014 to March 2017 were retrospectively reviewed to assess resectability (resectable, borderline resectable, or unresectable) according to NCCN criteria (version 1.2017) in 616 patients (369 men, 247 women; mean age, 63 years 6 10 [standard deviation]) with pancreatic cancer. Negative resection margin (R0) rates were assessed based on CT resectability status in patients who underwent upfront surgery. R0 resection-associated factors were identified by using logistic regression analysis. Results: In 371 patients who underwent surgery, R0 resection rates were 73% (171 of 235), 55% (57 of 104), and 16% (five of 32) for resectable, borderline resectable, and unresectable disease, respectively (P , .001). At multivariable analysis, tumor diameter larger than 4 cm (P , .001) and abutment to the portomesenteric vein (P , .001) were significantly associated with marginpositive resection in patients with resectable disease at CT. R0 resection rates were 80% (123 of 154) for resectable disease without portomesenteric vein abutment, 59% (48 of 81) for resectable disease with portomesenteric vein abutment, 83% (57 of 69) for resectable disease 2 cm or smaller, and 29% (five of 17) for tumors larger than 4 cm. Conclusion: CT resectability is used to stratify patients with pancreatic cancer according to the possibility of R0 resection. Larger tumor size and tumor abutment to the portomesenteric vein are associated with margin-positive resection in patients with resectable pancreatic cancer.

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Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

Cited by 52 publications

References 48 publications

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Pancreatic Cancer CT: Prediction of Resectability according to NCCN Criteria

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