CT and Pathologic Assessment of Prospective Nodal Staging in Patients  with Ductal Adenocarcinoma of the Head of the Pancreas

Roche, Clare; Hughes, Monica A.; Garvey, C.J.; Campbell, Fiona; White, Donagh; Jones, Lucie; Neoptolemos, John P.

doi:10.2214/ajr.180.2.1800475

Cited by 165 publications

(77 citation statements)

References 29 publications

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“…Choledochal or duodenal invasion was considered to be present if a suspected hypoattenuated or hypointense lesion directly invaded or reached the surface of the common bile duct and duodenum without evidence of intervening normal pancreatic parenchyma (24). Regional lymph nodes were considered positive when there was a short-axis diameter greater than 10 mm or there was necrosis regardless of its size (32).…”

Section: Image Analysismentioning

confidence: 99%

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

Park

Lee

Choi

et al. 2009

Magnetic Resonance Imaging

136

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Purpose:To determine the accuracy of magnetic resonance imaging (MRI) including dynamic imaging using three-dimensional gradient-echo (3D-GRE) sequences and MR cholangiopancreatograpy (MRCP) compared with that of multidetector row CT (MDCT) with regard to resectability in pancreas cancer. Materials and Methods:From February 2004 to July 2008, 54 patients (32 men, 22 women: age range, 28 -83 years; mean age, 63.1 years old) with surgically proven pancreatic carcinoma, who had undergone preoperative gadolinium-enhanced 3D-GRE MRI with MRCP and triplephase MDCT, were included in this retrospective study. Two, clinically experienced attending radiologists independently reviewed the two image sets. These readers evaluated the tumor conspicuity, presence of vascular invasion, choledochal and duodenal invasion, lymph node metastases, distant metastasis, and tumor resectability. The results were compared with the surgical and histopathologic findings using receiver operating characteristic analysis (Az) and kappa statistics. Results:Curative resections were performed on 42 patients. Regarding the tumor conspicuity, MRI had a significantly higher Az value compared with MDCT according to both reviewers (P Ͻ 0.05). The accuracy of resectability was Az ϭ 0.753 and 0.768 on MRI and Az ϭ 0.829 and 0.762 on MDCT for each reviewer, and the difference in the accuracy of resectability was not significant between MRI and MDCT for either reviewer (P Ͼ 0.05). Two imaging sets showed a similar diagnostic performance in the evaluation of vascular involvement, lymph node metastasis, and distant metastasis.Conclusion: Dynamic 3D-GRE MRI with MRCP shows superior tumor conspicuity and similar diagnostic performance compared with MDCT in evaluating the resectability of pancreatic cancer.

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Section: Image Analysismentioning

confidence: 99%

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

Park

Lee

Choi

et al. 2009

Magnetic Resonance Imaging

136

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“…However, since pancreatic cancer patients seldom exhibit disease-specific symptoms until late in the course of the disease, very few patients (<15-20%) have resectable disease by the time the diagnosis is made (1,2). A proportion of patients thought to be resectable by imaging studies will be found to have metastatic or locally unresectable disease at surgery; the proportion varies from 15% to 50% depending on quality of pre-operative imaging (3)(4)(5). Finally, a subset of patients undergoing curative resection (up to 30%) will have positive resection margins (6), reflecting incomplete resection.…”

Section: Why Is Pancreatic Cancer Mortality So High?mentioning

confidence: 99%

Detecting Early Pancreatic Cancer: Problems and Prospects

Chari

2007

Seminars in Oncology

146

133

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Pancreatic cancer has a poor prognosis. Improving survival will require diagnosis of early pancreatic cancer which can be defined based on resectability, size or curability. Pancreatic cancer progresses from non-invasive precursor lesions to invasive cancer over a variable time period. Retrospective review of CT scans done prior to diagnosis suggests that pancreatic cancer resectability may be significantly improved if detected as few as 6 months before clinical diagnosis. Since pancreatic cancer is relatively uncommon, to allow cost-effective screening the populations will have to be enriched for the disease using two "sieves", first would be a population of subjects at higher than average risk of pancreatic cancer and the second sieve could be a characteristic phenotype among the members of the high-risk group, an abnormality seen on non-invasive imaging or a serologic marker of early pancreatic cancer. So far two high risk groups have been targets of screening for pancreatic cancer, viz., hereditary pancreatic cancer kindreds and new-onset diabetes. There is no serologic marker of early pancreatic cancer. Confirmation of diagnosis usually requires invasive procedures such endoscopic ultrasonography. Though much work still needs to be done, the developments in the field provide us with hope that screening for early pancreatic cancer could become a reality in the not-so-distant future.

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“…Our study showed that in 86% of pN1 patients no lymph node was larger than 10 mm and the majority of nodes were smaller than 5 mm , whereas in 46% of pN0 patients at least one lymph node was larger than or equal 10 mm. This reflects the reported sensitivity and specificity of CT scan in the assessment of nodal metastases in pancreatic cancer which ranges from 14% to 37% and from 60% to 92% respectively 8,9,[14][15][16] . The lack of correlation between lymph node size and metastatic infiltration has also been reported for other solid tumors.…”

Section: Discussionmentioning

confidence: 67%

“…Computer tomography has proven to be of diagnostic value to identify patients with advanced and unresectable tumors but its performance in evaluation of local tumor extension in patients with potentially resectable cancer is poor [10][11][12][13] . Furthermore image modalities like CT-scan, MR and transgastric endosonography are limited in their predictive value to differentiate benign lymph nodes from malignant ones 14,15 . In the pretherapeutic lymph node staging of pancreatic cancer, a correlation between lymph node size and metastatic infiltration is assumed.…”

Section: Discussionmentioning

confidence: 99%

Lymph node size and metastatic infiltration in adenocarcinoma of the pancreatic head

Prenzel¹,

Hölscher²,

Vallböhmer³

et al. 2010

European Journal of Surgical Oncology (EJSO)

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CT and Pathologic Assessment of Prospective Nodal Staging in Patients with Ductal Adenocarcinoma of the Head of the Pancreas

Cited by 165 publications

References 29 publications

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

Detecting Early Pancreatic Cancer: Problems and Prospects

Lymph node size and metastatic infiltration in adenocarcinoma of the pancreatic head

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