Diagnostic Accuracy of Imaging Modalities in the Evaluation of Vascular Invasion in Pancreatic Adenocarcinoma: A Meta-Analysis

Abstract

BackgroundThe extent of vascular invasion is a key factor determining the resectability of non-metastatic pancreatic adenocarcinoma. The purpose of this study is to determine the diagnostic accuracy of computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) in the pre-operative evaluation of vascular invasion in pancreatic adenocarcinoma, with surgery as the reference standard.MethodsA search of the MEDLINE database for relevant articles in the English language published between January 2000 and February 2009 was performed. From each study, 2 × 2 tables were obtained, and pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and diagnostic odds ratios were calculated for each modality, along with a summary receiver operating characteristics (SROC) curve.Results16 studies with a total of 797 patients who had surgical assessment of vascular invasion were included in the analysis. Several studies evaluated more than one imaging modality, allowing 24 datasets to be obtained in total. Sensitivity was highest for CT (0.73, 95% CI 0.67 - 0.79), followed by EUS (0.66, 95% CI 0.56 - 0.75) and MRI (0.63, 95% CI 0.48 - 0.77). The specificity for all three imaging modalities was comparable. The diagnostic odds ratios for CT, EUS and MRI were 45.9 (95% CI 18.0 - 117.4), 23.0 (95%CI 9.4 - 56.6), 23.9 (95% CI 5.4 - 105.1) respectively.ConclusionCT was more accurate than EUS and MRI in the evaluation of vascular invasion in pancreatic adenocarcinoma and should be the first line investigation in pre-operative staging.

Radiological staging in neuroblastoma: computed tomography or magnetic resonance imaging?

“…IDRFs should be evaluated by CT or MRI with multiplanar techniques. Results of a meta-analysis showed that CT is superior to the evaluation of vascular involvement [20]. MRI is more accurate than CT for the analysis of spinal canal extension [3,21].…”

A promising tool for T-staging of lung cancer: Is convex probe endobronchial ultrasound superior to computed tomography in detecting invasion of mediastinal and hilar vessels?

“…There are several published data regarding the performance of endoscopic ultrasound (EUS) in showing vascular invasion in pancreatic cancers. [3][4][5][6][7][8] In a single, head-to-head comparison study of EUS and CT, EUS showed a sensitivity and specificity of 61.1% and 90.3%, respectively which was higher than CT alone. [7] This finding was also confirmed by a systematic review, which yielded the area under the curve values of EUS and CT as 0.9379 and 0.8589, respectively.…”

“…[8] However, in other meta-analyses and reviews, this superiority was not found. [4][5][6] Invasion of great mediastinal/hilar vessels in lung cancer is an important issue in identifying T component of Tumor, Node, Metastasis (TNM) staging. To date, contrast-enhanced CT has been the main modality used for assessing vascular invasions.…”

Performance of EUS-FNB in solid pancreatic masses: a lesson from 463 consecutive procedures and a practical nomogram

“…In meta-analyses, the pooled sensitivity and specificity were 66-86% and 89-94%, respectively [128][129][130]. The sensitivity of EUS is different for different vessels being over 80% for evaluation of portal vein invasion, consistently superior to CT-scan; for the evaluation of the superior mesenteric vein, superior mesenteric artery and celiac artery, the sensitivity of EUS is lower than CT [131][132][133]. CE-EUS increases the sensitivity of detection of PV involvement up to 100%.…”