Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature

Shrikhande, Shailesh V.; Barreto, Savio George; Goel, Mahesh; Arya, Supreeta

doi:10.1111/j.1477-2574.2012.00508.x

Cited by 139 publications

(66 citation statements)

References 80 publications

(235 reference statements)

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“…(20) Staging of pancreatic tumour size, local vascular involvement and lymph node metastasis is better evaluated on endoscopic ultrasonography with fine-needle aspiration biopsy than CT or MR imaging. (21) However, there is mounting evidence in the literature of the superior sensitivity of MR imaging in detecting and characterising liver lesions compared with CT, particularly when combined with the use of a specific hepatobiliary contrast agent and DWI. (22) While most of the data relates to colorectal cancer liver metastasis, MR imaging has been shown to be equally useful with other malignancies.…”

Section: Discussionmentioning

confidence: 99%

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography

Chew¹,

O’Dwyer²

2015

smedj

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INTRODUCTIONPancreatic cancer has an incidence rate of 13.6 per 100,000 in the United Kingdom.(1) Most patients with pancreatic cancer have advanced disease at the time of diagnosis, and their overall fiveyear survival rate is less than 5%, although this rate is estimated to rise to 10%-20% after curative surgery.(2-7) Curative and palliative operations are associated with an average inpatient stay of two weeks, a mortality rate of up to 5% and morbidity rates of 20%-50%.(8-10) Patient recovery is often slow and accompanied by further intervention. As a result, hospital and societal costs are high. Therefore, accurate patient staging is critical in order to avoid unnecessary operations.Magnetic resonance (MR) imaging, when used with a hepatocyte-specific contrast agent, has increased sensitivity and specificity compared to computed tomography (CT).(11) Therefore, MR imaging is now routinely used for disease staging in patients with colorectal or other operable liver diseases who are suitable for liver resection. The reported sensitivity of MR imaging in detecting liver metastasis is 81%-92%, compared to 70%-87% for multidetector CT (MDCT). (12,13) No guideline exists on separate and specific staging of the liver in the setting of pancreatic cancer, although international guidelines recommend staging using contrast-enhanced MDCT while reserving MR imaging for indeterminate liver lesions encountered on CT. (14,15) The aim of this study was to prospectively assess the impact of liver MR imaging on the preoperative staging of patients with findings of resectable pancreatic cancer on CT. METHODSAll patients referred to a regional centre for evaluation and treatment of suspected pancreatic cancer between April 2012 and December 2013 were included in this study. Investigations performed included CT (performed in the portal venous phase, 64-slice MDCT) of the chest, abdomen and pelvis, and endoscopic ultrasonography (EUS) with fine-needle aspiration biopsy of the pancreatic mass and suspicious adjacent lymph nodes.The imaging, pathologic and clinical findings were discussed at weekly multidisciplinary meetings attended by consultant surgeons, radiologists, pathologists and oncologists with a special interest in pancreatic cancer. Patients with pathologically confirmed pancreatic cancer deemed resectable on CT and EUS proceeded to MR imaging of the liver prior to surgery or neoadjuvant chemotherapy. The decision on resectability was based on established criteria (American Hepato-Pancreato-Biliary Association/Society of Surgical Oncology/Society for Surgery of the Alimentary Tract).(16,17) Institutional Review Board approval was sought but not deemed necessary, as we were already routinely using MR imaging to stage patients with metastatic colorectal cancer who were being assessed for liver resection in our department. As part of the staging process, all patients undergoing operation for resectable pancreatic cancer had undergone prior laparoscopy to exclude peritoneal metastasis.Patients were examined using a Magnatom® A...

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Section: Discussionmentioning

confidence: 99%

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography

Chew¹,

O’Dwyer²

2015

smedj

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“…EUS imaging of the pancreas has the inherent advantage of having a high-frequency transducer placed in close proximity to the tumor, thereby resulting in high-resolution images [5]. EUS offers the best sensitivity and specificity rates for lesions <2 cm; EUS, which is the most accurate method available for staging PanCa in the preoperative period, is predictive of surgical resectability [8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasonography for Tumor Node Staging and Vascular Invasion in Pancreatic Cancer: A Meta-Analysis

He²,

et al. 2014

Dig Surg

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Background/Aims: The accurate staging of pancreatic cancer (PanCa) is crucial in the development of a stage-specific treatment plan for PanCa patients. We aimed to perform a meta-analysis of endoscopic ultrasonography (EUS) in the tumor node (TN) staging and evaluation of vascular invasion in PanCa. Methods: A meta-analysis of diagnostic accuracy parameters was performed to evaluate the EUS-based TN staging, and vascular invasion by PanCa was compared to the results of intraoperative staging or to the histopathology of resected specimens. Results: Twenty studies with 726 PanCa cases were identified from 281 articles. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.72, 0.90, 6.27, 0.28, and 24.69, respectively, for T1-2 staging and 0.90, 0.72, 3.58, 0.16, and 24.69, respectively, for T3-4 staging. The overall sensitivity, specificity, PLR, NLR, and DOR were 0.62, 0.74, 2.54, 0.51, and 6.67, respectively, for N staging (positive vs. negative) and 0.87, 0.92, 7.16, 0.20, and 56.19, respectively, for vascular invasion. The area under the curve was 0.90, 0.90, 0.79, and 0.94 for T1-2 staging, T3-4 staging, N staging, and vascular invasion, respectively. Conclusions: EUS is a reliable and accurate diagnostic tool for the TN staging and evaluation of vascular invasion in PanCa. The nodal staging accuracy using EUS is less satisfactory. i 2014 S. Karger AG, Basel

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“…The assessment of resectability in these tumours is dramatically improved and is very accurate in modern era of multi-detector CT with angiography [12]. The reported sensitivity and specificity of multi-detector CT in assessing resectability and predicting vascular involvement in periampullary tumours is between 82-91 and 84% respectively [13,14].…”

Section: Discussionmentioning

confidence: 99%

Re-Operative Pancreaticoduodenectomy: Challenges and Outcomes

et al. 2018

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Background: Tata Memorial Centre (TMC) is a high-volume centre for pancreatic tumour resections. We found a continually increasing referral of pancreatic tumours for re-evaluation for surgery, after an initial unsuccessful attempt at resection. Aim: To evaluate reasons of initial in-operability, the feasibility of re-operative pancreatico-duodenectomy (R-PD) and short- and long-term outcomes after R-PD. Methods: Data was collected from a prospective database of GI and hepato-pancreato-biliary service, TMC, Mumbai from January 2008 to December 2016. Results: Forty patients with periampullary/pancreatic head tumours were referred to us after exploration. Thirty were planned for re-exploration, of whom 25 patients underwent successful R-PD, either upfront (n = 12) or after neo-adjuvant therapy (n = 13). Twenty were adenocarcinomas, 5 had other histologies. Majority of the patients were deemed inoperable in view of suspected vascular involvement at the time of initial surgery (68%). R0 resection was achieved in 90% of adenocarcinoma cases (n = 18). Postoperative major morbidity was 20% and mortality was 4% (n = 1). The estimated 1-, 2- and 5-year survival for those with adenocarcinoma was 83, 71.2, and 29.9% respectively. Conclusion: R-PD is safe and should be performed in experienced centres and can achieve long-term outcomes, comparable to conventional PD. The most common reason for denying resection at initial surgery was suspected or perceived vascular involvement.

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Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature

Cited by 139 publications

References 80 publications

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography

Endoscopic Ultrasonography for Tumor Node Staging and Vascular Invasion in Pancreatic Cancer: A Meta-Analysis

Re-Operative Pancreaticoduodenectomy: Challenges and Outcomes

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