Pancreatic Ductal Adenocarcinoma Radiology Reporting Template: Consensus Statement of the Society of Abdominal Radiology and the American Pancreatic Association

Abstract

Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions.

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

“…Gemcitabine + erlotinib c, 8 Gemcitabine + capecitabine 9 Gemcitabine + cisplatin 10 (especially for patients with BRCA1/BRCA2 or other DNA repair mutations) Gemcitabine Capecitabine (category 2B) CI 5-FU (category 2B) Fixed-dose-rate gemcitabine, docetaxel, capecitabine (GTX regimen) 11 (category 2B) Fluoropyrimidine + oxaliplatin (category 2B) (eg, 5-FU/leucovorin/oxaliplatin 12 or CapeOx 13 ) Induction chemotherapy with any of the chemotherapy options above (≥4-6 cycles) followed by chemoradiation* ,d or SBRT 14 (in selected patients, locally advanced disease without systemic metastases) 15 Chemoradiation* ,e or SBRT e (in select patients who are not candidates for combination therapy)…”

“…• Options for patients with good performance status include: FOLFIRINOX b,f,6 (category 1) (preferred) Gemcitabine + albumin-bound paclitaxel f,7 (category 1) (preferred) Gemcitabine + erlotinib c,8 (category 1) Gemcitabine (category 1) Gemcitabine + capecitabine 9 Gemcitabine + cisplatin 10 (Can be considered as an alternative to FOLFIRINOX in patients with possible hereditary cancers involving DNA repair mutations) Fixed-dose-rate gemcitabine, docetaxel, capecitabine (GTX regimen) 11 (category 2B) Fluoropyrimidine + oxaliplatin (category 2B) (eg, 5-FU/leucovorin/oxaliplatin 12 Unlike many other cancers, imaging is the primary modality through which pancreatic cancer stage is determined. High-quality, multiphase imaging can help to preoperatively distinguish between patients eligible for resection with curative intent and those with unresectable disease.…”

DPC4 gene expression in primary pancreatic ductal adenocarcinoma: relationship with CT characteristics

“…A tumour located to the right of the left edge of the portal-superior mesenteric vein confluence was considered to be a tumour on the pancreas head, and a tumour located to the left of the left edge of the portalsuperior mesenteric vein confluence was considered a tumour on the pancreas body/tail. 13 The homogeneity of the tumour was categorized as homogeneous or heterogeneous. A tumour with mixed-density necrosis or haemorrhage in .70% of the lesion was considered heterogeneous; otherwise, the tumour was considered homogeneous.…”

“…Lymph node enlargement was defined by a short axis measuring .1 cm, abnormal round morphology or central necrosis. 13 The pancreatic tumours were compared in terms of density within the pancreatic parenchyma on visual assessment and a Automated dose modulation using the maximum allowable tube current. b After attenuation of the aorta at the thoracolumbar junction had reached 100 HU.…”

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

“…Assessment according to TNM classification should be possible on the basis of the CT description [6,7]. The description should also contain the assessment of the tumour's resectability, according to the NCCN criteria [6,104].…”