Purpose: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to CT overestimation of tumor extension and residual vascular involvement. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging to achieve complete resection. Material and methods: We retrospectively enrolled 71 patients with locally advanced and borderline-resectable PDAC who underwent neoadjuvant chemoradiotherapy. Pre-operative CT or MR has been evaluated by three radiologists to assess major qualitative and quantitative parameters of lesions. Accuracy, sensibility and specificity compared to anatomopathological results were evaluated. Cohen’s K coefficient has been calculated to evaluate inter-observer agreement (IOA). Different dimensional cut-offs were tested and compared to anatomopathological diameter, tumor persistence and margin infiltration. Results: 25 mm cut-off was 67% sensitive, 90% specific and 77% accurate in assessing real tumor dimension. Sensitivity and specificity for 25 mm cut-off were, respectively, 23% and 94% for margin infiltration, and 51% and 67% for tumor persistence. The imaging presence of perivascular cuff reported a low accuracy in determining tumor persistence and margin infiltrations. Lesion enhancement and pattern homogeneity were not accurate in determining tumor persistence. IOA was generally poor to fair, except for 25 mm cut-off classification where IOA was moderate. Diagnostic accuracy is superior in consensus lecture rather than single lecture. Conclusion: Imaging methods tend to underestimate PDAC resectability after neoadjuvant-CRT. IOA is poor to fair in evaluating most of the qualitative parameters of downstaged pancreatic adenocarcinoma. Surgery should be considered for downstaged borderline resectable PDACs, independently of perivascular cuff presence, especially for tumors smaller than 25 mm
Preoperative imaging evaluation after downstaging of pancreatic ductal adenocarcinoma: a multi-center study
A. Beleù;G. Rizzo;A. Grecchi;I. Testa;G. Giannotti;N. Cardobi;R. De Robertis;D’Onofrio Mirko
2019-01-01
Abstract
Purpose: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to CT overestimation of tumor extension and residual vascular involvement. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging to achieve complete resection. Material and methods: We retrospectively enrolled 71 patients with locally advanced and borderline-resectable PDAC who underwent neoadjuvant chemoradiotherapy. Pre-operative CT or MR has been evaluated by three radiologists to assess major qualitative and quantitative parameters of lesions. Accuracy, sensibility and specificity compared to anatomopathological results were evaluated. Cohen’s K coefficient has been calculated to evaluate inter-observer agreement (IOA). Different dimensional cut-offs were tested and compared to anatomopathological diameter, tumor persistence and margin infiltration. Results: 25 mm cut-off was 67% sensitive, 90% specific and 77% accurate in assessing real tumor dimension. Sensitivity and specificity for 25 mm cut-off were, respectively, 23% and 94% for margin infiltration, and 51% and 67% for tumor persistence. The imaging presence of perivascular cuff reported a low accuracy in determining tumor persistence and margin infiltrations. Lesion enhancement and pattern homogeneity were not accurate in determining tumor persistence. IOA was generally poor to fair, except for 25 mm cut-off classification where IOA was moderate. Diagnostic accuracy is superior in consensus lecture rather than single lecture. Conclusion: Imaging methods tend to underestimate PDAC resectability after neoadjuvant-CRT. IOA is poor to fair in evaluating most of the qualitative parameters of downstaged pancreatic adenocarcinoma. Surgery should be considered for downstaged borderline resectable PDACs, independently of perivascular cuff presence, especially for tumors smaller than 25 mm
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