TY - JOUR
T1 - Preoperative MDCT assessment of resectability in borderline resectable pancreatic cancer
T2 - Effect of neoadjuvant chemoradiation therapy
AU - Joo, Ijin
AU - Lee, Jeong Min
AU - Lee, Eun Sun
AU - Ahn, Su Joa
AU - Lee, Dong Ho
AU - Kim, Sun Whe
AU - Ryu, Ji Kon
AU - Oh, Do Youn
AU - Kim, Kyubo
AU - Lee, Kyoung Bun
AU - Jang, Jin Young
N1 - Funding Information:
Supported by grant HI14C2640 from the Korean Health Technology R&D Project and grant 1120310 from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea.
Publisher Copyright:
© American Roentgen Ray Society.
PY - 2018/5
Y1 - 2018/5
N2 - OBJECTIVE. The purpose of this study is to evaluate the diagnostic performance of MDCT in assessing tumor resectability in patients with borderline resectable pancreatic cancers after receiving neoadjuvant chemoradiation therapy (CRT) in comparison with those undergoing upfront surgery. SUBJECTS AND METHODS. Thirty-seven patients with borderline resectable pancreatic cancers were randomly allocated to the neoadjuvant CRT group (arm 1; n = 18) or upfront surgery group (arm 2; n = 19). Three radiologists rated the likelihood of local resectability on a 5-point scale at preoperative MDCT in two separate sessions (session 1: post-CRT of arm 1, baseline of arm 2; session 2: using new imaging criteria reflecting the changes during CRT of arm 1). The AUC of each reviewer, as well as sensitivity, specificity, and accuracy based on consensus interpretation, were compared between arms and sessions. RESULTS. For local resectability (n = 30), AUC values at session 1 were 0.664, 0.669, and 0.588 for reviewers 1, 2, and 3, respectively, and were not significantly different between arms 1 (n = 15; 0.759, 0.713, and 0.593) and 2 (n = 15; 0.852, 0.685, and 0.722) (p > 0.05). In arm 1, MDCT sensitivity, specificity, accuracy were 22%, 100%, and 53%, respectively, at session 1 versus 78%, 67%, and 73%, respectively, at session 2 (p > 0.05). CONCLUSION. In patients with borderline resectable pancreatic cancers, neoadjuvant CRT did not significantly decrease the performance of MDCT for the prediction of local resectability. However, by considering post-CRT changes, such as nonprogression in tumor-vascular contact, MDCT may provide better sensitivity for locally resectable disease.
AB - OBJECTIVE. The purpose of this study is to evaluate the diagnostic performance of MDCT in assessing tumor resectability in patients with borderline resectable pancreatic cancers after receiving neoadjuvant chemoradiation therapy (CRT) in comparison with those undergoing upfront surgery. SUBJECTS AND METHODS. Thirty-seven patients with borderline resectable pancreatic cancers were randomly allocated to the neoadjuvant CRT group (arm 1; n = 18) or upfront surgery group (arm 2; n = 19). Three radiologists rated the likelihood of local resectability on a 5-point scale at preoperative MDCT in two separate sessions (session 1: post-CRT of arm 1, baseline of arm 2; session 2: using new imaging criteria reflecting the changes during CRT of arm 1). The AUC of each reviewer, as well as sensitivity, specificity, and accuracy based on consensus interpretation, were compared between arms and sessions. RESULTS. For local resectability (n = 30), AUC values at session 1 were 0.664, 0.669, and 0.588 for reviewers 1, 2, and 3, respectively, and were not significantly different between arms 1 (n = 15; 0.759, 0.713, and 0.593) and 2 (n = 15; 0.852, 0.685, and 0.722) (p > 0.05). In arm 1, MDCT sensitivity, specificity, accuracy were 22%, 100%, and 53%, respectively, at session 1 versus 78%, 67%, and 73%, respectively, at session 2 (p > 0.05). CONCLUSION. In patients with borderline resectable pancreatic cancers, neoadjuvant CRT did not significantly decrease the performance of MDCT for the prediction of local resectability. However, by considering post-CRT changes, such as nonprogression in tumor-vascular contact, MDCT may provide better sensitivity for locally resectable disease.
KW - Borderline resectable
KW - MDCT
KW - Neoadjuvant chemoradiation
KW - Pancreatic cancer
KW - Resectability
UR - http://www.scopus.com/inward/record.url?scp=85046129969&partnerID=8YFLogxK
U2 - 10.2214/AJR.17.18310
DO - 10.2214/AJR.17.18310
M3 - Article
C2 - 29489408
AN - SCOPUS:85046129969
VL - 210
SP - 1059
EP - 1065
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
SN - 0361-803X
IS - 5
ER -