Dorine S J Tseng1, Hjalmar C van Santvoort2, Samira Fegrachi2, Marc G Besselink3, Nicolaas P A Zuithoff4, Inne H Borel Rinkes2, Maarten S van Leeuwen5, I Quintus Molenaar6. 1. Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. Electronic address: D.S.J.Tseng@umcutrecht.nl. 2. Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. 3. Department of Surgery, Academic Medical Center Amsterdam, HG G4-196, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands. 4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HG STR6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. 5. Department of Radiology, University Medical Center Utrecht, HG E01.132, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. 6. Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. Electronic address: I.Q.Molenaar@umcutrecht.nl.
Abstract
OBJECTIVES: Computed tomography (CT) is the most widely used method to assess resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is the presence of extra-regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. METHODS: We systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra-regional lymph nodes in patients undergoing pancreatoduodenectomy were included. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data. RESULTS: After screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80-100% and 67-90% respectively. However, PPV and sensitivity ranged from 0 to 100% and 0-38%. Pooled sensitivity, specificity, PPV and NPV were 25%, 86%, 28% and 84% respectively. CONCLUSIONS: CT has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Therefore, suspicion of extra-regional lymph node metastases on CT alone should not be considered a contra-indication for exploration.
OBJECTIVES: Computed tomography (CT) is the most widely used method to assess resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is the presence of extra-regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. METHODS: We systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra-regional lymph nodes in patients undergoing pancreatoduodenectomy were included. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data. RESULTS: After screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80-100% and 67-90% respectively. However, PPV and sensitivity ranged from 0 to 100% and 0-38%. Pooled sensitivity, specificity, PPV and NPV were 25%, 86%, 28% and 84% respectively. CONCLUSIONS: CT has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Therefore, suspicion of extra-regional lymph node metastases on CT alone should not be considered a contra-indication for exploration.
Authors: Toshiro Masuda; Amanda M Dann; Irmina A Elliott; Hideo Baba; Stephen Kim; Alireza Sedarat; V Raman Muthusamy; Mark D Girgis; O Joe Hines; Howard A Reber; Timothy R Donahue Journal: J Gastrointest Surg Date: 2017-10-17 Impact factor: 3.452
Authors: Lennart B van Rijssen; Poorvi Narwade; Nadine C M van Huijgevoort; Dorine S J Tseng; Hjalmar C van Santvoort; Isaac Q Molenaar; Hanneke W M van Laarhoven; Casper H J van Eijck; Olivier R C Busch; Marc G H Besselink Journal: HPB (Oxford) Date: 2016-05-27 Impact factor: 3.647
Authors: Dorine S J Tseng; Bobby K Pranger; Maarten S van Leeuwen; Jan Pieter Pennings; Lodewijk A Brosens; Nadja Haj Mohammad; Vincent E de Meijer; Hjalmar C van Santvoort; Joris I Erdmann; I Quintus Molenaar Journal: Radiol Imaging Cancer Date: 2021-03-19