OBJECTIVE: Pancreatic adenocarcinoma is a rapidly progressive malignancy characterized by its tendency for early metastatic spread. MDCT is the primary diagnostic modality for the preoperative staging of patients with pancreatic cancer, with an accuracy established in multiple studies. However, for a variety of reasons, there is often a prolonged interval between staging MDCT and the surgical intervention. This study examines the relationship between the interval between imaging and surgery and the accuracy of MDCT in determining the presence or absence of metastatic disease at surgery in patients with pancreatic cancer. MATERIALS AND METHODS: Patients were identified who had undergone surgery for pancreatic cancer at our institution with a dedicated preoperative pancreas-protocol MDCT performed in our department. Findings from the preoperative MDCT report were correlated with the operative findings, as well as the time between imaging and surgery. RESULTS: Two hundred ninety-two MDCT scans were performed on 256 patients who underwent exploration for pancreatic adenocarcinoma. The patients had a median age of 67 years (range, 30-95 years), and 51.6% (132/256) were male. The median time between MDCT and surgical exploration was 15.5 days (range, 1-198 days). MDCT correctly predicted the absence of metastatic disease at surgery in 233 of 274 (85.0%) studies. MDCT was more accurate in predicting the absence of metastatic disease if the study was performed within 25 days of surgery than it was if the study was performed within more than 25 days of surgery (89.3% vs 77.0%; p = 0.0097). Furthermore, regression models showed that the negative predictive value of a given MDCT significantly decreased after approximately 4 weeks. CONCLUSION: MDCT is an accurate method to stage patients with pancreatic cancer, but its accuracy in excluding distant metastatic disease depreciates over time. Patients should undergo a repeat MDCT within 25 days of any planned definitive operative intervention for pancreatic cancer to avoid unexpectedly finding metastatic disease at surgery.
OBJECTIVE:Pancreatic adenocarcinoma is a rapidly progressive malignancy characterized by its tendency for early metastatic spread. MDCT is the primary diagnostic modality for the preoperative staging of patients with pancreatic cancer, with an accuracy established in multiple studies. However, for a variety of reasons, there is often a prolonged interval between staging MDCT and the surgical intervention. This study examines the relationship between the interval between imaging and surgery and the accuracy of MDCT in determining the presence or absence of metastatic disease at surgery in patients with pancreatic cancer. MATERIALS AND METHODS:Patients were identified who had undergone surgery for pancreatic cancer at our institution with a dedicated preoperative pancreas-protocol MDCT performed in our department. Findings from the preoperative MDCT report were correlated with the operative findings, as well as the time between imaging and surgery. RESULTS: Two hundred ninety-two MDCT scans were performed on 256 patients who underwent exploration for pancreatic adenocarcinoma. The patients had a median age of 67 years (range, 30-95 years), and 51.6% (132/256) were male. The median time between MDCT and surgical exploration was 15.5 days (range, 1-198 days). MDCT correctly predicted the absence of metastatic disease at surgery in 233 of 274 (85.0%) studies. MDCT was more accurate in predicting the absence of metastatic disease if the study was performed within 25 days of surgery than it was if the study was performed within more than 25 days of surgery (89.3% vs 77.0%; p = 0.0097). Furthermore, regression models showed that the negative predictive value of a given MDCT significantly decreased after approximately 4 weeks. CONCLUSION: MDCT is an accurate method to stage patients with pancreatic cancer, but its accuracy in excluding distant metastatic disease depreciates over time. Patients should undergo a repeat MDCT within 25 days of any planned definitive operative intervention for pancreatic cancer to avoid unexpectedly finding metastatic disease at surgery.
Authors: Douglas B Evans; Michael B Farnell; Keith D Lillemoe; Charles Vollmer; Steven M Strasberg; Richard D Schulick Journal: Ann Surg Oncol Date: 2009-04-23 Impact factor: 5.344
Authors: Mark P Callery; Kenneth J Chang; Elliot K Fishman; Mark S Talamonti; L William Traverso; David C Linehan Journal: Ann Surg Oncol Date: 2009-04-24 Impact factor: 5.344
Authors: C S van Kessel; M S van Leeuwen; M A A J van den Bosch; I H M Borel Rinkes; W P T M Mali; P Westers; R van Hillegersberg Journal: Dig Surg Date: 2011-02-04 Impact factor: 2.588
Authors: F Iafrate; M Ciolina; P Sammartino; P Baldassari; M Rengo; P Lucchesi; S Sibio; F Accarpio; A Di Giorgio; A Laghi Journal: Abdom Imaging Date: 2012-08
Authors: Eric P Tamm; Aparna Balachandran; Priya R Bhosale; Matthew H Katz; Jason B Fleming; Jeffrey H Lee; Gauri R Varadhachary Journal: Radiol Clin North Am Date: 2012-04-06 Impact factor: 2.303
Authors: Jun Yu; Yoshihiko Sadakari; Koji Shindo; Masaya Suenaga; Aaron Brant; Jose Alejandro Navarro Almario; Michael Borges; Thomas Barkley; Shahriar Fesharakizadeh; Madeline Ford; Ralph H Hruban; Eun Ji Shin; Anne Marie Lennon; Marcia Irene Canto; Michael Goggins Journal: Gut Date: 2016-07-18 Impact factor: 23.059
Authors: K Gerken; K J Roberts; B Reichert; R P Sutcliffe; F Marcon; S K Kamarajah; A Kaltenborn; T Becker; N G Heits; D F Mirza; J Klempnauer; H Schrem Journal: BJS Open Date: 2018-06-08
Authors: G Litjens; D M Rivière; E J M van Geenen; S A Radema; L A A Brosens; M Prokop; C J H M van Laarhoven; J J Hermans Journal: BMC Cancer Date: 2020-08-10 Impact factor: 4.430
Authors: R Pandé; J Hodson; A Murray; F Marcon; M Kalisvaart; R Marudanayagam; R P Sutcliffe; D F Mirza; J Isaac; K J Roberts Journal: BJS Open Date: 2019-04-02