Ijin Joo1,2, Jeong Min Lee1,2,3, Eun Sun Lee4, Su Joa Ahn1,2, Dong Ho Lee1,2, Sun-Whe Kim5, Ji Kon Ryu6, Do-Youn Oh7, Kyubo Kim8, Kyoung-Bun Lee9, Jin-Young Jang5. 1. 1 Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, Korea. 2. 2 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. 3. 3 Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea. 4. 4 Department of Radiology, Chung-Ang University Hospital, Seoul, Korea. 5. 5 Department of Surgery, Seoul National University Hospital, Seoul, Korea. 6. 6 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. 7. 7 Department of Internal Medicine and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 8. 8 Department of Radiation Oncology, Ewha Woman's University School of Medicine, Seoul, Korea. 9. 9 Department of Pathology, Seoul National University Hospital, Seoul, Korea.
Abstract
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 up-front 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.
RCT Entities:
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 up-front 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.
Authors: Hae Young Kim; Yoon Jin Lee; Won Chang; Jungheum Cho; Ji Hoon Park; Jong-Chan Lee; Jaihwan Kim; Jin-Hyeok Hwang; Young Hoon Kim Journal: Eur Radiol Date: 2022-01-15 Impact factor: 5.315