Sohee Park1, Jong Keon Jang2, Jae Ho Byun1, Jin Hee Kim1, Seung Soo Lee1, Hyoung Jung Kim1, Seung Baek Hong3, Seong Ho Park1. 1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. 2. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. jongkeon.jang@gmail.com. 3. Department of Radiology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, 49241, South Korea.
Abstract
OBJECTIVES: We aimed to systematically evaluate the diagnostic accuracy of CT-determined resectability following neoadjuvant treatment for predicting margin-negative resection (R0 resection) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: Original studies with sufficient details to obtain the sensitivity and specificity of CT-determined resectability following neoadjuvant treatment, with a reference on the pathological margin status, were identified in PubMed, EMBASE, and Cochrane databases until February 24, 2020. The identified studies were divided into two groups based on the criteria of R0 resectable tumor (ordinary criterion: resectable PDAC alone; extended criterion: resectable and borderline resectable PDAC). The meta-analytic summary of the sensitivity and specificity for each criterion was estimated separately using a bivariate random-effect model. Summary results of the two criteria were compared using a joint-model bivariate meta-regression. RESULTS: Of 739 studies initially searched, 6 studies (6 with ordinary criterion and 5 with extended criterion) were included for analysis. The meta-analytic summary of sensitivity and specificity was 45% (95% confidence interval [CI], 19-73%; I2 = 88.3%) and 85% (95% CI, 65-94%; I2 = 60.5%) for the ordinary criterion, and 81% (95% CI, 71-87%; I2 = 0.0%) and 42% (95% CI, 28-57%; I2 = 6.2%) for the extended criterion, respectively. The diagnostic accuracy significantly differed between the two criteria (p = 0.02). CONCLUSIONS: For determining resectability on CT, the ordinary criterion might be highly specific but insensitive for predicting R0 resection, whereas the extended criterion increased sensitivity but would decrease specificity. Further investigations using quantitative parameters may improve the identification of R0 resection. KEY POINTS: • CT-determined resectability of PDAC after neoadjuvant treatment using the ordinary criterion shows low sensitivity and high specificity in predicting R0 resection. • With the extended criterion, CT-determined resectability shows higher sensitivity but lower specificity than with the ordinary criterion. • CT-determined resectability with both criteria achieved suboptimal diagnostic performances, suggesting that care should be taken while selecting surgical candidates and when determining the surgical extent after neoadjuvant treatment in patients with PDAC.
OBJECTIVES: We aimed to systematically evaluate the diagnostic accuracy of CT-determined resectability following neoadjuvant treatment for predicting margin-negative resection (R0 resection) in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: Original studies with sufficient details to obtain the sensitivity and specificity of CT-determined resectability following neoadjuvant treatment, with a reference on the pathological margin status, were identified in PubMed, EMBASE, and Cochrane databases until February 24, 2020. The identified studies were divided into two groups based on the criteria of R0 resectable tumor (ordinary criterion: resectable PDAC alone; extended criterion: resectable and borderline resectable PDAC). The meta-analytic summary of the sensitivity and specificity for each criterion was estimated separately using a bivariate random-effect model. Summary results of the two criteria were compared using a joint-model bivariate meta-regression. RESULTS: Of 739 studies initially searched, 6 studies (6 with ordinary criterion and 5 with extended criterion) were included for analysis. The meta-analytic summary of sensitivity and specificity was 45% (95% confidence interval [CI], 19-73%; I2 = 88.3%) and 85% (95% CI, 65-94%; I2 = 60.5%) for the ordinary criterion, and 81% (95% CI, 71-87%; I2 = 0.0%) and 42% (95% CI, 28-57%; I2 = 6.2%) for the extended criterion, respectively. The diagnostic accuracy significantly differed between the two criteria (p = 0.02). CONCLUSIONS: For determining resectability on CT, the ordinary criterion might be highly specific but insensitive for predicting R0 resection, whereas the extended criterion increased sensitivity but would decrease specificity. Further investigations using quantitative parameters may improve the identification of R0 resection. KEY POINTS: • CT-determined resectability of PDAC after neoadjuvant treatment using the ordinary criterion shows low sensitivity and high specificity in predicting R0 resection. • With the extended criterion, CT-determined resectability shows higher sensitivity but lower specificity than with the ordinary criterion. • CT-determined resectability with both criteria achieved suboptimal diagnostic performances, suggesting that care should be taken while selecting surgical candidates and when determining the surgical extent after neoadjuvant treatment in patients with PDAC.
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
Authors: Thomas F Stoop; Eran van Veldhuisen; L Bengt van Rijssen; Remy Klaassen; Oliver J Gurney-Champion; Ignace H de Hingh; Olivier R Busch; Hanneke W M van Laarhoven; Krijn P van Lienden; Jaap Stoker; Johanna W Wilmink; C Yung Nio; Aart J Nederveen; Marc R W Engelbrecht; Marc G Besselink Journal: Langenbecks Arch Surg Date: 2022-10-15 Impact factor: 2.895