Preoperative MDCT Assessment of Resectability in Borderline Resectable Pancreatic Cancer: Effect of Neoadjuvant Chemoradiation Therapy
- 주제(키워드) borderline resectable , MDCT , neoadjuvant chemoradiation , pancreatic cancer , resectability
- 주제(기타) Radiology, Nuclear Medicine & Medical Imaging
- 설명문(일반) [Joo, Ijin; Lee, Jeong Min; Ahn, Su Joa; Lee, Dong Ho] Seoul Natl Univ Hosp, Dept Radiol, 101 Daehak Ro, Seoul 03080, South Korea; [Joo, Ijin; Lee, Jeong Min; Ahn, Su Joa; Lee, Dong Ho] Seoul Natl Univ, Coll Med, Dept Radiol, Seoul, South Korea; [Lee, Jeong Min] Seoul Natl Univ Hosp, Inst Radiat Med, Seoul, South Korea; [Lee, Eun Sun] Chung Ang Univ Hosp, Dept Radiol, Seoul, South Korea; [Kim, Sun-Whe; Jang, Jin-Young] Seoul Natl Univ Hosp, Dept Surg, Seoul, South Korea; [Ryu, Ji Kon] Seoul Natl Univ, Coll Med, Dept Internal Med, Seoul, South Korea; [Ryu, Ji Kon] Seoul Natl Univ, Coll Med, Liver Res Inst, Seoul, South Korea; [Oh, Do-Youn] Seoul Natl Univ, Coll Med, Dept Internal Med, Seoul, South Korea; [Oh, Do-Youn] Seoul Natl Univ, Coll Med, Canc Res Inst, Seoul, South Korea; [Kim, Kyubo] Ewha Womans Univ, Sch Med, Dept Radiat Oncol, Seoul, South Korea; [Lee, Kyoung-Bun] Seoul Natl Univ Hosp, Dept Pathol, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 AMER ROENTGEN RAY SOC
- 발행년도 2018
- URI http://www.dcollection.net/handler/ewha/000000151854
- 본문언어 영어
- Published As http://dx.doi.org/10.2214/AJR.17.18310
초록/요약
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.
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