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Preoperative CT staging of borderline pancreatic cancer patients after neoadjuvant treatment: accuracy in the prediction of vascular invasion and resectability

  • Pancreas
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Abstract

Objectives

To assess the utility of MDCT tumor–vascular interface criteria for predicting vascular invasion and resectability in borderline pancreatic cancer (BRPC) patients after neoadjuvant therapy (NAT).

Methods

This prospective study included 90 patients with BRPC who finished NAT, showed no progression in preoperative CTs and underwent surgery. Two radiologists independently assessed preoperative vessel-tumor interface criteria. The area under the ROC curve (AUC) was used to evaluate the diagnostic performance for predicting vascular invasions and resectability using surgical and pathological results as the gold standard. Inter-reader agreement was assessed using the κ coefficient.

Results

Pathologic vascular invasion was confirmed in 47 (54.7%) veins and 14 (16.3%) arteries. R0 resection was achieved in (82.6%71/86) pancreatic resection. Using criteria of circumferential interface ≥ 180 degrees with contour deformity ≥ grade 3 and/or length of tumor contact > 2 cm to predict vascular invasion, the AUCs for the two readers were 0.85–0.88 for arterial invasion and 0.92–0.87 for venous invasion. Using criteria of circumferential interface ≤ 180° with contour deformity ≤ grade 2 and/or length of tumor contact < 2 cm to predict R0 resection, the AUCs was 0.85–0.86 for the two readers. The overall inter-reader agreement was good (κ = 0.75–0.80). The κ values for venous invasion, arterial invasion and R0 resection were 0.76, 0.78, and 0.80.

Conclusion

Tumor–vessel criteria demonstrated good diagnostic performance and reproducibility in the prediction of vascular invasion after NAT in BRPC. These criteria could be helpful in the prediction of R0 resection in cases with only venous involvement.

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Abbreviations

MDCT:

Multidetector computed tomography

BRPC:

Borderline pancreatic cancer

NAT:

Neoadjuvant therapy

NCCN:

National comprehensive cancer network

MPV:

Main portal vein

SMV:

Superior mesenteric vein

SMA:

Superior mesenteric artery

CA:

Celiac artery

CHA:

Common hepatic artery

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Author information

Authors and Affiliations

  1. Radiodiagnosis, South Egypt Cancer Institute, Assiut University, Asyut, Egypt

    Shimaa Abdalla Ahmed & Amr F. Mourad

  2. General Surgery, Faculty of Medicine, Alrajhy Liver Hospital, Assiut University, Asyut, Egypt

    Ramy A. Hassan & Ahmed Soliman

  3. Urology, Egyptian Armed Forces, Cairo, Egypt

    Mohamed Abd Elsalam Ibrahim

  4. Surgical Oncology, South Egypt Cancer Institute, Assiut University, Asyut, Egypt

    Ebrahim Aboeleuon & Murad A. Jabir

  5. Radiotherapy and Nuclear Medicine Department, South Egypt Cancer Institute, Assiut University, Asyut, Egypt

    Osama Mostafa Abd Elbadee

  6. Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267-0595, USA

    Helal F. Hetta

  7. Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Asyut, Egypt

    Helal F. Hetta

  8. Kyoto University, Kyoto, Japan

    Murad A. Jabir

  9. Case Western Reserve University, Cleveland, USA

    Murad A. Jabir

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  1. Shimaa Abdalla Ahmed
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Ahmed, S.A., Mourad, A.F., Hassan, R.A. et al. Preoperative CT staging of borderline pancreatic cancer patients after neoadjuvant treatment: accuracy in the prediction of vascular invasion and resectability. Abdom Radiol 46, 280–289 (2021). https://doi.org/10.1007/s00261-020-02605-4

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