Abstract
Purpose
The purpose of this study was to determine the frequency in which the pelvis component of an abdominopelvic CT provides information that would influence clinical management in two separate groups of patients: those with previously resected pancreatic ductal adenocarcinoma (PDA) and those with locally advanced unresectable PDA.
Methods
This institutional review-board approved HIPAA compliant retrospective study with waived informed consent included 247 subjects with histologically proven PDA, including 153 subjects post-pancreaticoduodenectomy and 94 subjects with locally advanced unresectable disease. Imaging reports interpreted between January 2005 and December 2013 were obtained from our institution’s Radiology Information System by searching a Cancer Registry database of PDA patients separately for the words “whipple” and “unresectable.” CT findings were separated by location in the abdomen or pelvis, and subsequently reviewed and graded for their likelihood of representing metastatic disease. The probability of pelvic CT influencing clinical management—i.e., of finding isolated pelvic metastatic disease—was determined using 95% binomial proportion confidence intervals for both the post-pancreaticoduodenectomy and locally advanced unresectable groups.
Results
No subjects who had undergone pancreaticoduodenectomy had an isolated pelvic metastasis on follow-up imaging (0%; 95% CI 0–2.38, p = 0.0004); 33 had metastatic disease in the abdomen, and 120 had no or equivocal evidence of abdominopelvic metastatic disease. One subject with locally advanced unresectable PDA had a possible isolated pelvic metastasis on follow-up imaging (1.1%; 95% CI 0.03–5.79, p = 0.048); 20 had metastatic disease in the abdomen, and 73 had no or equivocal evidence of abdominopelvic metastatic disease.
Conclusion
Isolated pelvic metastatic disease rarely occurs in patients with PDA who have had prior pancreaticoduodenectomy or have a locally advanced unresectable primary tumor, suggesting routine pelvic CT in follow-up imaging of these patients may not be necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Values were obtained using the physician fee schedule search provided by cms.gov and reflect fees based on both technical and diagnostic fees using the “Global Service” prices based on a national payment amount for Medicare-enrolled providers for procedure codes 74177 and 74160.
See footnote 1
References
Siegel RL, Miller KD, Jemal A (2015) Cancer statistics. CA Cancer J Clin 65:5–29
Ho CK, Kleeff J, Friess H, Buchler MW (2005) Complications of pancreatic surgery. HPB 7(2):99–108
Yachida S, Iacobuzio-Donahue CA (2009) The pathology and genetics of metastatic pancreatic cancer. Arch Pathol Lab Med 133(3):413–422
Disibio G, French SW (2008) Metastatic patterns of cancers: results from a large autopsy study. Arch Pathol Lab Med 132(6):931–939
Yeo CJ, Abrams RA, Grochow LB, et al. (1997) Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225(5):621–636
Spanknebel K, Conlon KC (2001) Advances in the surgical management of pancreatic cancer. Cancer J 7(4):312–323
NCCN guidelines for physicians: pancreatic cancer (Version 2.2015). National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf
Centers for Medicare & Medicaid Services: physician fee schedule search tool. https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=1&CT=0&H1=74177&H2=74160&M=1/
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was funded by the Grant Award Number UL1TR000433.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent
For this type of study, formal consent is not required.
Rights and permissions
About this article
Cite this article
Bailey, J.J., Ellis, J.H., Davenport, M.S. et al. Value of pelvis CT during follow-up of patients with pancreatic adenocarcinoma. Abdom Radiol 42, 211–215 (2017). https://doi.org/10.1007/s00261-016-0869-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-016-0869-6