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Systematic review and meta-analysis of diagnostic performance of CT imaging for assessing resectability of pancreatic ductal adenocarcinoma after neoadjuvant therapy: importance of CT criteria

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Abstract

Purpose

To assess the CT diagnostic performance for evaluating resectability of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy and identify the factor(s) that affect(s) diagnostic performance.

Methods

Databases were searched to identify studies published from January 1, 2000, to November 5, 2019 that evaluated the CT diagnostic performance for assessing resectability of post-neoadjuvant PDAC. Two reviewers independently extracted data and assessed the study quality. A meta-analysis was performed to obtain summary sensitivity and specificity values using a bivariate random-effects model, and heterogeneity across studies was assessed. Univariable meta-regression analysis was performed with eight variables, including the different CT criteria for resectability, conventional National Comprehensive Cancer Network (NCCN) criteria for upfront surgery, and modified criteria for post-neoadjuvant surgery.

Results

Ten studies were included and analyzed. The summary sensitivity and specificity for resectability were 78% (95% CI 68–86%) and 60% (95% CI 44–74%), respectively. No significant heterogeneity was identified (bivariate correlation coefficient ρ = − 1, p-value for hierarchical summary receiver operating characteristics model β = 0.667). The two different CT criteria showed different diagnostic performance (p < 0.01), with higher sensitivity (81% [95% CI 73–90%] vs. 28% [95% CI 15–42%], p < 0.01) and lower specificity (57% [95% CI 41–73%] vs. 90% [95% CI 80–100%], p < 0.01) for the modified criteria. No other variables affected the diagnostic performance.

Conclusion

CT criteria were the factors that affected the diagnostic performance. Modification of the conventional criteria improved sensitivity but lowered specificity. Further modifications are required to improve specificity and uniformity.

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Abbreviations

AJCC:

American Joint Committee on Cancer

AUC:

Area under the receiver operating characteristic curve

CA 19-9:

Carbohydrate antigen 19-9

CRT:

Combined chemotherapy and radiation therapy

CT:

Computed tomography

FOLFIRINOX:

5-Fluorouracil, leucovorin, irinotecan, and oxaliplatin

HSROC:

Hierarchical summary receiver operating characteristic

IUAC:

International Union against Cancer

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

PDAC:

Pancreatic ductal adenocarcinoma

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

SROC:

Summary receiver operating characteristic

UICC:

Union for International Cancer Control

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Acknowledgements

We thank Dr. Woojoo Lee (Seoul National University) for providing statistical advice for this manuscript.

Funding

This work did not receive any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Sciences, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hyun Kyung Yang, Mi-Suk Park & Jaeseung Shin

  2. Department of Clinical Evidence Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea

    Miyoung Choi

  3. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seung Soo Lee & Sang Hyun Choi

  4. Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Woo Kyoung Jeong

  5. Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea

    Shin Hye Hwang

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Yang, H.K., Park, MS., Choi, M. et al. Systematic review and meta-analysis of diagnostic performance of CT imaging for assessing resectability of pancreatic ductal adenocarcinoma after neoadjuvant therapy: importance of CT criteria. Abdom Radiol 46, 5201–5217 (2021). https://doi.org/10.1007/s00261-021-03198-2

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