Abstract
Purpose
To evaluate interobserver agreement on the findings of baseline contrast-enhanced multidetector computed tomography (CE-MDCT) performed at the postoperative third month in patients who underwent surgery due to ductal adenocarcinoma of the pancreatic head and investigate the value of these findings in predicting locoregional recurrence.
Material and methods
The baseline CE-MDCT images of 198 patients who underwent the Whipple procedure due to pancreatic head tumors were evaluated independently by three radiologists at the postoperative third month. The radiologists were asked to note suspicious findings in terms of locoregional recurrence, including postoperative fat stranding, the presence of perivascular contrast-enhanced solid tissue, short diameter of solid tissue if present, the shape of solid tissue (convex/concave), presence of peritoneal implants, diameter (mm) of pancreatic duct dilatation if present, the presence of lymph nodes larger than 5 mm, portal vein stenosis (≥50 and <50%), the presence of ascites, and the presence of distant metastases, as specified by the Society of Abdominal Radiology in October 2022. The agreement between the radiologists and the value of these parameters in predicting locoregional recurrence were investigated.
Results
Among the CE-MDCT findings evaluated, the radiologists had a moderate-to-high level of agreement concerning the presence of perivascular contrast-enhanced solid tissue. However, there was a poor interobserver agreement on the shape of solid tissue. A very high level of agreement was found among the radiologists in the evaluation of pancreatic duct dilatation, peritoneal implants, ascites, and the presence of distant metastases. According to the univariate analysis, the rates of portal vein stenosis had a 1.419 -fold effect [odds ratio (OR)=1.419, [95% confidence interval (CI)= 0.548–3.679, p=0.041], lymph node presence had a 2.337 -fold effect [odds ratio (OR)=2.337, [95% confidence interval (CI)= 1.165–4.686, p=0.015], perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.241, [95% confidence interval (CI)= 1.072–4.684, p=0.005]. In the multivariate analysis, perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.519, [95% confidence interval (CI)= 1.132–5.605, p=0.024].
Conclusion
In the postoperative baseline CE-MDCT examination, the presence of solid tissue, lymph node presence, and portal vein stenosis in the surgical bed are among the findings that may indicate early locoregional recurrence in patients with pancreatic ductal adenocarcinoma.
Graphical abstract
Similar content being viewed by others
REFERENCES
Chu LC, Wang ZJ, Kambadakone A, Hecht EM, He J, Narang AK et al. (2022) Postoperative surveillance of pancreatic ductal adenocarcinoma (PDAC) recurrence: practice pattern on standardized imaging and reporting from the society of abdominal radiology disease focus panel on PDAC. Abdom Radiol (NY) 48: 318. Epub ahead of print PMID: 36241752.
Huicochea Castellanos S, Corrias G, Ulaner GA, Dunphy M, Junting Z, Capanu M, et al (2019) Detection of recurrent pancreatic cancer: value of second-opinion interpretations of cross-sectional images by subspecialized radiologists. Abdominal radiology 44 (2):586-592
Daamen LA, Groot VP, Goense L, Wessels FJ, Borel Rinkes IH, Intven MPWet al. The diagnostic performance of CT versus FDG PET-CT for the detection of recurrent pancreatic cancer: a systematic review and metaanalysis. European journal of radiology.2018;106:128-136.
Kulkarni NM, Mannelli L, Zins M, Bhosale PR, Arif-Tiwari H, Brook OR et al . White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals. Abdom Radiol (NY). 2020;45(3):729-742.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019; 69: 7-34.
Conroy T, Castan F, Lopez A, Turpin A, Ben Abdelghani M, Wei AC, et al; Canadian Cancer Trials Group and the Unicancer-GI–PRODIGE Group. Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial. JAMA Oncol. 2022;8(11):1571-1578.
Riedl JM, Posch F, Horvath L, Gantschnigg A, Renneberg F, Schwarzenbacher E, et al. Gemcitabine/nab-Paclitaxel versus FOLFIRINOX for palliative first-line treatment of advanced pancreatic cancer: A propensity score analysis. Eur J Cancer. 2021 ;151:3-13.
Jones RP, Psarelli EE, Jackson R, Ghaneh P, Halloran CM, Palmer DH. Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial. JAMA Surg.2019;154:1038-1048.
Redmond KJ, Wolfgang CL, Sugar EA, et al. Adjuvant chemoradiation therapy for adenocarcinoma of the distal pancreas. Ann Surg Oncol 2010;17:3112-3119.
Groot VP, Blair AB, Gemenetzis G, Ding D, Burkhart RA, Yu J, et al. Recurrence after neoadjuvant therapy and resection of borderline resectable and locally advanced pancreatic cancer. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.2019;45:1674-1683.
Honselmann KC, Pergolini I, Castillo CF, Deshpande V, Ting D, Taylor MS. Tim- ing But Not Patterns of Recurrence Is Diferent Between Node negative and Node-positive Resected Pancreatic Cancer. Annals of surgery.2020;272:357-365.
Ratnayake B, Savastyuk AY, Nayar M, Wilson CH, Windsor JA, Roberts K et al. Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis. J Clin Med. 2020 ;97:2132.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
Blair AB, Yin LD, Pu N, Yu J, Groot VP, Rozich NS et al. Recurrence in Patients Achieving Pathological Complete Response After Neoadjuvant Treatment for Advanced Pancreatic Cancer. Ann Surg. 2021;274:162-169.
Wang ZJ, Arif-Tiwari H, Zaheer A, Ameli S, Bhosale PR, Do RK et al. Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and func- tional imaging techniques. Abdominal radiology 2020;45:4273-4289.
Kovač JD, Mayer P, Hackert T, Klauss M. The Time to and Type of Pancreatic Cancer Recurrence after Surgical Resection: Is Prediction Possible? Acad Radiol. 2019;26:775-781.
Groot VP, Rezaee N, Wu W, Cameron JL, Fishman EK, Hruban RH et al. Patterns, Timing, and Predictors of Recurrence Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma. Annals of surgery 2018;267:936-945.
Kolbeinsson H, Hoppe A, Bayat A, Kogelschatz B, Mbanugo C, Chung M. Recurrence patterns and postrecurrence survival after curative intent resection for pancreatic ductal adenocarcinoma. Surgery.2021;169:649-654.
Tempero MA, Malafa MP, Al-Hawary M, Behrman SW, Benson AB, Cardin DB et al.Pancreatic Adenocarcinoma, Version 2.NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw.2021;19:439–457.
Javed AA, Bleich K, Bagante F, He J, Weiss MJ, Wolfgang CL. Pancreaticoduodenectomy with venous resection and reconstruction: current surgical techniques and associated postoperative imaging fndings. Abdominal radiology.2018;43:1193-1203.
Kawai M, Hirono S, Okada KI, Miyazawa M, Kitahata Y, Kob- ayashi R. Radiographic Splenic Artery Involvement Is a Poor Prognostic Factor in Upfront Surgery for Patients with Resectable Pancreatic Body and Tail Cancer. Annals of surgical oncology.2021;28:1521-1532.
Luchini C, Pea A, Yu J, He J, Salvia R, Riva G, Weiss MJ, Bassi C, Cameron JL, Hruban RH, Goggins M, Wolfgang CL, Scarpa A, Wood LD, Lawlor RT. Pancreatic cancer arising in the remnant pancreas is not always a relapse of the preceding primary. Mod Pathol. 2019;32(5):659-665.
Katz MH, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolf R et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not refected by radiographic indicators. Cancer 2012;118(23):5749- 5756.
Zins M, Matos C, Cassinotto C. Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy. Radiology 2018;287(2):374-390.
Quiney B, Harris A, McLaughlin P, Nicolaou S. Dual-energy CT increases reader confdence in the detection and diagnosis of hypoattenuating pancreatic lesions. Abdom Imaging 2015;40(4):859-864.
Mileto A, Mazziotti S, Gaeta M, Bottari A, Zimbaro F, Giardina C. Pancreatic dual-source dual-energy CT: is it time to discard unenhanced imaging? Clin Radiol 2012;67(4):334-339.
Han MY, Borazanci EH. Malignant ascites in pancreatic cancer: Pathophysiology, diagnosis, molecular characterization, and therapeutic strategies. Front Oncol. 2023;13:1138759.
Wang, Justin Dejia, and Andrew Eugene Hendifar. "Pancreatic cancer associated ascites: Risk factors, outcomes, and management." (2023): e16305-e16305.
You MS, Lee SH, Choi YH, Shin BS, Paik WH, Ryu JK et al. Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment. BMC Cancer 2019; 19: 952.
Hur C, Tramontano AC, Dowling EC, Brooks GA, Jeon A, Brugge WR, et al. Early pancreatic ductal adenocarcinoma survival is dependent on size: positive implications for future targeted screening. Pancreas 2016; 45:1062–1066.
Lovecek M, Skalicky P, Chudacek J, Szkorupa M, Svebisova H, Lemstrova R et al. Different clinical presentations of metachronous pulmonary metastases after resection of pancreatic ductal adenocarcinoma: Retrospective study and review of the literature. World J Gastroenterol. 2017;23:6420-6428.
Lyu SC, Wang HX, Liu ZP, Wang J, Huang JC, He Q et al. Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages. World J Gastrointest Surg. 2022;14:1204-1218.
Neuzillet C, Gaujoux S, Williet N, Bachet JB, Bauguion L, Colson Durand L, et al. Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). Dig Liver Dis 2018;50(12):1257e71.
Kim HS, Kim YJ, Kim KG, Park JS. Preoperative CT texture features predict prognosis after curative resection in pancreatic cancer. Sci Rep 2019; 9: 17389.
Groot VP, van Santvoort HC, Rombouts SJ, Hagendoorn J, Borel Rinkes IH, van Vulpen M, Herman JM, Wolfgang CL, Besselink MG, Molenaar IQ. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. HPB (Oxford). 2017 ;19(2):83-92.
Hong SB, Lee SS, Kim JH, Kim HJ, Byun JH, Hong SM et al. Pancreatic Cancer CT: Prediction of Resectability according to NCCN Criteria. Radiology 2018; 289: 710-718.
Rieser CJ, Zenati M, Hamad A, Al Abbas AI, Bahary N, Zureikat AH, et al. CA19-9 on postoperative surveillance in pancreatic ductal adenocarcinoma: predicting recurrence and changing prognosis over time. Ann Surg Oncol 2018;25:3483e91.
Funding
None to declare.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Akkaya, H., Özdemir, S., Dilek, O. et al. Evaluation of the performance of and interobserver agreement on postoperative baseline CT findings in the identification of locoregional recurrence in patients with pancreatic ductal adenocarcinoma. Abdom Radiol 48, 3135–3146 (2023). https://doi.org/10.1007/s00261-023-04012-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-023-04012-x