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CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We aimed to systematically evaluate the diagnostic accuracy of CT-determined resectability following neoadjuvant treatment for predicting margin-negative resection (R0 resection) in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

Original studies with sufficient details to obtain the sensitivity and specificity of CT-determined resectability following neoadjuvant treatment, with a reference on the pathological margin status, were identified in PubMed, EMBASE, and Cochrane databases until February 24, 2020. The identified studies were divided into two groups based on the criteria of R0 resectable tumor (ordinary criterion: resectable PDAC alone; extended criterion: resectable and borderline resectable PDAC). The meta-analytic summary of the sensitivity and specificity for each criterion was estimated separately using a bivariate random-effect model. Summary results of the two criteria were compared using a joint-model bivariate meta-regression.

Results

Of 739 studies initially searched, 6 studies (6 with ordinary criterion and 5 with extended criterion) were included for analysis. The meta-analytic summary of sensitivity and specificity was 45% (95% confidence interval [CI], 19–73%; I2 = 88.3%) and 85% (95% CI, 65–94%; I2 = 60.5%) for the ordinary criterion, and 81% (95% CI, 71–87%; I2 = 0.0%) and 42% (95% CI, 28–57%; I2 = 6.2%) for the extended criterion, respectively. The diagnostic accuracy significantly differed between the two criteria (p = 0.02).

Conclusions

For determining resectability on CT, the ordinary criterion might be highly specific but insensitive for predicting R0 resection, whereas the extended criterion increased sensitivity but would decrease specificity. Further investigations using quantitative parameters may improve the identification of R0 resection.

Key Points

• CT-determined resectability of PDAC after neoadjuvant treatment using the ordinary criterion shows low sensitivity and high specificity in predicting R0 resection.

• With the extended criterion, CT-determined resectability shows higher sensitivity but lower specificity than with the ordinary criterion.

• CT-determined resectability with both criteria achieved suboptimal diagnostic performances, suggesting that care should be taken while selecting surgical candidates and when determining the surgical extent after neoadjuvant treatment in patients with PDAC.

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Abbreviations

AHPBA:

American Hepato-Pancreato-Biliary Association

CA:

Celiac axis

CCRT:

Concurrent chemoradiotherapy

CHA:

Common hepatic artery

HSROC:

Hierarchical summary receiver operating characteristics

NCCN:

National Comprehensive Cancer Network

PDAC:

Pancreatic ductal adenocarcinoma

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PV:

Portal vein

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies

SMA:

Superior mesenteric artery

SMV:

Superior mesenteric vein

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Sohee Park, Jong Keon Jang, Jae Ho Byun, Jin Hee Kim, Seung Soo Lee, Hyoung Jung Kim & Seong Ho Park

  2. Department of Radiology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, 49241, South Korea

    Seung Baek Hong

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  1. Sohee Park
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Correspondence to Jong Keon Jang.

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The scientific guarantor of this publication is Jong Keon Jang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Seung Baek Hong, who is one of the authors of our study, provided statistical advice for this manuscript.

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Written informed consent was not required because this study was a meta-analysis.

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Institutional Review Board approval was not required because this study was a meta-analysis.

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Park, S., Jang, J.K., Byun, J.H. et al. CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis. Eur Radiol 31, 3383–3393 (2021). https://doi.org/10.1007/s00330-020-07433-0

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