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Accuracy and Prognostic Impact of Nodal Status on Preoperative Imaging for Management of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study

  • Pancreatic Tumors
  • Published:
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Abstract

Background

We sought to define the accuracy of preoperative imaging to detect lymph node metastasis (LNM) among patients with pancreatic neuroendocrine tumors (pNETs), as well as characterize the impact of preoperative imaging nodal status on survival.

Methods

Patients who underwent curative-intent resection for pNETs between 2000 and 2020 were identified from eight centers. Sensitivity and specificity of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, and OctreoScan for LNM were evaluated. The impact of preoperative lymph node status on lymphadenectomy (LND), as well as overall and recurrence-free survival was defined.

Results

Among 852 patients, 235 (27.6%) individuals had LNM on final histologic examination (hN1). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 12.4%, 98.1%, 71.8%, and 74.4% for CT, 6.3%, 100%, 100%, and 80.1% for MRI, 9.5%, 100%, 100%, and 58.7% for PET, 11.3%, 97.5%, 66.7%, and 70.8% for OctreoScan, respectively. Among patients with any combination of these imaging modalities, overall sensitivity, specificity, PPV, and NPV was 14.9%, 97.9%, 72.9%, and 75.1%, respectively. Preoperative N1 on imaging (iN1) was associated with a higher number of LND (iN1 13 vs. iN0 9, p = 0.003) and a higher frequency of final hN1 versus preoperative iN0 (iN1 72.9% vs. iN0 24.9%, p < 0.001). Preoperative iN1 was associated with a higher risk of recurrence versus preoperative iN0 (median recurrence-free survival, iN1→hN1 47.5 vs. iN0→hN1 92.7 months, p = 0.05).

Conclusions

Only 4% of patients with LNM on final pathologic examine had preoperative imaging that was suspicious for LNM. Traditional imaging modalities had low sensitivity to determine nodal status among patients with pNETs.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Nan Zhang MD, Yi Lv MD, PhD & Xu-Feng Zhang MD, PhD

  2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Jin He MD

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Shishir K. Maithel MD

  4. Department of Surgery, Stanford University, Palo Alto, CA, USA

    George Poultsides MD

  5. Department of Surgery, Oregon Health and Science University, Portland, OR, USA

    Flavio Rocha MD

  6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon Weber MD

  7. Department of Surgery, Washington University School of Medicine, St. Louis, WI, USA

    Ryan Fields MD

  8. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, TN, USA

    Kamran Idrees MD

  9. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Cliff Cho MD

  10. Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Xu-Feng Zhang MD, PhD & Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon.)

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  1. Nan Zhang MD
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Correspondence to Xu-Feng Zhang MD, PhD or Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon.).

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Zhang, N., He, J., Maithel, S.K. et al. Accuracy and Prognostic Impact of Nodal Status on Preoperative Imaging for Management of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study. Ann Surg Oncol 31, 2882–2891 (2024). https://doi.org/10.1245/s10434-023-14758-9

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