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High-resolution pancreatic computed tomography for assessing pancreatic ductal adenocarcinoma resectability: a multicenter prospective study

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objective

This prospective multicenter study aimed to evaluate the diagnostic performance of 80-kVp thin-section pancreatic CT in determining pancreatic ductal adenocarcinoma (PDAC) resectability according to the recent National Comprehensive Cancer Network (NCCN) guidelines.

Methods

We prospectively enrolled surgical resection candidates for PDAC from six tertiary referral hospitals (study identifier: NCT03895177). All participants underwent pancreatic CT using 80 kVp tube voltage with 1-mm reconstruction interval. The local resectability was prospectively evaluated using NCCN guidelines at each center and classified into three categories: resectable, borderline resectable, and unresectable.

Results

A total of 138 patients were enrolled; among them, 60 patients underwent neoadjuvant therapy. R0 resection was achieved in 103 patients (74.6%). The R0 resection rates were 88.7% (47/53), 52.4% (11/21), and 0.0% (0/4) for resectable, borderline resectable, and unresectable disease, respectively, in 78 patients who underwent upfront surgery. Meanwhile, the rates were 90.9% (20/22), 76.7% (23/30), and 25.0% (2/8) for resectable, borderline resectable, and unresectable PDAC, respectively, in patients who received neoadjuvant therapy. The area under curve of high-resolution CT in predicting R0 resection was 0.784, with sensitivity, specificity, and accuracy of 87.4% (90/103), 48.6% (17/35), and 77.5% (107/138), respectively. Tumor response was significantly associated with the R0 resection after neoadjuvant therapy (odds ratio [OR] = 38.99, p = 0.016).

Conclusion

An 80-kVp thin-section pancreatic CT has excellent diagnostic performance in assessing PDAC resectability, enabling R0 resection rates of 88.7% and 90.9% for patients with resectable PDAC who underwent upfront surgery and patients with resectable PDAC after neoadjuvant therapy, respectively.

Key Points

• The margin-negative (R0) resection rates were 88.7% (47/53), 52.4% (11/21), and 0.0% (0/4) for resectable, borderline resectable, and unresectable pancreatic ductal adenocarcinoma (PDAC), respectively, on 80-kVp thin-section pancreatic CT in the 78 patients who underwent upfront surgery.

• Among the 60 patients who underwent neoadjuvant therapy, the R0 rates were 90.9% (20/22), 76.7% (23/30), and 25.0% (2/8) for resectable, borderline resectable, and unresectable PDAC, respectively.

• Tumor response, along with the resectability status on pancreatic CT, was significantly associated with the R0 resection rate after neoadjuvant therapy.

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Abbreviations

AUC:

Area under the receiver operating curve

CNR:

Contrast-to-noise ratio

CRT:

Chemoradiation therapy

IQR:

Interquartile range

NCCN:

National Comprehensive Cancer Network

PDAC:

Pancreatic ductal adenocarcinoma

R0:

Margin-negative

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Funding

This study has received funding from Central medical service.

Author information

Author notes

  1. Dong Ho Lee and Hong Il Ha equally contributed as co-first authors.

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, Korea

    Dong Ho Lee & Jeong Min Lee

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Korea

    Dong Ho Lee & Jeong Min Lee

  3. Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea

    Hong Il Ha

  4. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    **-Young Jang

  5. Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea

    Jung Woo Lee

  6. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    **-Young Choi

  7. Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Seungmin Bang

  8. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

    Chang Hee Lee

  9. Division of Hepato-Biliary-Pancreatic Surgery, Korea University Guro Hospital, Seoul, Korea

    Wan Bae Kim

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

    Seung Soo Lee

  11. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Song Cheol Kim

  12. Department of Radiology, Hanyang University College of Medicine, Seoul, Korea

    Bo-Kyeong Kang

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  1. Dong Ho Lee
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Corresponding author

Correspondence to Jeong Min Lee.

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Guarantor

The scientific guarantor of this publication is Jeong Min Lee.

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

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical Approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• multicenter study

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Lee, D.H., Ha, H.I., Jang, JY. et al. High-resolution pancreatic computed tomography for assessing pancreatic ductal adenocarcinoma resectability: a multicenter prospective study. Eur Radiol 33, 5965–5975 (2023). https://doi.org/10.1007/s00330-023-09584-2

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  • DOI: https://doi.org/10.1007/s00330-023-09584-2

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