Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy.
BACKGROUND
Preoperative chemoradiation can potentially improve outcomes in patients with pancreatic cancer. This study addresses its effect on staging pancreatic cancer with multidetector computed tomography (MDCT).


METHODS
Fifty-five patients underwent a dual-phase MDCT pancreas protocol for proved pancreatic cancer. Of these, 16 patients underwent preoperative chemoradiation. Three radiologists independently reviewed images to assess for locally advanced disease, liver and peritoneal metastases on baseline studies of all 55 patients, and on follow-up preoperative studies for the 16 patients receiving preoperative therapy. Overall score for resectability was graded on a scale from 1 to 5 (1, definitely resectable; 5. definitely unresectable). Receiver operating characteristic curves and weighted (kappa statistics were determined.


RESULTS
The areas under the receiver operating characteristic curves for readers 1, 2, and 3 were 0.98, 0.96, and 0.90, respectively. Weighted kappa values for reader 1 versus reader 2, reader 1 versus reader 3, and reader 2 versus reader 3 were 0.90, 0.57, and 0.54, respectively. Interpreting scores of 1 to 3 for resectability as resectable disease, the mean values for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 0.92, 0.91, 0.74, 0.98, and 0.92 respectively.


CONCLUSIONS
The negative predictive value for MDCT for identifying unresectable pancreatic cancer in the setting of preoperative therapy is comparable to that reported in the absence of neoadjuvant therapy.
Tamm
E P
EP
Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77070, USA. etamm@mdanderson.org
Loyer
E M
EM
Faria
S
S
Raut
C P
CP
Evans
D B
DB
Wolff
R A
RA
Crane
C H
CH
Dubrow
R A
RA
Charnsangavej
C
C
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol