title: Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Computed tomography (CT) is the most widely used method to assess resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is the presence of extra-regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer.
  
  
  METHODS
  We systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra-regional lymph nodes in patients undergoing pancreatoduodenectomy were included. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data.
  
  
  RESULTS
  After screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80-100% and 67-90% respectively. However, PPV and sensitivity ranged from 0 to 100% and 0-38%. Pooled sensitivity, specificity, PPV and NPV were 25%, 86%, 28% and 84% respectively.
  
  
  CONCLUSIONS
  CT has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Therefore, suspicion of extra-regional lymph node metastases on CT alone should not be considered a contra-indication for exploration.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. Electronic address: D.S.J.Tseng@umcutrecht.nl.
authors.forename: Dorine S J
authors.initials: DS
authors.lastname: Tseng
authors.affiliation: Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Samira
authors.initials: S
authors.lastname: Fegrachi
authors.affiliation: Department of Surgery, Academic Medical Center Amsterdam, HG G4-196, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HG STR6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Nicolaas P A
authors.initials: NP
authors.lastname: Zuithoff
authors.affiliation: Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Inne H
authors.initials: IH
authors.lastname: Borel Rinkes
authors.affiliation: Department of Radiology, University Medical Center Utrecht, HG E01.132, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Maarten S
authors.initials: MS
authors.lastname: van Leeuwen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, HG G04.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. Electronic address: I.Q.Molenaar@umcutrecht.nl.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
mesh_terms: D014670:Ampulla of Vater; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed
keywords: Computed tomography; Diagnostic accuracy; Lymph node metastases; Lymphadenopathy; Pancreatic cancer