title: Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma: A Meta-Analysis.
abstract: Imaging tests are central to the diagnosis and staging of pancreatic adenocarcinoma. We performed a systematic review and meta-analysis of the pertinent evidence on 5 imaging tests (computed tomography (CT), magnetic resonance imaging, CT angiography, endoscopic ultrasound with fine-needle aspiration, and combined positron emission tomography with CT). Searches of several databases up to March 1, 2014, yielded 9776 articles, and 24 provided comparative effectiveness of 2 or more imaging tests. Multiple reviewers applied study inclusion criteria, extracted data from each study, rated the risk of bias, and graded the strength of evidence. Data included accuracy of diagnosis and resectability in primary untreated pancreatic adenocarcinoma, including tumor stage, nodal stage, metastases, and vascular involvement. Where possible, study results were combined using bivariate meta-analysis. Studies were at low or moderate risk of bias. Most comparisons between imaging tests were insufficient to permit conclusions, due to imprecision or inconsistency among study results. However, moderate-grade evidence revealed that CT and magnetic resonance imaging had similar sensitivities and specificities for both diagnosis and vascular involvement. Other conclusions were based on low-grade evidence. In general, more direct evidence is needed to inform decisions about imaging tests for pancreatic adenocarcinoma.
authors.affiliation: From the *ECRI-Penn Evidence-Based Practice Center, Plymouth Meeting, PA; †Department of Radiology, and ‡Department of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Treadwell
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Zafar
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Mitchell
authors.forename: Kelley
authors.initials: K
authors.lastname: Tipton
authors.forename: Ursina
authors.initials: U
authors.lastname: Teitelbaum
authors.forename: Jane
authors.initials: J
authors.lastname: Jue
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D044963:Biopsy, Fine-Needle / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009367:Neoplasm Staging; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods