title: Value of apparent diffusion coefficient prior to neoadjuvant therapy is a predictor of histologic response in patients with borderline resectable pancreatic carcinoma.
abstract: BACKGROUND
  The parameters to predict histological response to neoadjuvant therapy remain controversial in borderline resectable pancreatic carcinoma (BRPC).
  
  
  METHODS
  Twenty-four patients who underwent diffusion-weighted magnetic resonance imaging (DW-MRI) prior to expected neoadjuvant chemo/chemoradiotherapy and surgery were reviewed retrospectively. Analyses for correlation between percent tumor cell destruction and the following was performed to investigate the parameter and cut off value: tumor size, whole tumor apparent diffusion coefficient (ADC) value of DW-MRI, maximum standardized uptake value of18F-fluorodeoxyglucose positron emission tomography, carbohydrate antigen 19-9, and their change ratios. The selected parameter was assessed for prediction ability of the histological response to neoadjuvant chemo/chemoradiotherapy and R0 curability.
  
  
  RESULTS
  Pre-treatment ADC value was correlated with tumor cell destruction rate among all parameters (R = 0.625, P = 0.001). The ADC cut-off value for discriminating between nonresponders (grade I) and responders (grade IIa and more) after treatment was determined as 1.20 × 10-3mm2/s and the sensitivity, 100%; specificity, 75%; accuracy, 83% for responder, and the sensitivity, 100%; specificity, 63%; accuracy, 71% for R0 curability.
  
  
  CONCLUSIONS
  Pre-treatment ADC value appeared to be a predictor of R0 curability in BRPC patients because of effective histological response to neoadjuvant therapy, and there was a significant correlation between the baseline ADC value and histological tumor cell destruction rate.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Okada
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Miyazawa
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kitahata
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayami
authors.affiliation: Department of Human Pathology, Wakayama Medical University, Wakayama, Japan.
authors.forename: Fumiyoshi
authors.initials: F
authors.lastname: Kojima
authors.affiliation: Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Apparent diffusion coefficient; Borderline resectable; R0 curability