title: Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT.
abstract: OBJECTIVE
  To obtain a summary positive predictive value (sPPV) of contrast-enhanced CT in determining resectability.
  
  
  METHODS
  The MEDLINE and EMBASE databases from JAN2005 to DEC2015 were searched and checked for inclusion criteria. Data on study design, patient characteristics, imaging techniques, image evaluation, reference standard, time interval between CT and reference standard, and data on resectability/unresectablity were extracted by two reviewers. We used a fixed-effects or random-effects approach to obtain sPPV for resectability. Several subgroups were defined: 1) bolus-triggering versus fixed-timing; 2) pancreatic and portal phases versus portal phase alone; 3) all criteria (liver metastases/lymphnode involvement/local advanced/vascular invasion) versus only vascular invasion as criteria for unresectability.
  
  
  RESULTS
  Twenty-nine articles were included (2171 patients). Most studies were performed in multicentre settings, initiated by the department of radiology and retrospectively performed. The I2-value was 68%, indicating heterogeneity of data. The sPPV was 81% (95%CI: 75-86%). False positives were mostly liver, peritoneal, or lymphnode metastases. Bolus-triggering had a slightly higher sPPV compared to fixed-timing, 87% (95%CI: 81-91%) versus 78% (95%CI: 66-86%) (p = 0.077). No differences were observed in other subgroups.
  
  
  CONCLUSIONS
  This meta-analysis showed a sPPV of 81% for predicting resectability by CT, meaning that 19% of patients falsely undergo surgical exploration.
  
  
  CONCLUSIONS
  • Predicting resectability of pancreatic cancer by CT is 81% (95%CI: 75-86%). • The percentage of patients falsely undergoing surgical exploration is 19%. • The false positives are liver metastases, peritoneal metastases, or lymph node metastases.
authors.affiliation: Department of Radiology, Academic Medical Centre, University of Amsterdam, G1-212, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Inne
authors.initials: I
authors.lastname: Somers
authors.affiliation: Department of Radiology, Academic Medical Centre, University of Amsterdam, G1-212, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.bipat@amc.uva.nl.
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
mesh_terms: D003287:Contrast Media; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019564:Unnecessary Procedures
chemical_list: D003287:Contrast Media
keywords: Computed Tomography; Pancreatic Neoplasms; Positive Predictive Value; Surgery; Systematic Review