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Cancers 2019, 11(2), 267;

Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study

Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Department of Radiology, Istituto Oncologico Giovanni Paolo II, 70124 Bari, Italy
Department of Pathology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Department of Radiology, G. Martino Hospital, University of Messina, 98125 Messina, Italy
Department of Radiology, Ospedale Generale Regionale “F. Miulli”, 70021 Acquaviva della Fonti, Italy
Department of Radiology, Ospedale P. Pederzoli, 37019 Peschiera del Garda, Italy
Department of Radiology, Ospedale Civile Maggiore Borgo Trento, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
Department of Radiology, Ospedale “Sacro Cuore, Don Calabria”, 37024 Negrar, Italy
Department of Surgery, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Author to whom correspondence should be addressed.
Received: 20 January 2019 / Revised: 12 February 2019 / Accepted: 19 February 2019 / Published: 25 February 2019
(This article belongs to the Special Issue Advances in Pancreatic Cancer Research)
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Introduction: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to computed tomography (CT) overestimation of tumor extension and residual vascular involvement, limiting access to surgery to some patients with potentially resectable tumors. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging in the evaluation of PDAC after chemoradiotherapy in order to achieve complete resection. Methods: We retrospectively enrolled 71 patients with locally advanced and borderline resectable PDAC who underwent neoadjuvant chemoradiotherapy. Pre-operative CT or magnetic resonance (MR) have been evaluated by three radiologists to assess major qualitative and quantitative parameters of lesions. Accuracy, sensitivity, and specificity compared to anatomopathological results were evaluated for each parameter. Cohen’s K-coefficient has been calculated to evaluate the inter-observer agreement (IOA). Both single and consensus lecture have been tested. Different dimensional cut-offs were tested to categorize tumors according to their major axis and to compare with anatomopathological diameter, tumor persistence, and margin infiltration. Results: A 25 mm cut-off was 67% sensitive, 90% specific, and 77% accurate in assessing real tumor dimension. 25 mm cut-off reported a 64% sensitivity, 78% specificity, and 69% accuracy in assessing R0 resection. Each 5 mm increment of major axis dimension there is an odds ratio (OR) 1.79 (95% CI 1.13–2.80, p = 0.012) for R+ resection. Imaging presence of the perivascular cuff is not associated with tumor persistence and resection margin infiltration (p = 0.362). Lesion enhancement and pattern homogeneity were not accurate in determining tumor persistence. IOA was generally poor to fair, except for >25 mm cut-off classification where IOA was moderate. Diagnostic accuracy is superior in consensus lecture rather than single lecture. Conclusion: Imaging methods tend to underestimate PDAC resectability after neoadjuvant-CRT. IOA is poor to fair in evaluating most of the qualitative parameters of downstaged pancreatic adenocarcinoma. Surgery should be considered for downstaged borderline resectable PDACs, independently from perivascular cuff presence, especially for tumors smaller than 25 mm. View Full-Text
Keywords: pancreas; pancreatic cancer; adenocarcinoma; downstaging; CT; chemotherapy pancreas; pancreatic cancer; adenocarcinoma; downstaging; CT; chemotherapy

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Beleù, A.; Calabrese, A.; Rizzo, G.; Capelli, P.; Bellini, N.; Caloggero, S.; Calbi, R.; Tinazzi Martini, P.; De Robertis, R.; Carbognin, G.; Marchegiani, G.; Scarpa, A.; Salvia, R.; Bassi, C.; D’Onofrio, M. Preoperative Imaging Evaluation after Downstaging of Pancreatic Ductal Adenocarcinoma: A Multi-Center Study. Cancers 2019, 11, 267.

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