The only potential cure for pancreatic ductal adenocarcinoma (PDA) is curative surgery, which relies in achieving complete resection (R0) (1-3).For patients with high risk of positive margins (R1) neoadjuvant therapy with chemotherapy or radiation therapy is currently recommended (1, 4, 5). Patient’s indication to surgery, focused on the likelihood of R0, is largely performed on dedicated high-quality CT (1, 4).
Despite the advances in imaging, current methods to evaluate vascular involvement are not reliable in the assessment of resectability, in terms of likelihood of complete...
Methods and materials
The study workflow is summarized inFig. 1 .
In this retrospective study 156 consecutive patients with a mean age of 65.3 years ± 9.2 standard deviation (age range, 37- 83 years), were included between 2012 and 2018. Patients were eligible for our study if (i) they underwent surgery for PDA at our institution, (ii) had pathological confirmed diagnosis of PDA located in the head, body, or uncinate process, and (iii) had available preoperative CT imaging at our institution (Fig. 2).
Standard of Care:...
The clinical characteristics of all patients are summarized in Table 1 and Table 2.
The radiologists’ accuracy in the assessment of SMA involvement showed an AUC of 0.54 among the 156 patients. The results were similar for the training set (AUC=0.55) and the testing set (AUC=0.53).
The perivascular features showed higher diagnostic accuracy of the average internal cross-validated AUC (0.69, 95% CI: 0.59, 0.79) compared to radiologists (0.55), while clinical features and tumor radiomic features showed comparable diagnostic accuracy (0.56, 95% CI:0.44, 0.68; and 0.54...
Our study demonstrated that a predictive model based on perivascular tissue's radiomic features outperforms radiologists performance, as well as clinical and tumor radiomic features in the presurgical assessment of SMA.
The analysis confirmed that this is a challenging task for the radiologists, using a visual grading approach and that the application of our model resulted in overall better performance, with a signifincant increase in sensitivity (86.7% vs.13.3% of the radiologists on the same patients).
Several limitations may affect these results, including the retrospective nature of...
Personal information and conflict of interest
F. Rigiroli; Durham/US - nothing to disclose J. Hoye; Durham/US - nothing to disclose C. Li; Durham/US - nothing to disclose M. Meyer; Mannheim/DE - Research/Grant Support at Siemens Healthineers J. C. Ramirez Girlando; Durham/US - Employee at Siemens Healthineers P. Lyu; Durham/US - Research/Grant Support at GE Healthcare S. Luo; Durham/US - nothing to disclose E. Samei; Durham, NC, NC/US - nothing to disclose D. Marin; Durham/US - Research/Grant Support at Siemens Healthineers
1.Tempero MA, Malafa MP, Chiorean EG, Czito B, Scaife C, Narang AK, et al. NCCN Guidelines Insights: Pancreatic Adenocarcinoma, Version 1.2019. J Natl Compr Canc Netw. 2019;17(3):202-10.
2.Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg. 2011;254(2):311-9.
3.Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg....