Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma

Minniti, Salvatore; Bruno, Costanza; Biasiutti, Carlo; Tonel, Davide; Falzone, Andrea; Falconi, Massimo; Procacci, Carlo

doi:10.1002/jcu.10156

Cited by 54 publications

(31 citation statements)

References 40 publications

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“…Initial imaging may include transabdominal ultrasound 22 but the gold standard for pancreatic imaging is MDCT. This technology provides three-dimensional multiplanar reconstruction techniques enabling accurate determination of tumour involvement of the common bile duct, pancreatic duct and peripancreatic vasculature.…”

Section: Standard Diagnostic Practicementioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Standard Diagnostic Practicementioning

confidence: 99%

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Ghaneh

Hanson

Titman

et al. 2018

Health Technol Assess

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“…In these cases, in fact, a ''simple'' US can solve the problem, because the lesion can be usually immediately detected owing to its hypoechoic appearance in contrast to the usual slightly hyperechoic pancreatic parenchyma with significant acoustic impedance difference and subsequent better conspicuity of the tumor [11]. Cystic changes are not a rare occurrence in histologic specimens, since they can be present in up to 8% of ductal adenocarcinomas.…”

Section: Uncommon Presentationsmentioning

confidence: 92%

Uncommon presentations of common pancreatic neoplasms: a pictorial essay

et al. 2015

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Pancreatic neoplasms are a wide group of solid and cystic lesions with different and often characteristic imaging features, clinical presentations, and management. Among solid tumors, ductal adenocarcinoma is the most common: it arises from exocrine pancreas, comprises about 90% of all pancreatic neoplasms, and generally has a bad prognosis; its therapeutic management must be multidisciplinary, involving surgeons, oncologists, gastroenterologists, radiologists, and radiotherapists. The second most common solid pancreatic neoplasms are neuroendocrine tumors: they can be divided into functioning or non-functioning and present different degrees of malignancy. Cystic pancreatic neoplasms comprise serous neoplasms, which are almost always benign, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, which can vary from benign to frankly malignant lesions, and solid pseudopapillary tumors. Other pancreatic neoplasms, such as lymphoma, metastases, or pancreatoblastoma, are rarely seen in clinical practice and have different and sometimes controversial managements. Rare clinical presentations and imaging appearance of the most common pancreatic neoplasms, both solid and cystic, are more frequently seen and clinically relevant than rare pancreatic tumors; their pathologic and radiologic appearances must be known to improve their management. The purpose of this paper is to present some rare or uncommon clinical and radiological presentations of common pancreatic neoplasms providing examples of multi-modality imaging approach with pathologic correlations, thus describing the histopathological bases that can explain the peculiar imaging features, in order to avoid relevant misdiagnosis and to improve lesion management.

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“…The accuracy of US in detecting pancreatic adenocarcinoma can be higher than 90 %, especially in the setting of small pancreatic masses; in a study comparing US and Computer Tomography (CT) in 64 patients with adenocarcinoma, US correctly identifi ed 61 (95.3 %) of 64 tumors, whereas CT correctly identifi ed 57 (89.1 %) of the 64 tumors [ 7 ].…”

Section: Ultrasoundmentioning

confidence: 97%

Imaging Stigmata Review and Interpretation

Gallotti

Alessandrino

Calliada

2014

Imaging and Pathology of Pancreatic Neoplasms

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Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma

Abstract: Sonography is more reliable than CT in identifying pancreatic adenocarcinoma, and its accuracy in staging is similar to that of CT.

Cited by 54 publications

References 40 publications

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

Uncommon presentations of common pancreatic neoplasms: a pictorial essay

Imaging Stigmata Review and Interpretation

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