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Systematic review and meta-analysis of diagnostic performance of CT imaging for assessing resectability of pancreatic ductal adenocarcinoma after neoadjuvant therapy: importance of CT criteria

Authors
 Hyun Kyung Yang  ;  Mi-Suk Park  ;  Miyoung Choi  ;  Jaeseung Shin  ;  Seung Soo Lee  ;  Woo Kyoung Jeong  ;  Shin Hye Hwang  ;  Sang Hyun Choi 
Citation
 ABDOMINAL RADIOLOGY, Vol.46(11) : 5201-5217, 2021-11 
Journal Title
ABDOMINAL RADIOLOGY
ISSN
 2366-004X 
Issue Date
2021-11
MeSH
Carcinoma, Pancreatic Ductal* / diagnostic imaging ; Carcinoma, Pancreatic Ductal* / surgery ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Pancreatic Neoplasms* / diagnostic imaging ; Pancreatic Neoplasms* / pathology ; Pancreatic Neoplasms* / surgery ; Sensitivity and Specificity ; Tomography, X-Ray Computed
Keywords
Carcinoma ; pancreatic ductal ; Neoadjuvant therapy ; Neoplasm staging ; Pancreatectomy ; Tomography ; X-ray computed
Abstract
Purpose: To assess the CT diagnostic performance for evaluating resectability of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy and identify the factor(s) that affect(s) diagnostic performance.

Methods: Databases were searched to identify studies published from January 1, 2000, to November 5, 2019 that evaluated the CT diagnostic performance for assessing resectability of post-neoadjuvant PDAC. Two reviewers independently extracted data and assessed the study quality. A meta-analysis was performed to obtain summary sensitivity and specificity values using a bivariate random-effects model, and heterogeneity across studies was assessed. Univariable meta-regression analysis was performed with eight variables, including the different CT criteria for resectability, conventional National Comprehensive Cancer Network (NCCN) criteria for upfront surgery, and modified criteria for post-neoadjuvant surgery.

Results: Ten studies were included and analyzed. The summary sensitivity and specificity for resectability were 78% (95% CI 68-86%) and 60% (95% CI 44-74%), respectively. No significant heterogeneity was identified (bivariate correlation coefficient ρ = - 1, p-value for hierarchical summary receiver operating characteristics model β = 0.667). The two different CT criteria showed different diagnostic performance (p < 0.01), with higher sensitivity (81% [95% CI 73-90%] vs. 28% [95% CI 15-42%], p < 0.01) and lower specificity (57% [95% CI 41-73%] vs. 90% [95% CI 80-100%], p < 0.01) for the modified criteria. No other variables affected the diagnostic performance.

Conclusion: CT criteria were the factors that affected the diagnostic performance. Modification of the conventional criteria improved sensitivity but lowered specificity. Further modifications are required to improve specificity and uniformity.
Full Text
https://link.springer.com/article/10.1007%2Fs00261-021-03198-2
DOI
10.1007/s00261-021-03198-2
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Shin, Jaeseung(신재승) ORCID logo https://orcid.org/0000-0002-6755-4732
Yang, Hyun Kyung(양현경) ORCID logo https://orcid.org/0000-0003-3576-9146
Hwang, Shin Hye(황신혜)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187069
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