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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

 Hyun Kyung Yang  ;  Mi-Suk Park  ;  Miyoung Choi  ;  Jaeseung Shin  ;  Seung Soo Lee  ;  Woo Kyoung Jeong  ;  Shin Hye Hwang  ;  Sang Hyun Choi 
 ABDOMINAL RADIOLOGY, Vol.46(11) : 5201-5217, 2021-11 
Journal Title
Issue Date
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
Carcinoma ; pancreatic ductal ; Neoadjuvant therapy ; Neoplasm staging ; Pancreatectomy ; Tomography ; X-ray computed
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.
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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)
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