Post-op CT May Help Diagnose Recurrent Pancreatic Ductal Adenocarcinoma

Post-operative CT has a moderate diagnostic accuracy in the detection of recurrent pancreatic ductal adenocarcinoma (PDAC), according to a study published in the European Journal of Radiology.

Researchers from the Netherlands examined the literature for information on the diagnostic performance of different imaging modalities for the detection of recurrent disease after surgery for PDAC.

The researchers performed a systematic search in PubMed, EMBASE and Cochrane Library for studies up to December 20, 2017. They included all studies that reported on the diagnostic value of imaging modalities for the detection of local and/or distant disease recurrence during follow-up after resection of PDAC. Both histologic confirmation of recurrent PDAC and clinical confirmation by disease progression on follow-up imaging were considered as suitable reference standard. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used for critical appraisal of methodological quality.

Seven retrospective studies with 333 relevant patients were ultimately eligible for data extraction. All seven articles described test results of contrast-enhanced CT. Five and three articles reported outcomes on diagnostic accuracy of FDG PET-CT and FDG PET-CT combined with contrast-enhanced CT, respectively.

Pooled estimates:

                CT FDG/  PET-CT/  FDG PET-CT + contrast enhanced CT
Sensitivity   0.70     0.88                0.95
Specificity   0.80     0.89                0.81

The researchers concluded that according to the current literature, post-operative CT has a moderate diagnostic accuracy in the detection of recurrent disease. FDG PET-CT imaging could be of additional value when disease recurrence is suspected despite negative or equivocal CT findings. Nevertheless, evidence supporting radiologic surveillance after resection of PDAC is limited. Future prospective studies are needed to optimize surveillance strategies after resection of pancreatic cancer.