Faculty Collaboration Database

Postoperative surveillance of pancreatic ductal adenocarcinoma (PDAC) recurrence: practice pattern on standardized imaging and reporting from the society of abdominal radiology disease focus panel on PDAC. Abdom Radiol (NY) 2023 Jan;48(1):318-339

Date

10/15/2022

Pubmed ID

36241752

DOI

10.1007/s00261-022-03693-0

Scopus ID

2-s2.0-85140245527 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

PURPOSE: Surgical resection is the only potential curative treatment for patients with pancreatic ductal adenocarcinoma (PDAC), but unfortunately most patients recur within 5 years of surgery. This article aims to assess the practice patterns across major academic institutions and develop consensus recommendations for postoperative imaging and interpretation in patients with PDAC.

METHODS: The consensus recommendations for postoperative imaging surveillance following PDAC resection were developed using the Delphi method. Members of the Society of Abdominal Radiology (SAR) PDAC Disease Focused Panel (DFP) underwent three rounds of surveys followed by live webinar group discussions to develop consensus recommendations.

RESULTS: Significant variations currently exist in the postoperative surveillance of PDAC, even among academic institutions. Differentiating common postoperative inflammatory and fibrotic changes from tumor recurrence remains a diagnostic challenge, and there is no reliable size threshold or growth rate of imaging findings that can provide differentiation. A new liver lesion or peritoneal nodule should be considered suspicious for tumor recurrence, and the imaging features should be interpreted in the appropriate clinical context (e.g., CA 19-9, clinical presentation, pathologic staging).

CONCLUSION: Postoperative imaging following PDAC resection is challenging to interpret due to the presence of confounding postoperative inflammatory changes. A standardized reporting template for locoregional findings and report impression may improve communication of relaying risk of recurrence with referring providers, which merits validation in future studies.

Author List

Chu LC, Wang ZJ, Kambadakone A, Hecht EM, He J, Narang AK, Laheru DA, Arif-Tiwari H, Bhosale P, Bolan CW, Brook OR, Bezuidenhout AF, Do RKG, Galgano SJ, Goenka AH, Guimaraes AR, Hough DM, Kulkarni N, Le O, Luk L, Mannelli L, Rosenthal M, Sangster G, Shah ZK, Soloff EV, Tolat PP, Zins M, Fishman EK, Tamm EP, Zaheer A

Authors

Naveen Kulkarni MD Assistant Professor in the Radiology department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Associate Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Carcinoma, Pancreatic Ductal
Gastrointestinal Diseases
Humans
Neoplasm Recurrence, Local
Pancreatic Neoplasms
Radiology
Tomography, X-Ray Computed