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Determination of "borderline resectable" pancreatic cancer - A global assessment of 30 shades of grey. HPB (Oxford) 2023 Nov;25(11):1393-1401



Pubmed ID




Scopus ID

2-s2.0-85171365378 (requires institutional sign-in at Scopus site)   4 Citations


BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways.

METHODS: In this multicentre observational study, an international group of 96 clinicians (42 hepatopancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed.

RESULTS: Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons.

CONCLUSION: Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.

Author List

Badgery HE, Muhlen-Schulte T, Zalcberg JR, D'souza B, Gerstenmaier JF, Pickett C, Samra J, Croagh D, Pancreatic Cancer Image Biobank Authorship Group


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
Neoadjuvant Therapy
Pancreatic Neoplasms
Tomography, X-Ray Computed