Faculty Collaboration Database

Characterizing indeterminate liver lesions in patients with localized pancreatic cancer at the time of diagnosis. Abdom Radiol (NY) 2018 Feb;43(2):351-363

Date

12/01/2017

Pubmed ID

29185014

DOI

10.1007/s00261-017-1404-0

Scopus ID

2-s2.0-85035138788 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND: In patients with newly diagnosed pancreatic cancer, the classification of indeterminate liver lesions is an unanswered clinical dilemma as misclassification of these lesions can impact the assignment of clinical stage and subsequent treatment planning. Our objective was to design a standardized classification system to more accurately define the risk of malignancy in indeterminate liver lesions.

METHODS: In this retrospective study, patients with localized, non-metastatic pancreatic cancer were identified and pre-treatment computed tomography (CT) scans were evaluated for the presence or absence of liver lesions. Liver lesions were defined as definitely benign (1) or indeterminate (2). Indeterminate lesions were further sub-classified as either indeterminate probably benign (2B) or indeterminate possibly malignant (2M). The index liver lesion was evaluated on follow-up imaging for stability or unequivocal disease progression.

RESULTS: From 2008 to 2015, 304 patients with localized, non-metastatic pancreatic cancer were identified and 125 (41%) patients had liver lesions. Of the 125 patients, the liver lesions in 35 (28%) were classified as definitely benign and in 90 (72%) patients they were classified as indeterminate. The 90 patients with indeterminate lesions included 80 (89%) classified as indeterminate probably benign (2B) and 10 (11%) classified as indeterminate possibly malignant (2M). After a median follow-up of 56 weeks, no patient with a definitely benign lesion had metastatic disease progression of the index lesion. Of the 90 patients with indeterminate liver lesions, the index lesion progressed to unequivocal liver metastasis in 8 (9%) patients; 5 (6%) of the 80 lesions classified as indeterminate probably benign (2B), and 3 (30%) of the ten lesions classified as indeterminate possibly malignant (2M). The sensitivity of the classification system was 38% and the specificity was 91%. The positive predictive value was 30% and the negative predictive value was 94%.

CONCLUSIONS: A significant proportion of patients with localized pancreatic cancer will have liver lesions identified at the time of diagnosis and most of these lesions will have indeterminate characteristics. A classification system which further stratifies indeterminate liver lesions by malignant potential can assist clinicians in determining optimal treatment plan and is associated with a high negative predictive value.

Author List

Bhalla M, Aldakkak M, Kulkarni NM, O'Connor SD, Griffin MO Jr, Christians KK, Evans DB, Tsai S, Tolat PP

Authors

Mohammed Aldakkak MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Douglas B. Evans MD Professor in the Surgery department at Medical College of Wisconsin
Michael O. Griffin PhD, MD Associate Professor in the Radiology department at Medical College of Wisconsin
Naveen Kulkarni MBBS Associate Professor in the Radiology department at Medical College of Wisconsin
Parag P. Tolat MD Chief, Professor in the Radiology department at Medical College of Wisconsin

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

Aged
Biomarkers, Tumor
Contrast Media
Female
Humans
Liver Neoplasms
Male
Neoadjuvant Therapy
Neoplasm Staging
Pancreatic Neoplasms
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Tomography, X-Ray Computed