Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer

Abstract Accuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPN...

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Autores principales:	Ekaterina Khristenko, Igor Shrainer, Galia Setdikova, Oxana Palkina, Valentin Sinitsyn, Vladimir Lyadov
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/acde3539645b4557a99d975e655b4989
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spelling	oai:doaj.org-article:acde3539645b4557a99d975e655b49892021-12-02T13:51:16ZPreoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer10.1038/s41598-021-81322-42045-2322https://doaj.org/article/acde3539645b4557a99d975e655b49892021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-81322-4https://doaj.org/toc/2045-2322Abstract Accuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPNI preoperatively in resectable PDAC of the pancreatic head. Retrospective study design was approved by institutional review board. Preoperative CT-series of 46 patients with resectable PDAC were evaluated by two independent observers. Plexus Pancreaticus Capitalis-II (PPC-II) was assessed as this area is more susceptible for EPNI. All patients underwent surgery with dedicated histopathology, which served as the reference standard. Histologically EPNI was confirmed in 63.1%. Sensitivity of MDCT was 93.1% (95% confidence interval (CI) 77.23% to 99.15%), specificity 64.7% (95% CI 38.33% to 85.79%) with area under the curve (AUC) 0.789 for the first observer. Positive predictive value (PPV) was 81.82% (95% CI 70.12% to 89.62%), negative predictive value (NPV—84.62% (95% CI 57.98% to 95.64%) with diagnostic accuracy of 82.61% (95% CI 68.58% to 92.18%). Interobserver agreement showed k-value of 0.893 ( $${p} < 0.001$$ p < 0.001 ), which represents very good agreement between observers. Median actual survival in patients without EPNI was 30 months (95% CI 18.284–41.716), in patients with EPNI—13 months (95% CI 12.115–13.885). CT provides sufficient diagnostic information to detect PPC-II invasion in patients with resectable PDAC of the pancreatic head. Preoperative detection of EPNI might be an additional argument to perform neoadjuvant chemotherapy in patients with resectable PDAC. It should be included in preoperative evaluation form of CT-findings.Ekaterina KhristenkoIgor ShrainerGalia SetdikovaOxana PalkinaValentin SinitsynVladimir LyadovNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ekaterina Khristenko Igor Shrainer Galia Setdikova Oxana Palkina Valentin Sinitsyn Vladimir Lyadov Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer
description	Abstract Accuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPNI preoperatively in resectable PDAC of the pancreatic head. Retrospective study design was approved by institutional review board. Preoperative CT-series of 46 patients with resectable PDAC were evaluated by two independent observers. Plexus Pancreaticus Capitalis-II (PPC-II) was assessed as this area is more susceptible for EPNI. All patients underwent surgery with dedicated histopathology, which served as the reference standard. Histologically EPNI was confirmed in 63.1%. Sensitivity of MDCT was 93.1% (95% confidence interval (CI) 77.23% to 99.15%), specificity 64.7% (95% CI 38.33% to 85.79%) with area under the curve (AUC) 0.789 for the first observer. Positive predictive value (PPV) was 81.82% (95% CI 70.12% to 89.62%), negative predictive value (NPV—84.62% (95% CI 57.98% to 95.64%) with diagnostic accuracy of 82.61% (95% CI 68.58% to 92.18%). Interobserver agreement showed k-value of 0.893 ( $${p} < 0.001$$ p < 0.001 ), which represents very good agreement between observers. Median actual survival in patients without EPNI was 30 months (95% CI 18.284–41.716), in patients with EPNI—13 months (95% CI 12.115–13.885). CT provides sufficient diagnostic information to detect PPC-II invasion in patients with resectable PDAC of the pancreatic head. Preoperative detection of EPNI might be an additional argument to perform neoadjuvant chemotherapy in patients with resectable PDAC. It should be included in preoperative evaluation form of CT-findings.
format	article
author	Ekaterina Khristenko Igor Shrainer Galia Setdikova Oxana Palkina Valentin Sinitsyn Vladimir Lyadov
author_facet	Ekaterina Khristenko Igor Shrainer Galia Setdikova Oxana Palkina Valentin Sinitsyn Vladimir Lyadov
author_sort	Ekaterina Khristenko
title	Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer
title_short	Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer
title_full	Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer
title_fullStr	Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer
title_full_unstemmed	Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer
title_sort	preoperative ct-based detection of extrapancreatic perineural invasion in pancreatic cancer
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/acde3539645b4557a99d975e655b4989
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Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer

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