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Diagnostic Accuracy of Preoperative Multidetector-Row Computed Tomography Imaging in Predicting Microscopic Curative Resection of Hepatobiliary and Pancreatic Malignancy: a Prospective Multi-Institutional Study
Kazuaki Shimada*1, Yoshito Takeuchi2, Masaru Konishi3, Tatsushi Kobayashi4, Akio Saiura5, Kiyoshi Matsueda6, Tsuyoshi Sano7, Hideyuki Kanemoto8, Katsuhiko Uesaka8
1Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan; 2Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan; 3Division of Digestive Surgery, National Cancer Center Hospital East, Kasiwa, Japan; 4Diagnostic Radiology, National Cancer Center Hospital East, Kasiwa, Japan; 5Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; 6Diagnostic Radiology, Cancer Institute Hospital , Japanese Foundation for Cancer Research, Tokyo, Japan; 7Gastroenterological Surgery, Aichi Cancer Center Hospital, Tokyo, Japan; 8Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Tokyo, Japan
Purpose: To assess the accuracy of preoperative diagnosis of hepatobiliary and pancreatic malignancy with multidetector-row computed tomography (MDCT) to predict microscopic curative resection.
Design and settings: Prospective observational study of hepatobiliary and pancreatic malignancy resected between November 2007 and December 2008, in 5 Cancer Center Hospitals in Japan.
Participants: 271 consecutive patients with highly suspected and potential resectable hepatobiliary and pancreatic malignancy undergoing MDCT judged fit for laparotomy were studied.
Main outcomes measures: Sensitivity and specificity of MDCT predicting a microscopic curative resection based on the histopathological examination of presence or absence of tumors at the margin of the specimen.
Results: 164 patients of 217 macroscopic resectable patients (75.6%) with hepatobiliary and pancreatic malignancy underwent microscopic curative resection. MDCT predicted clear margin resections in 146 patients (89.0%). Sensitivity for prediction of microscopic curative resection by MDCT in perihilar cholangiocarcinoma, gallbladder carcinoma, middle/lower bile duct carcinoma, and pancreatic carcinoma was 64.7%[CI,52.3-78.9%], 90.9%[CI,90.9-97.29%], 95.5%[CI,97.7-99.1%], and 89.7%[CI,86.3-93.1%], respectively. On the other hand, specificity was 30.8% [CI, 14.5-49.3%], 0%, 33.3% [CI, 14.4-42.4%], and 36.4% [CI, 21.5-51.6%], respectively.
Conclusions: Expert radiologists in hepatobiliary and pancreatic disease could not predict microscopic curative resection in patients with perihilar cholangiocarcinoma. Even if MDCT predict a possibility of surgical margin positive resections, surgery seems to be not always contraindicated in hepatobiliary and pancreatic malignancy, because the accurate preoperative diagnosis with MDCT has still remained difficult.
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