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Pancreas-Protocol Imaging Provides Important Benefits to Patients With Pancreatic Cancer: Presented at SSO By Jill Stein SAINT LOUIS, Mo -- March 6, 2010 -- Pancreas-protocol imaging at a high-volume centre improves preoperative staging and alters management in a high percentage of patients with pancreatic ductal adenocarcinoma (PDAC) who undergo prereferral imaging, researchers said here on March 5 at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO). Dustin M. Walters, MD, University of Virginia, Charlottesville, Virginia, and colleagues reviewed data in all patients with PDAC who presented to their surgical oncology clinic during a recent 4-year period. “The only potential cure for PDAC is surgical resection,” Dr. Walters observed. “The most critical part of the work-up for PDAC involves preoperative staging with cross-sectional imaging in order to separate patients into categories of resectable, borderline resectable, and unresectable. Resectable patients are taken to surgery whereas borderline resectable patients undergo neoadjuvant therapy followed by restaging and surgery.” Patients with PDAC are often referred to high-volume tertiary care centres for the treatment of their disease. The accuracy of prereferral imaging in the preoperative staging of PDAC is unknown at this point. In the study, patients were classified into 3 groups: resectable, borderline resectable, unresectable based on the most recent cross-sectional imaging (computed tomography or magnetic resonance imaging). The date and location of imaging and performing facility as well as the patient’s resectability at the time of surgery were recorded. The investigators then determined which patients had prereferral imaging and whether they were re-imaged at the investigators’ institution. In those patients who were re-imaged, the investigators determined whether re-imaging changed led to changes in patient management. Of 230 patients who presented to their surgical oncology clinic with PDAC during the study period, 169 of them had prereferral imaging. Of the 169 patients with prereferral imaging, 124 patients were re-imaged at the investigators’ institution. Based on cross-sectional imaging, 108 of the 230 patients were deemed to be resectable and, of those, 99 opted for surgery. Of patients opting for surgery, 17 had prereferral imaging only and 47% of those patients were unresectable at the time of surgery. The other 82 patients had imaging at the study institution and 27% of those patients were unresectable at the time of surgery. Overall, 56% of patients with prereferral imaging who were re-imaged at the study institution had their management changed. That group included 55 patients who were deemed to be resectable on prereferral imaging but on repeat imaging were found to be borderline resectable (n = 27) or unresectable (n = 28). Dr. Walters said that the findings demonstrate that repeat imaging with pancreas protocols and dedicated radiologists is justified at high-volume centres. [Presentation Title: Pancreas-Protocol Imaging at a High Volume Center Leads to Improved Preoperative Staging and of Pancreatic Ductal Adenocarcinoma. Abstract P109] E-mail this page to a friend or colleague! To print, use this version