Summary: A study in the American Journal of Roentgenology highlights that soft tissue, especially with vessel encasement and luminal narrowing, significantly raises suspicion for local recurrence after pancreatic ductal adenocarcinoma resection, with these features seen in 80-86% of post-Whipple patients.
Key Takeaways
- Soft tissue, especially with vessel encasement and luminal narrowing, is a strong indicator of local recurrence after PDAC resection.
- The study reinforces the Society of Abdominal Radiology’s (SAR) PDAC Disease-Focused Panel consensus statement on the importance of specific imaging features in detecting postresection recurrence.
- Interreader agreement was moderate to fair, with new or increased soft tissue identified in 80-86% of first surveillance CT exams showing recurrence.
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An accepted manuscript published in the American Journal of Roentgenology (AJR) highlights the role of soft tissue, particularly when associated with vessel encasement and luminal narrowing, in raising suspicion for local recurrence (LR) after pancreatic ductal adenocarcinoma (PDAC) resection.
Post-Whipple Surgery
“This AJR study provides insight into findings described in the Society of Abdominal Radiology’s (SAR) PDAC Disease-Focused Panel (DFP) consensus statement that indicate the presence, or likely development, of postresection LR, while highlighting opportunities for continued optimization,” writes corresponding author Tae-Hyung Kim, MD, MS, from the radiology department at Memorial Sloan Kettering Cancer Center in New York City.
Kim and his colleagues’ study involved 126 patients (mean age 68.5 years; 72 men, 54 women) who underwent Whipple surgery for PDAC between January 2009 and December 2014. Three radiologists independently reviewed preoperative and postoperative contrast-enhanced abdominopelvic CT scans taken within two years after surgery.
Identifying PDAC Recurrence
The researchers assessed features outlined in the SAR PDAC DFP consensus, including surgical bed stranding, soft tissue presence, vessel encasement, main pancreatic duct dilatation, and ascites. Interreader agreement was calculated, and a reference standard for local recurrence (LR) within two years was established using all available data. Frequencies of imaging features were calculated for the first surveillance exams indicating LR.
Ultimately, on the first surveillance CT examinations showing LR after PDAC resection, across three readers, new or increased soft tissue was present in 80%–86%, and soft tissue with vessel encasement and luminal narrowing in 36–59%. These findings showed moderate and fair interreader agreement, respectively.
