Postoperative surveillance of pancreatic ductal adenocarcinoma (PDAC) recurrence: practice pattern on standardized imaging and reporting from the society of abdominal radiology disease focus panel on PDAC

Linda C. Chu, Zhen J. Wang, Avinash Kambadakone, Elizabeth M. Hecht, Jin He, Amol K. Narang, Daniel A. Laheru, Hina Arif-Tiwari, Priya Bhosale, Candice W. Bolan, Olga R. Brook, Abraham F. Bezuidenhout, Richard K.G. Do, Samuel J. Galgano, Ajit H. Goenka, Alexander R. Guimaraes, David M. Hough, Naveen Kulkarni, Ott Le, Lyndon LukLorenzo Mannelli, Michael Rosenthal, Guillermo Sangster, Zarine K. Shah, Erik V. Soloff, Parag P. Tolat, Marc Zins, Elliot K. Fishman, Eric P. Tamm, Atif Zaheer

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Surgical resection is the only potential curative treatment for patients with pancreatic ductal adenocarcinoma (PDAC), but unfortunately most patients recur within 5 years of surgery. This article aims to assess the practice patterns across major academic institutions and develop consensus recommendations for postoperative imaging and interpretation in patients with PDAC. Methods: The consensus recommendations for postoperative imaging surveillance following PDAC resection were developed using the Delphi method. Members of the Society of Abdominal Radiology (SAR) PDAC Disease Focused Panel (DFP) underwent three rounds of surveys followed by live webinar group discussions to develop consensus recommendations. Results: Significant variations currently exist in the postoperative surveillance of PDAC, even among academic institutions. Differentiating common postoperative inflammatory and fibrotic changes from tumor recurrence remains a diagnostic challenge, and there is no reliable size threshold or growth rate of imaging findings that can provide differentiation. A new liver lesion or peritoneal nodule should be considered suspicious for tumor recurrence, and the imaging features should be interpreted in the appropriate clinical context (e.g., CA 19–9, clinical presentation, pathologic staging). Conclusion: Postoperative imaging following PDAC resection is challenging to interpret due to the presence of confounding postoperative inflammatory changes. A standardized reporting template for locoregional findings and report impression may improve communication of relaying risk of recurrence with referring providers, which merits validation in future studies. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StateAccepted/In press - 2022

Keywords

  • CT
  • MRI
  • Pancreatic ductal adenocarcinoma
  • Recurrence

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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