Determination of "borderline resectable" pancreatic cancer - A global assessment of 30 shades of grey.
Journal
HPB : the official journal of the International Hepato Pancreato Biliary Association
ISSN: 1477-2574
Titre abrégé: HPB (Oxford)
Pays: England
ID NLM: 100900921
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
26
01
2023
revised:
29
06
2023
accepted:
12
07
2023
pubmed:
10
8
2023
medline:
10
8
2023
entrez:
9
8
2023
Statut:
ppublish
Résumé
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. In this multicentre observational study, an international group of 96 clinicians (42 hepatopancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.
Sections du résumé
BACKGROUND
BACKGROUND
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways.
METHODS
METHODS
In this multicentre observational study, an international group of 96 clinicians (42 hepatopancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed.
RESULTS
RESULTS
Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons.
CONCLUSION
CONCLUSIONS
Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.
Identifiants
pubmed: 37558564
pii: S1365-182X(23)01867-1
doi: 10.1016/j.hpb.2023.07.883
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1393-1401Investigateurs
Farhan Ahmed
(F)
Emel Allan
(E)
Inna Amelina
(I)
Somaiah Aroori
(S)
Nalayini Balendran
(N)
Ee J Ban
(EJ)
David Bartlett
(D)
Roger Berry
(R)
Abraham Bezuidenhout
(A)
Ricky Bhogal
(R)
Candice Bolan
(C)
Louisa Bolm
(L)
Cristiana Bonifacio
(C)
Adina Borsaru
(A)
David Burnett
(D)
Nick Butterfield
(N)
Roberto Cannella
(R)
Giovanni Capretti
(G)
Carlos Carnelli
(C)
Nikolaos Chatzizacharias
(N)
Felix Chingoli
(F)
Linda Chu
(L)
Wai Pong Chu
(WP)
Toshimasa Clark
(T)
Saxon Connor
(S)
Stephen Currin
(S)
Jurstine Daruwalla
(J)
Domenico De Santis
(D)
Ankita Dhawan
(A)
Bruno Di Muzio
(B)
Marco Dioguardi Burgio
(M)
Joel Dunn
(J)
Georgios Gemenetzis
(G)
Mark Goodwin
(M)
Andrew Gray
(A)
Christopher Halloran
(C)
George Harisis
(G)
Heather Harris
(H)
Jin He
(J)
Elizabeth Hecht
(E)
Asmus Heumann
(A)
Russell Hodgson
(R)
Cathryn Hui
(C)
Petr Kalinin
(P)
Jorg Kleeff
(J)
Hyun S Ko
(HS)
Ksenia Kozyreva
(K)
Numan Kutaiba
(N)
Joel Lewin
(J)
Christopher Lim
(C)
Fabian Lohöfer
(F)
Benjamin Loveday
(B)
Giovanni Marchegiani
(G)
Katerina Mastrocostas
(K)
Vasileios K Mavroeidis
(VK)
Neil Merrett
(N)
Martina Nebbia
(M)
John Neoptolemos
(J)
Denis Nesterov
(D)
Charles Pilgrim
(C)
Bradley N Reames
(BN)
Alistair Rowcroft
(A)
Melanie Seale
(M)
Sabbir Siddique
(S)
Marty Smith
(M)
Gavin Sugrue
(G)
Jatin Thakur
(J)
Rose Thomas
(R)
Walid Tibermacine
(W)
Parag Tolat
(P)
Charikleia Triantopoulou
(C)
Stanislav Trofimov
(S)
Faik G Uzunoglu
(FG)
Federica Vernuccio
(F)
Diederick W De Boo
(DW)
Laurence Webber
(L)
Alice Wei
(A)
Verity Wood
(V)
Marc Zins
(M)
Informations de copyright
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.