Value of pelvis CT during followup of patients wi

Authors: Jason J Bailey James H Ellis Matthew S Davenport Richard H Cohan Bin Nan Aishwarya Parameswaran Lin Hsu Vaibhav Sahai Isaac R Francis

Publish Date: 2016/08/13

Volume: 42, Issue: 1, Pages: 211-215

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Abstract

The purpose of this study was to determine the frequency in which the pelvis component of an abdominopelvic CT provides information that would influence clinical management in two separate groups of patients those with previously resected pancreatic ductal adenocarcinoma PDA and those with locally advanced unresectable PDAThis institutional reviewboard approved HIPAA compliant retrospective study with waived informed consent included 247 subjects with histologically proven PDA including 153 subjects postpancreaticoduodenectomy and 94 subjects with locally advanced unresectable disease Imaging reports interpreted between January 2005 and December 2013 were obtained from our institution’s Radiology Information System by searching a Cancer Registry database of PDA patients separately for the words “whipple” and “unresectable” CT findings were separated by location in the abdomen or pelvis and subsequently reviewed and graded for their likelihood of representing metastatic disease The probability of pelvic CT influencing clinical management—ie of finding isolated pelvic metastatic disease—was determined using 95 binomial proportion confidence intervals for both the postpancreaticoduodenectomy and locally advanced unresectable groupsNo subjects who had undergone pancreaticoduodenectomy had an isolated pelvic metastasis on followup imaging 0 95 CI 0–238 p = 00004 33 had metastatic disease in the abdomen and 120 had no or equivocal evidence of abdominopelvic metastatic disease One subject with locally advanced unresectable PDA had a possible isolated pelvic metastasis on followup imaging 11 95 CI 003–579 p = 0048 20 had metastatic disease in the abdomen and 73 had no or equivocal evidence of abdominopelvic metastatic diseaseIsolated pelvic metastatic disease rarely occurs in patients with PDA who have had prior pancreaticoduodenectomy or have a locally advanced unresectable primary tumor suggesting routine pelvic CT in followup imaging of these patients may not be necessaryAll procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards This article does not contain any studies with animals performed by any of the authors

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