Research paperImaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy
Introduction
More than 3000 Australians are estimated to have developed pancreatic cancer in 2015, making it the 10th most commonly diagnosed cancer in Australia [1]. Despite accounting for only 2.4% of all new cancer diagnoses, pancreatic cancer caused an estimated 5.8% of all deaths from cancer in 2015. Further, patients diagnosed with this disease entity can expect 24% and 6% 1- and 5-year survivals respectively; only a modest improvement on the 4% 5-year survival with the same diagnosis in 1982–1986 [1]. As a result of its poor prognosis, pancreatic cancer has an impact out of proportion to its incidence.
The imbalance between incidence and mortality in pancreatic cancer can be partially explained by the fact that these cancers are often clinically silent until advanced stages, often following metastases [2]. Patients who are diagnosed with localized disease have a 26% 5-year survival, while only 2% of patients diagnosed with advanced disease survive at 5 years [3]. Because of this stark survival contrast, any improvement in detection will significantly improve survival in pancreatic cancer through earlier intervention.
Previous reviews of diagnostic imaging modalities used in pancreatic ductal adenocarcinoma (PDAC), the most common form of pancreatic cancer, have been undertaken [4], [5], [6]. However these reviews have not taken into account the rapid advancement in imaging technology in their analysis. For example, it is inappropriate to compare modern nuclear imaging techniques such as positron emission tomography (PET) to computed tomography (CT) or magnetic resonance imaging (MRI) technology from 20 years earlier.
The American Agency for Healthcare Research and Quality published a report on the diagnosis and staging of PDAC in 2015 in which it highlighted the paucity of high-quality, systematic review literature on the detection of this disease [6]. It is therefore the aim of this systematic review to determine the sensitivity, specificity and diagnostic accuracy of the available imaging modalities for the detection of PDAC.
Section snippets
Design and methods
The study protocol for this systematic review was prospectively registered with PROSPERO, international prospective register of systematic reviews, (registration number: CRD42015024862) and may be found on the PROSPERO website (https://www.crd.york.ac.uk/PROSPERO/). The study protocol followed the PRISMA checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [7].
Results
The search strategy returned 1347 original articles, of which 135 were selected for full-text review with 52 of these meeting all inclusion criteria for final analysis (Fig. 1). These 52 studies represent 5399 patients, of whom 3567 had PDAC (Table 1). Eleven of these studies report data for MRI (349/586 patients with PDAC) [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], 15 for CT/MDCT (815/1338 with PDAC) [14], [17], [18], [20], [21], [22], [23], [24], [25], [26], [27], [28],
Discussion
The results of this meta-analysis stand in contrast to the previously published literature reviews on this topic. A 2005 meta-analysis found helical CT to be the most sensitive and specific modality and ultrasound to be the least useful [4]. Because the literature search in the 2005 review was restricted to studies conducted prior to December 2003, there is no overlap with the current review, which found higher sensitivities and specificities for all modalities (most significantly for
Conflicts of interest
The authors declare no conflicts of interest or competing financial incentive.
Sources of funding
This project was completely supported with time donations in kind from the contributing authors
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