Experts recently tested new consensus recommendations for the preoperative evaluation of extrahepatic bile duct cancer using multiphasic computed tomography.
For the study, researchers referred to the Korean Society of Abdominal Radiology consensus recommendations when evaluating the CT scans of 122 patients with extrahepatic bile duct (EHD) cancer. When using the images to evaluate tumor extent, vascular invasion and resectability, experts found the consensus recommendations to offer acceptable guidance that resulted in good interreader agreement and adequate performance in predicting negative-margin resection.
“The cure for EHD cancer relies on radical surgery with a cancer-free margin, which requires surgical expertise, accurate preoperative radiologic evaluation, and a dedicated multidisciplinary team,” corresponding author Jeong Min Lee, from the Department of Radiology at Seoul National University Hospital in South Korea, and co-authors explained. “Of them, noninvasive radiologic evaluation can offer comprehensive information regarding the longitudinal spread of the disease and the presence of major vascular invasion, lymph node metastasis, or distant organ metastasis that is critical for predicting tumor resectability.”
EHD cancer is rare and, therefore, radiological guidelines pertaining to its tumor assessment are lacking. This, the researchers suggested, creates the issue of reproducibility and reliability in image assessment. Although uncommon, EHD cancer occurs more frequently in South Korea, China, Taiwan and Thailand. That, coupled with the need for more structured interpretation guidelines, is what led the Korean Society of Abdominal Radiology to recently produce their own consensus recommendations based on discussion and voting by its members.
Experts sought to evaluate the performance of these new recommendations using multiphasic, multidetector CT imaging to assess tumor extent, hepatic artery and portal vein (PV) invasion and tumor resectability, as well as interreader agreement on these measures. The images that were obtained were retrospectively analyzed by four abdominal radiologists and diagnostic performance was assessed with sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve.
The results of the analysis were variable on many fronts. The accuracy of tumor extent assessments ranged from 76.8%–96.4%. Detection sensitivity for secondary confluence involvement was lower than it was for the primary confluence or intrapancreatic duct, at 38.5%–75% compared to 72.1%–96.3%. Vascular invasion had high specificity (77.5%–99.0%), but lower sensitivity (28.6%–71.4%). These numbers did appear to improve when it came to predicting negative-margin (R0) resection, with researchers reporting higher sensitivity of 71.8%-96.5%.
“Overall, the consensus recommendations enabled systematic assessment of the disease status and provided acceptable performance in predicting negative-margin resection of EHD cancer with use of multiphasic CT,” the experts said. “A multidisciplinary team approach may overcome challenges in predicting R0 resection using the present imaging technique.”
The detailed research can be viewed in Radiology.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.