Comparison of conventional and 3-dimensional computed tomography against histopathologic examination in determining pancreatic adenocarcinoma tumor size: Implications for radiation therapy planning

作者：Qiu Haoming; Wild Aaron T; Wang Hao; Fishman Elliot K; Hruban Ralph H; Laheru Daniel A; Kumar Rachit; Hacker Prietz Amy; Tuli Richard; Tryggestad Erik; Schulick Richard D; Cameron John L; Edil Barish H; Pawlik Timothy M; Wolfgang Christopher L; Herman Joseph M^*

来源：Radiotherapy and Oncology, 2012, 104(2): 167-172.

DOI：10.1016/j.radonc.2012.07.004

• Pancreatic cancer
• Resectable
• Radiation treatment planning
• 3D-cr
• SBRT

Background and purpose: This study seeks to: (a) quantify radiologic-pathologic discrepancy for pancreatic adenocarcinoma by comparing tumor size on conventional computed tomography (C-CT) and 3-dimensional CT (3D-CT) to corresponding pathologic specimens; and (b) to identify clinico-pathologic characteristics predictive of radiologic-pathologic discrepancy to assist radiotherapy planning.
Materials and methods: Sixty-three pkients with pancreatic adenocarcinoma and preoperative C-CT and volume-rendered 3D-CT imaging within 6 weeks of resection were identified. Maximum tumor diameter (MTD) was measured on pathology, C-CT, and 3D-CT and compared for each patient as well as among different clinico-pathologic subgroups.
Results: There was a trend toward C-CT underestimation of MTD compared to final pathology (p = 0.08), but no significant difference between 3D-CT MTD and pathology (p = 0.54). Pathologic tumor size was significantly underestimated by C-CI' in patients with larger pathologic tumor size (>3.0 cm, p = 0.0001), smaller tumor size on C-CT (<3.0 cm, p = 0.003), higher CA19-9 (>90 U/mL, p = 0.008), and location in the pancreatic head (p = 0.015). A model for predicting pathologic MTD using C-CT MTD and CA19-9 level was generated.
Conclusions: 3D-CT may allow for more accurate contouring of pancreatic tumors than C-CT. Patients with the above clinico-pathologic characteristics may require expanded margins relative to tumor size estimates on C-CT during radiotherapy planning.

• 出版日期2012-8