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

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

Research output: Contribution to journalArticle

Abstract

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 patients 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-CT 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.

Original languageEnglish (US)
Pages (from-to)167-172
Number of pages6
JournalRadiotherapy and Oncology
Volume104
Issue number2
DOIs
StatePublished - Aug 1 2012

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Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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