e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Pilot results following introduction of a synoptic radiologic report for pancreatic ductal adenocarcinoma (PDAC). (#242)

Charles HC Pilgrim 1 , Anna Maciejewska 2 , Nadia Ayres 3 , Mark Goodwin 4 , Adrian Fox 5 , Adina Borsaru 6 , Andrew Haydon 1
  1. The Alfred Hospital, Melbourne, VIC, Australia
  2. Southern Melbourne Integrated Cancer Service, Melbourne, Vic, Australia
  3. Northern Melbourne Integrated Cancer Service, Melbourne, Vic, Australia
  4. Radiology, Austin Hospital, Melbourne, Vic, Australia
  5. Surgery, St Vincents Hospital, Melbourne, Vic, Australia
  6. Monash , Melbourne, Vic, Australia

Context:

International consensus on surgical resectability for PDAC exists but is yet to be incorporated into routine practice. Anatomic resectability characteristics based on CT lend themselves to synoptic radiologic reporting. Lack of knowledge regarding resectability in Victoria was identified as a key issue in PDAC management at the 2017 Victorian Integrated Cancer Services (VICS) Pancreas Cancer Summit.

Aims:   

Develop and test a pilot synoptic radiologic report outlining resectability for PDAC based on international consensus guidelines.

Quantify proportion of patients with PDAC classified as clearly resectable (CR), borderline resectable (BR) and locally advanced (LA) according to this report.

Methods:

Two VICS engaged local PDAC specialists to review and identify criteria to guide PDAC staging.

The anatomic definition of resectability outlined in ‘International consensus on definition and criteria of borderline resectable PDAC’ 1 was agreed upon and subsequently used to derive a synoptic radiologic report. Further metrics regarding adequacy of CT scanning were added for quality assurance.

Results:  

88 suspected PDAC cases were assessed using the radiological synoptic tool. Image quality was inadequate in 20% to allow any comment on resectability. In a further 21%, imaging was suboptimal but assessment of resectability was possible. Eleven percent had metastatic disease. Of those with non-metastatic disease, (and where resectability was able to be determined), 64% were classified CR, 19% BR (6% due to venous and 13% arterial involvement) and 17% were classified LA.

Conclusions:

Radiological synoptic reporting requires high quality CT imaging and current practice demonstrates only 59% of presented patients had optimal scanning at the time of MDM. Use of a structured report highlights that only 64% of patients with non-metastatic disease are CR at diagnosis and a large proportion of patients present with BR and LA disease, a previously suspected but largely unquantified yet critical and clinically relevant finding.

  1. Isaji, S., et al., International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology, 2018. 18(1): p. 2-11.