Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, 14186 Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, 14186 Stockholm, Sweden.
Pancreatology. 2013 Nov-Dec;13(6):570-5. doi: 10.1016/j.pan.2013.09.004. Epub 2013 Oct 10.
BACKGROUND/OBJECTIVES: Ductal adenocarcinoma in the head of the pancreas (PDAC) is usually unresectable at the time of diagnosis due to the involvement of the peripancreatic vessels. Various preoperative classification algorithms have been developed to describe the relationship of the tumor to these vessels, but most of them lack a surgically based approach. We present a CT-based classification algorithm for PDAC based on surgical resectability principles with a focus on interobserver variability.
Thirty patients with PDAC undergoing pancreaticoduodenectomy were examined by using a standard CT protocol. Nine radiologists, representing three different levels of expertise, evaluated the CT examinations and the tumors were classified into four categories (A-D) according to the proposed system. For the interobserver agreement, the Intraclass Correlation Coefficient (ICC) was estimated.
The overall ICC was 0.94 and the ICCs among the trainees, experienced radiologists, and experts were 0.85, 0.76, and 0.92, respectively. All tumors classified as category A1 showed no signs of vascular invasion at surgery. In category A2, 40% of the tumors had corresponding infiltration and required resection of the superior mesenteric vein/portal vein (SMV/PV). One of two tumors in category B2 and two of three in category C required SMV/PV resection. All six patients in category D had both arterial and venous involvement.
There is almost perfect agreement among radiologists with different levels of expertise in regards to the local staging of PDAC. For tumors in a more advanced preoperative category, an increased risk for vascular involvement was noticed at surgery.
背景/目的：由于胰周血管受累，胰腺头部导管腺癌（PDAC）在诊断时通常无法切除。已经开发了各种术前分类算法来描述肿瘤与这些血管的关系，但大多数缺乏基于手术的方法。我们提出了一种基于 CT 的 PDAC 分类算法，该算法基于手术可切除性原则，并侧重于观察者间的变异性。
对 30 例接受胰十二指肠切除术的 PDAC 患者进行了标准 CT 检查。9 名放射科医生，代表三种不同水平的专业知识，评估了 CT 检查，根据提出的系统将肿瘤分为四个类别（A-D）。为了评估观察者间的一致性，使用了组内相关系数（ICC）。
总体 ICC 为 0.94，而受训者、有经验的放射科医生和专家的 ICC 分别为 0.85、0.76 和 0.92。所有分类为 A1 类的肿瘤在手术中均无血管侵犯的迹象。在 A2 类中，40%的肿瘤有相应的浸润，需要切除肠系膜上静脉/门静脉（SMV/PV）。B2 类的 2 个肿瘤中有 1 个和 C 类的 3 个肿瘤中有 2 个需要切除 SMV/PV。D 类的所有 6 个患者均有动静脉受累。
不同专业水平的放射科医生在 PDAC 的局部分期方面几乎具有完美的一致性。对于术前更高级别的肿瘤，手术中注意到血管受累的风险增加。
