对比影像学 CT 扫描报告在符合国际共识指南的标准下，对胰腺腺癌进行手术可切除性评估：维多利亚州的一项试点研究。

Synoptic CT scan reporting of pancreatic adenocarcinoma to align with international consensus guidelines on surgical resectability: a Victorian pilot.

机构信息

Hepatopancreaticobiliary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.

Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

出版信息

ANZ J Surg. 2022 Oct;92(10):2565-2570. doi: 10.1111/ans.17999. Epub 2022 Aug 24.

DOI:10.1111/ans.17999

PMID:36054233

Abstract

BACKGROUND

Non-metastatic pancreatic ductal adenocarcinoma (PDAC) is classified as resectable (R), borderline resectable (BR) or locally advanced (LA). International Consensus Guidelines on these definitions exist, but have not been integrated into everyday Australian practice. The anatomical features on CT imaging lend themselves to synoptic reporting which should enhance completeness, comparability and consistency.

METHODS

We developed and tested a synoptic report for PDAC derived from the International Consensus Guidelines at two metropolitan pancreatic cancer services to standardize CT reporting in the region. Consecutive scans with suspected PDAC discussed at multidisciplinary meetings were reported using the template between October 2020 and September 2021. A purpose-built database captured data regarding resectability and image-quality parameters.

RESULTS

Ninety-five scans were reviewed, 57.9% (N = 55) of which conformed to high-quality pancreatic CT protocols. Of suboptimal scans, meaningful synoptic reports were able to be issued for a further 24/40 (due to metastases in 9, and unequivocal resectability status in 15). Of 79 classifiable scans, 20% were metastatic, 51% deemed resectable, 16% locally advanced and 13% borderline resectable.

DISCUSSION

PDAC lends itself to synoptic reporting given the specific anatomical considerations that classify resectability. This relies, however, on high-quality CT imaging and it was surprising that over 40% of scans reviewed were of suboptimal quality. Despite this, resectability status according to the International Consensus Guidelines was designated for 83% of scans. Optimal treatment algorithms for LA, BR and resectable disease vary widely underscoring the critical importance of accurately differentiating these anatomic subtypes of PDAC, and thus support further implementation of a synoptic report of this nature.

摘要

背景

非转移性胰腺导管腺癌（PDAC）可分为可切除（R）、边界可切除（BR）或局部晚期（LA）。国际共识指南对此有明确的定义，但尚未在澳大利亚的日常实践中得到应用。CT 影像学上的解剖特征适用于综合报告，这应能提高完整性、可比性和一致性。

方法

我们在两个大都市胰腺癌服务中心开发并测试了一个源自国际共识指南的 PDAC 综合报告，以规范该地区的 CT 报告。2020 年 10 月至 2021 年 9 月，多学科会议讨论的疑似 PDAC 连续病例均使用模板进行报告。一个专门构建的数据库捕获了有关可切除性和图像质量参数的数据。

结果

共回顾了 95 例扫描，其中 57.9%（N=55）符合高质量胰腺 CT 方案。在质量不佳的扫描中，由于 9 例存在转移，15 例明确为可切除状态，因此仍能提供有意义的综合报告。在 79 例可分类的扫描中，20%为转移性，51%为可切除性，16%为局部晚期，13%为边界可切除。

讨论

PDAC 适用于综合报告，因为有特定的解剖学考虑因素来分类可切除性。然而，这依赖于高质量的 CT 成像，令人惊讶的是，超过 40%的扫描质量不佳。尽管如此，根据国际共识指南，仍有 83%的扫描确定了可切除性状态。LA、BR 和可切除疾病的最佳治疗方案差异很大，这突显了准确区分 PDAC 的这些解剖亚型的重要性，因此支持进一步实施这种综合报告。