5035 - Advantage of three-dimensional image analysis of pancreatic cancer using computed tomography

Background

Although pancreatic cancer has irregular shape in three-dimensional (3D), when T staging by imaging, only the axial plane is generally used to measure the largest diameter of the mass. We analysed the size of the pancreatic cancer from multi-plane and 3D reconstructed CT images and investigated their clinical usefulness.

Methods

Patients who underwent surgery for pancreatic adenocarcinoma from 2009 to 2016 were included in this study. We measured the largest diameter of pancreatic cancer in axial, coronal, and sagittal planes of CT. In addition, semi-automated segmentation was performed and three-dimensional (3D) maximal diameter and cancer volume were obtained. The obtained data were compared with the actual pathology report and the effect of each value on prognosis was analyzed by receiver operating characteristics (ROC) curves.

Results

A total of 183 patients were analyzed. The maximal pathologic diameter of cancer was 3.4 ± 1.4 cm and median survival was 18.1 months. The maximal diameters measured in axial, coronal, and sagittal planes were 2.9 ± 1.1, 3.2 ± 1.0, and 3.2 ± 0.9, respectively, which were significantly smaller than pathologic data (all p < 0.05 by paired T test). The longest diameter among measured on the 3 planes (3.4 ± 1.1) were not significantly different from that of pathologic report and maximal diameter from 3D image (3.8 ± 1.3) was larger than pathologic diameter. Cancer volume demonstrated the higher area under the ROC curve [0.714, (95% confidence interval: 0.640-0.788)] in predicting early death within 18 months than any measured diameter.

Conclusions

The diameter of pancreatic cancer needs to be measured on all of axial, coronal, and sagittal planes of CT. Cancer volume had a stronger correlation with overall survival than cancer diameter.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

The National Research Foundation of Korea.

Disclosure

All authors have declared no conflicts of interest.