Determination of "borderline resectable" pancreatic cancer : a global assessment of 30 shades of grey

Henry E. Badgery; Tjuntu Muhlen-Schulte; John R. Zalcberg; Bianka D’souza; Jan F. Gerstenmaier; Craig Pickett; Jaswinder Samra; Daniel Croagh; null Pancreatic Cancer Image Biobank Authorship Group; Farhan Ahmed; Emel Allan; Inna Amelina; Somaiah Aroori; Nalayini Balendran; Ee J. Ban; David Bartlett; Roger Berry; Abraham Bezuidenhout; Ricky Bhogal; Candice Bolan; Louisa Bolm; Cristiana Bonifacio; Adina Borsaru; David Burnett; Nick Butterfield; Roberto Cannella; Giovanni Capretti; Carlos Carnelli; Nikolaos Chatzizacharias; Felix Chingoli; Linda Chu; Wai Pong Chu; Toshimasa Clark; Saxon Connor; Stephen Currin; Jurstine Daruwalla; Domenico De Santis; Ankita Dhawan; Bruno Di Muzio; Marco Dioguardi Burgio; Joel Dunn; Georgios Gemenetzis; Mark Goodwin; Andrew Gray; Christopher Halloran; George Harisis; Heather Harris; Jin He; Elizabeth Hecht; Neil Merrett; null et al

doi:10.1016/j.hpb.2023.07.883

Determination of "borderline resectable" pancreatic cancer : a global assessment of 30 shades of grey

Henry E. Badgery, Tjuntu Muhlen-Schulte, John R. Zalcberg, Bianka D’souza, Jan F. Gerstenmaier, Craig Pickett, Jaswinder Samra, Daniel Croagh, Pancreatic Cancer Image Biobank Authorship Group, Farhan Ahmed, Emel Allan, Inna Amelina, Somaiah Aroori, Nalayini Balendran, Ee J. Ban, David Bartlett, Roger Berry, Abraham Bezuidenhout, Ricky Bhogal, Candice BolanLouisa Bolm, Cristiana Bonifacio, Adina Borsaru, David Burnett, Nick Butterfield, Roberto Cannella, Giovanni Capretti, Carlos Carnelli, Nikolaos Chatzizacharias, Felix Chingoli, Linda Chu, Wai Pong Chu, Toshimasa Clark, Saxon Connor, Stephen Currin, Jurstine Daruwalla, Domenico De Santis, Ankita Dhawan, Bruno Di Muzio, Marco Dioguardi Burgio, Joel Dunn, Georgios Gemenetzis, Mark Goodwin, Andrew Gray, Christopher Halloran, George Harisis, Heather Harris, Jin He, Elizabeth Hecht, Neil Merrett, et al

Western Sydney University

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prog-nosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. Methods: In this multicentre observational study, an international group of 96 clinicians (42 hepato-pancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. Results: Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. Conclusion: Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.

Original language	English
Pages (from-to)	1393-1401
Number of pages	9
Journal	HPB
Volume	25
Issue number	11
DOIs	https://doi.org/10.1016/j.hpb.2023.07.883
Publication status	Published - Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)

Open Access - Access Right Statement

© 2023 The Author(s). Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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10.1016/j.hpb.2023.07.883

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Badgery, H. E., Muhlen-Schulte, T., Zalcberg, J. R., D’souza, B., Gerstenmaier, J. F., Pickett, C., Samra, J., Croagh, D., Pancreatic Cancer Image Biobank Authorship Group, Ahmed, F., Allan, E., Amelina, I., Aroori, S., Balendran, N., Ban, E. J., Bartlett, D., Berry, R., Bezuidenhout, A., Bhogal, R., ... et al (2023). Determination of "borderline resectable" pancreatic cancer : a global assessment of 30 shades of grey. HPB, 25(11), 1393-1401. https://doi.org/10.1016/j.hpb.2023.07.883

@article{79fad5f086db4acebb9f8d89c9d484f1,

title = "Determination of {"}borderline resectable{"} pancreatic cancer : a global assessment of 30 shades of grey",

abstract = "Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prog-nosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. Methods: In this multicentre observational study, an international group of 96 clinicians (42 hepato-pancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. Results: Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. Conclusion: Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.",

author = "Badgery, {Henry E.} and Tjuntu Muhlen-Schulte and Zalcberg, {John R.} and Bianka D{\textquoteright}souza and Gerstenmaier, {Jan F.} and Craig Pickett and Jaswinder Samra and Daniel Croagh and {Pancreatic Cancer Image Biobank Authorship Group} and Farhan Ahmed and Emel Allan and Inna Amelina and Somaiah Aroori and Nalayini Balendran and Ban, {Ee J.} and David Bartlett and Roger Berry and Abraham Bezuidenhout and Ricky Bhogal and Candice Bolan and Louisa Bolm and Cristiana Bonifacio and Adina Borsaru and David Burnett and Nick Butterfield and Roberto Cannella and Giovanni Capretti and Carlos Carnelli and Nikolaos Chatzizacharias and Felix Chingoli and Linda Chu and Chu, {Wai Pong} and Toshimasa Clark and Saxon Connor and Stephen Currin and Jurstine Daruwalla and {De Santis}, Domenico and Ankita Dhawan and {Di Muzio}, Bruno and Burgio, {Marco Dioguardi} and Joel Dunn and Georgios Gemenetzis and Mark Goodwin and Andrew Gray and Christopher Halloran and George Harisis and Heather Harris and Jin He and Elizabeth Hecht and Neil Merrett and {et al}",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2023",

month = nov,

doi = "10.1016/j.hpb.2023.07.883",

language = "English",

volume = "25",

pages = "1393--1401",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier",

number = "11",

}

Badgery, HE, Muhlen-Schulte, T, Zalcberg, JR, D’souza, B, Gerstenmaier, JF, Pickett, C, Samra, J, Croagh, D, Pancreatic Cancer Image Biobank Authorship Group, Ahmed, F, Allan, E, Amelina, I, Aroori, S, Balendran, N, Ban, EJ, Bartlett, D, Berry, R, Bezuidenhout, A, Bhogal, R, Bolan, C, Bolm, L, Bonifacio, C, Borsaru, A, Burnett, D, Butterfield, N, Cannella, R, Capretti, G, Carnelli, C, Chatzizacharias, N, Chingoli, F, Chu, L, Chu, WP, Clark, T, Connor, S, Currin, S, Daruwalla, J, De Santis, D, Dhawan, A, Di Muzio, B, Burgio, MD, Dunn, J, Gemenetzis, G, Goodwin, M, Gray, A, Halloran, C, Harisis, G, Harris, H, He, J, Hecht, E, Merrett, N & et al 2023, 'Determination of "borderline resectable" pancreatic cancer : a global assessment of 30 shades of grey', HPB, vol. 25, no. 11, pp. 1393-1401. https://doi.org/10.1016/j.hpb.2023.07.883

TY - JOUR

T1 - Determination of "borderline resectable" pancreatic cancer : a global assessment of 30 shades of grey

AU - Badgery, Henry E.

AU - Muhlen-Schulte, Tjuntu

AU - Zalcberg, John R.

AU - D’souza, Bianka

AU - Gerstenmaier, Jan F.

AU - Pickett, Craig

AU - Samra, Jaswinder

AU - Croagh, Daniel

AU - Pancreatic Cancer Image Biobank Authorship Group, null

AU - Ahmed, Farhan

AU - Allan, Emel

AU - Amelina, Inna

AU - Aroori, Somaiah

AU - Balendran, Nalayini

AU - Ban, Ee J.

AU - Bartlett, David

AU - Berry, Roger

AU - Bezuidenhout, Abraham

AU - Bhogal, Ricky

AU - Bolan, Candice

AU - Bolm, Louisa

AU - Bonifacio, Cristiana

AU - Borsaru, Adina

AU - Burnett, David

AU - Butterfield, Nick

AU - Cannella, Roberto

AU - Capretti, Giovanni

AU - Carnelli, Carlos

AU - Chatzizacharias, Nikolaos

AU - Chingoli, Felix

AU - Chu, Linda

AU - Chu, Wai Pong

AU - Clark, Toshimasa

AU - Connor, Saxon

AU - Currin, Stephen

AU - Daruwalla, Jurstine

AU - De Santis, Domenico

AU - Dhawan, Ankita

AU - Di Muzio, Bruno

AU - Burgio, Marco Dioguardi

AU - Dunn, Joel

AU - Gemenetzis, Georgios

AU - Goodwin, Mark

AU - Gray, Andrew

AU - Halloran, Christopher

AU - Harisis, George

AU - Harris, Heather

AU - He, Jin

AU - Hecht, Elizabeth

AU - Merrett, Neil

AU - et al, null

PY - 2023/11

Y1 - 2023/11

N2 - Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prog-nosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. Methods: In this multicentre observational study, an international group of 96 clinicians (42 hepato-pancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. Results: Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. Conclusion: Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.

AB - Background: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prog-nosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. Methods: In this multicentre observational study, an international group of 96 clinicians (42 hepato-pancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. Results: Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. Conclusion: Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.

UR - https://hdl.handle.net/1959.7/uws:74103

U2 - 10.1016/j.hpb.2023.07.883

DO - 10.1016/j.hpb.2023.07.883

M3 - Article

SN - 1365-182X

VL - 25

SP - 1393

EP - 1401

JO - HPB

JF - HPB

IS - 11

ER -

Determination of "borderline resectable" pancreatic cancer : a global assessment of 30 shades of grey

Abstract

Bibliographical note

Open Access - Access Right Statement

UN SDGs

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