Role of Multidetector Computed Tomography in Assessing Resectability of Pancreatic Ductal Adenocarcinoma and the Utility of Structured Template-Based Reporting: A Hospital-Based Observational Study

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive gastrointestinal malignancies and is associated with poor survival. Accurate preoperative staging and assessment of resectability are crucial for selecting appropriate candidates for curative surgery. Multidetector computed tomography (MDCT) with pancreatic protocol is considered the imaging modality of choice for evaluating local tumor extent, vascular invasion, metastatic disease, and surgical resectability. Structured template-based reporting has recently gained importance in improving communication between radiologists and surgeons. Based on this objective of this study is to evaluate the efficacy of MDCT in detecting, staging, and assessing the resectability of pancreatic ductal adenocarcinoma and to determine the utility of structured template-based reporting. Materials and Methods: A hospital-based observational descriptive study was conducted in the Department of Radiodiagnosis, Coimbatore Medical College Hospital, from June 2021 to June 2022. Thirty adult patients with ultrasonographically suspected pancreatic adenocarcinoma underwent contrast-enhanced MDCT using a pancreatic protocol. Tumors were staged according to TNM criteria, vascular invasion was assessed using Lu, Loyer, and Raptopoulos grading systems, and resectability was categorized as resectable, borderline resectable, or unresectable. Structured template-based reporting was utilized in all cases. Statistical analysis was performed using SPSS and Microsoft Excel. Results: The majority of patients were males (90%) and belonged to the 51–60-year age group (50%). The pancreatic head was the commonest site of involvement (86%). Abdominal pain was the predominant presenting symptom (80%). Peripancreatic infiltration was observed in 93% of patients, while regional lymph node involvement was present in 90%. Liver metastasis was identified in 30% and peritoneal metastasis in 13% of cases. MDCT classified 47% of tumors as resectable, 40% as borderline resectable, and 13% as unresectable. Significant associations were observed between vascular grading systems and surgical outcomes (p<0.05). MDCT demonstrated 100% sensitivity, 67% specificity, 71% positive predictive value, 100% negative predictive value, and 82% overall accuracy in predicting resectability. Conclusion: MDCT with pancreatic protocol is highly effective in the preoperative staging and resectability assessment of PDAC. Structured template-based reporting improves completeness of radiological evaluation, facilitates surgical planning, and enhances communication between radiologists and surgeons.

Keywords: Pancreatic ductal adenocarcinoma; Multidetector computed tomography; Resectability; Structured reporting; Vascular invasion; Pancreatic cancer staging.