In that study, MDCT had a sensitivity of 48.4% and specificity of 98% for liver metastases compared to CTAP + CTHA, which had a sensitivity of 94.2% and specificity of 82.7%. Although the results of CTAP + CTHA were impressive, the data regarding current state-of-the-art MDCT are not representative of modern practice. Peritoneal metastases from pancreatic cancer are typically difficult to identify by any of the modalities because of their typically small size or miliary appearance. In our literature search, no studies that tried to assess overall sensitivity for peritoneal metastases by CT were available, likely because patients were already found to have unresectable disease secondary to other causes such as liver metastases or extensive vascular involvement. Studies that were retrieved in our examination focused on the question of the additional usefulness of preoperative laparoscopic assessment following CT. Results have been controversial, but indirectly these provide information regarding whether CT is sufficient for detection of peritoneal disease for disease management. A meta-analysis of 1,015 patients across 15 studies concluded that, on average, out of 100 patients identified as having resectable disease based on CT, use of follow-up laparoscopy would have avoided 23 unnecessary laparotomies [38]. Another recent meta-analysis that analyzed 12 studies between 1999 and 2010 showed a pooled sensitivity of laparoscopic assessment of 75% for peritoneal implants [39]. In our anecdotal experience, institutions will variably use laparoscopy, sometimes in the setting of suspicion for peritoneal disease, but for some others more globally, with or without laparoscopic peritoneal washing, with the plan to proceed directly to laparotomy at the same setting for planned pancreatic resection in the absence of detection of peritoneal disease.
Staging of Pancreatic Ductal Adenocarcinoma. In that study, MDCT had a sensitivity of 48.4% and specificity of 98% for liver metastases compared to CTAP + CTHA, which had a sensitivity of 94.2% and specificity of 82.7%. Although the results of CTAP + CTHA were impressive, the data regarding current state-of-the-art MDCT are not representative of modern practice. Peritoneal metastases from pancreatic cancer are typically difficult to identify by any of the modalities because of their typically small size or miliary appearance. In our literature search, no studies that tried to assess overall sensitivity for peritoneal metastases by CT were available, likely because patients were already found to have unresectable disease secondary to other causes such as liver metastases or extensive vascular involvement. Studies that were retrieved in our examination focused on the question of the additional usefulness of preoperative laparoscopic assessment following CT. Results have been controversial, but indirectly these provide information regarding whether CT is sufficient for detection of peritoneal disease for disease management. A meta-analysis of 1,015 patients across 15 studies concluded that, on average, out of 100 patients identified as having resectable disease based on CT, use of follow-up laparoscopy would have avoided 23 unnecessary laparotomies [38]. Another recent meta-analysis that analyzed 12 studies between 1999 and 2010 showed a pooled sensitivity of laparoscopic assessment of 75% for peritoneal implants [39]. In our anecdotal experience, institutions will variably use laparoscopy, sometimes in the setting of suspicion for peritoneal disease, but for some others more globally, with or without laparoscopic peritoneal washing, with the plan to proceed directly to laparotomy at the same setting for planned pancreatic resection in the absence of detection of peritoneal disease.