Evaluate resectability for borderline resectable tumor. Only five articles that addressed the topic of preoperative therapy in the context of staging a tumor were identified in the literature search. CT CT Only very limited information is available regarding staging in the setting of preoperative chemotherapy and/or radiation therapy. Challenges include differences in treatment regimens. A small study comparing 31 patients who had undergone neoadjuvant therapy (between 2005 and 2010) for locally advanced disease that went on to attempted curative resection with a control group of 41 patients who went directly to surgery showed that the accuracy of MDCT (in this study, 16- and 64-detector row) for determining resectability was significantly less in the neoadjuvant group (58% versus 83%), primarily secondary to an overestimation of vascular invasion [50]. This study was limited by a mix of treatment regimens including chemotherapy alone, radiation therapy alone, and combination chemoradiation. Other studies have also shown that imaging signs of vascular involvement by tumor persist even after successful therapy because of the inability of imaging to distinguish viable from nonviable tumor [51,52]. No information was available from our search in regard to the accuracy of identifying nodal metastases, liver metastases, or peritoneal disease in the setting of neoadjuvant therapy. MRI The literature search did not identify any studies that examined the accuracy of MRI in the assessment of staging following preoperative therapy. EUS The literature search did not identify any studies that examined the accuracy of EUS in the assessment of vascular involvement by tumor following neoadjuvant therapy. US The literature search did not identify any studies that examined the accuracy of transabdominal US in the assessment of vascular involvement by tumor following neoadjuvant therapy.
Staging of Pancreatic Ductal Adenocarcinoma. Evaluate resectability for borderline resectable tumor. Only five articles that addressed the topic of preoperative therapy in the context of staging a tumor were identified in the literature search. CT CT Only very limited information is available regarding staging in the setting of preoperative chemotherapy and/or radiation therapy. Challenges include differences in treatment regimens. A small study comparing 31 patients who had undergone neoadjuvant therapy (between 2005 and 2010) for locally advanced disease that went on to attempted curative resection with a control group of 41 patients who went directly to surgery showed that the accuracy of MDCT (in this study, 16- and 64-detector row) for determining resectability was significantly less in the neoadjuvant group (58% versus 83%), primarily secondary to an overestimation of vascular invasion [50]. This study was limited by a mix of treatment regimens including chemotherapy alone, radiation therapy alone, and combination chemoradiation. Other studies have also shown that imaging signs of vascular involvement by tumor persist even after successful therapy because of the inability of imaging to distinguish viable from nonviable tumor [51,52]. No information was available from our search in regard to the accuracy of identifying nodal metastases, liver metastases, or peritoneal disease in the setting of neoadjuvant therapy. MRI The literature search did not identify any studies that examined the accuracy of MRI in the assessment of staging following preoperative therapy. EUS The literature search did not identify any studies that examined the accuracy of EUS in the assessment of vascular involvement by tumor following neoadjuvant therapy. US The literature search did not identify any studies that examined the accuracy of transabdominal US in the assessment of vascular involvement by tumor following neoadjuvant therapy.