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Diagnostic accuracy of CT in assessing extra regional lymphadenopathy in pancreatic cancer and Perimaginal Cancer: Systematic review and meta-analysis

Gunter Schneider

Objectives: Computed tomography (CT) is the most widely used method to assess respectability of pancreatic and peri-ampullary cancer. One of the contraindicationsfor curative resection is the presence of extra regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra regional lymph node metastases in pancreatic and peri-ampullary cancer. Methods: We systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra regional lymph nodes in patients undergoing pancreas to duo denectomy were included. Data on baseline characteristics, CT investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data. Results: After screening, 4 cohort studies reporting on CT findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80100% and 6790% respectively. However, PPV and sensitivity ranged from 0 to 100% and 038%. The pooled sensitivity, specificity, PPV, and NPV were 25%, 86%, 28%, and 84%, respectively. Conclusion: CT has poor diagnostic accuracy in assessing extra regional lymph node metastases in pancreatic cancer and perimaginal cancer. Therefore, suspicion of extra regional lymph node metastasis on CT alone should not be considered a contraindication to exploration.