Determination of “borderline resectable” pancreatic cancer – A global assessment of 30 shades of grey
Henry Badgery, Tjuntu Muhlen‐Schulte, John Zalcberg, Bianka D'souza, Jan Gerstenmaier, Craig W. Pickett, Jaswinder S. Samra, Daniel Croagh, Farhan Jalees Ahmed, Emel Allan, I. D. Amelina, Somaiah Aroori, Nalayini Balendran, Ee Jun Ban, David Bartlett, Roger Berry, Abraham F. Bezuidenhout, Ricky H. Bhogal, Candice W. Bolan, Louisa Bolm, Cristiana Bonifacio, Adina Borsaru, David Burnett, Nick Butterfield, Roberto Cannella, Giovanni Capretti, Carlos Carnelli, N. Chatzizacharias, Felix Chingoli, Linda C. Chu, W. 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 A. Harris, Jin He, Elizabeth M. Hecht, Asmus Heumann, Russell Hodgson, Cathryn Hui, Petr Kalinin, Jörg Kleeff, Hyun Soo Ko, Ksenia Kozyreva, Numan Kutaiba, Joel Lewin, Christopher Seng Hong Lim, Fabian Lohöfer, Benjamin Loveday, Giovanni Marchegiani, Katerina Mastrocostas, Vasileios Mavroeidis, Neil D. Merrett, Martina Nebbia, John P. Neoptolemos, Д. В. Нестеров, Charles Pilgrim, Bradley N. Reames, Alistair Rowcroft, Melanie Seale, Sabbir Siddique, Marty Smith, Gavin Sugrue, Jatin Thakur, Thomas F. Rose, Walid Tibermacine, Parag Tolat, Charikleia Triantopoulou, S. L. Trofimov, Faik G. Uzunoǧlu, Federica Vernuccio, Diederick W. De Boo, Laurence Webber, Alice C. Wei, Verity Wood, Marc Zins
Abstract
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. 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 hepatopancreatobiliary 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.