CT Attenuation of Hepatic Pancreatic Cancer Metastases Correlates with Prognostically Detrimental Metastatic Necrosis.

Reischl, Stefan; Ziegelmayer, Sebastian; Graf, Markus; Gawlitza, Joshua; Sauter, Andreas Philipp; Steinhardt, Manuel; Weber, Marie-Christin; Neumann, Philipp-Alexander; Makowski, Marcus Richard; Lohöfer, Fabian Karl; Mogler, Carolin; Braren, Rickmer Früdd

doi:10.3390/jcm12237319

2023

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Title:: CT Attenuation of Hepatic Pancreatic Cancer Metastases Correlates with Prognostically Detrimental Metastatic Necrosis.
Document type:: Journal Article
Author(s):: Reischl, Stefan; Ziegelmayer, Sebastian; Graf, Markus; Gawlitza, Joshua; Sauter, Andreas Philipp; Steinhardt, Manuel; Weber, Marie-Christin; Neumann, Philipp-Alexander; Makowski, Marcus Richard; Lohöfer, Fabian Karl; Mogler, Carolin; Braren, Rickmer Früdd
Abstract:: Percutaneous CT-guided biopsy is a frequently performed procedure for the confirmation and molecular workup of hepatic metastases of pancreatic ductal adenocarcinoma (PDAC). Tumor necrosis of primary PDAC has shown a negative prognostic impact in recent studies. This study aims to examine predictability in CT scans and the prognostic impact of necrosis in hepatic metastases of PDAC. In this tertiary-center retrospective cohort study, we included 36 patients with hepatic metastases of PDAC who underwent CT-guided hepatic biopsies. Normalized attenuation of the biopsied metastasis was determined in venous phase contrast-enhanced planning scans obtained prior to biopsy by automatic, threshold-based 3D segmentation and manual, blinded 2D segmentation. A board-certified pathologist specialized in hepatic pathology histologically quantified the tumor necrosis and cellularity of the biopsy cylinders. We found a significant inverse-linear correlation between normalized attenuation and the fraction of necrosis (Pearson's r = 0.51, p < 0.001 for automatic 3D segmentation or Pearson's r = 0.52, p < 0.001 for manual 2D segmentation), whereas no correlation was found with tumor cellularity. Additionally, we discovered that patients with a fraction of necrosis ≥ 20% in metastases had a significantly shorter overall survival (p < 0.035). In summary, tumor necrosis of PDAC metastases can be estimated from contrast-enhanced CT scans, which could help to improve biopsy sample pattern planning. In addition, liver metastatic necrosis may serve as a prognostic biomarker in PDAC.
Journal title abbreviation:: J Clin Med
Year:: 2023
Journal volume:: 12
Journal issue:: 23
Fulltext / DOI:: doi:10.3390/jcm12237319
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/38068377
TUM Institution:: Institut für Diagnostische und Interventionelle Radiologie (Prof. Makowski); Klinik und Poliklinik für Chirurgie (Prof. Friess)
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