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

  • Stefan Reischl
  • , Sebastian Ziegelmayer
  • , Markus Graf
  • , Joshua Gawlitza
  • , Andreas Philipp Sauter
  • , Manuel Steinhardt
  • , Marie Christin Weber
  • , Philipp Alexander Neumann
  • , Marcus Richard Makowski
  • , Fabian Karl Lohöfer
  • , Carolin Mogler
  • , Rickmer Früdd Braren
  • Technical University of Munich
  • German Cancer Research Center

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number7319
JournalJournal of Clinical Medicine
Volume12
Issue number23
DOIs
StatePublished - Dec 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

  1. SDG 3 - Good Health and Well-being
    SDG 3 Good Health and Well-being

Keywords

  • biopsy
  • computed tomography
  • imaging
  • intervention
  • necrosis
  • pancreatic cancer

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