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

Author:

Reischl Stefan1ORCID,Ziegelmayer Sebastian1,Graf Markus1,Gawlitza Joshua1,Sauter Andreas Philipp1ORCID,Steinhardt Manuel1,Weber Marie-Christin2ORCID,Neumann Philipp-Alexander2,Makowski Marcus Richard1,Lohöfer Fabian Karl1,Mogler Carolin3ORCID,Braren Rickmer Früdd14

Affiliation:

1. Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany

2. Department of Surgery, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany

3. Institute of Pathology, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany

4. German Cancer Consortium (DKTK, Partner Site Munich), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany

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.

Funder

German research foundation

Publisher

MDPI AG

Subject

General Medicine

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