Imaging-based diagnosis of pancreatic cancer: a systematic review and meta-analysis of direct comparative studies

Abstract Objectives Pancreatic ductal adenocarcinoma (PDAC) is a fast-evolving malignancy, with resection being the only chance of cure. We aim to determine which imaging technique provides the best diagnostic performance in detecting and assessing the spread of PDAC. Materials and methods Our study was registered on PROSPERO (CRD42024567008). On July 9, 2024, a systematic search was conducted in three databases, focusing on direct comparative studies that reported on patients suspected of PDAC who underwent at least two imaging methods. When available, the reference test was represented by pathological examinations, and the diagnostic performance of each diagnostic method was assessed. A bivariate model was used to calculate the pooled sensitivity and specificity, along with 95% confidence intervals (CI) for the meta-analysis. Results Forty direct comparative studies were eligible for meta-analysis. CT, MRI, and endoscopic ultrasound (EUS) had no significant differences in diagnostic performance for detecting PDAC. MRI showed higher sensitivity [0.89 [0.67–0.97]) and specificity (0.91 [0.76–0.97]) compared to CT (sensitivity 0.60 (CI: 0.44–0.74) and specificity 0.84 [CI: 0.70–0.93]) in distinguishing liver metastases. CT outperformed MRI for vascular invasion assessment. For lymph node detection, EUS proved to have higher sensitivity than CT or FDG-PET/CT. CT had a higher specificity (0.88 [CI: 0.76–0.94]) compared to MRI (0.63 [CI: 0.48–0.76]) when assessing resectability. Conclusion MRI has a higher pooled sensitivity and specificity for detecting liver metastases of PDAC compared to CT, while the specificity of CT proves to be higher than that of MRI for assessing resectability. Key Points Question Given the pancreatic cancer’s tight therapeutic window and the need for precise diagnosis, we aim to determine how to best assess it with imaging techniques . Findings MRI has a significantly higher pooled sensitivity for liver metastases detection than CT. CT has a significantly higher pooled sensitivity for vascular invasion and specificity for resectability assessment than MRI . Clinical relevance A liver MRI may provide additional value before potentially curative surgery to rule out small metastases. CT should be performed to search for additional metastatic sites and exclude non-resectable cases. Both imaging techniques provide valuable information for assessing pancreatic cancer .