Comparative Effectiveness Review Number 141 Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma Comparative Effectiveness Review Number 141 Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2012-00011-I Prepared by: ECRI Institute-Penn Medicine Evidence-based Practice Center Plymouth Meeting, PA Investigators: Jonathan Treadwell, Ph.D. Matthew Mitchell, Ph.D. Kelley Eatmon, M.P.H. Jane Jue, M.D., M.Sc. Hanna Zafar, M.D., M.H.S. Ursina Teitelbaum, M.D. Karen Schoelles, M.D., S.M., FACP AHRQ Publication No. 14-EHC045-EF September 2014 This report is based on research conducted by the ECRI Institute-Penn Medicine Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00011-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report. This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Treadwell JR, Mitchell MD, Eatmon K, Jue J, Zafar H, Teitelbaum U, Schoelles K. Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma. Comparative Effectiveness Review No. 141. (Prepared by the ECRI Institute-Penn Medicine Evidence-based Practice Center under Contract No. 290-2012-00011-I.) AHRQ Publication No.14-EHC045-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an e-mail list to learn about new program products and opportunities for input. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Richard G. Kronick, Ph.D. Yen-Pin Chiang, Ph.D. Director Acting Deputy Director Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Nahed El-Kassar, M.D., Ph.D. Director Task Order Officer Evidence-based Practice Program Center for Evidence and Practice Center for Evidence and Practice Improvement Improvement Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments We greatly appreciate the assistance of numerous ECRI Institute–Penn Medicine EPC employees including Eloise DeHaan (copyediting), Lydia Dharia (document formatting, reference list generation and reference formatting), Helen Dunn (document retrieval, database organization), Gina Giradi (conference call planning, conference call note-taking, project management), Allison Gross (literature search), Janice Kaczmarek (project management), Tracy Monastero-Stem (document retrieval), and Craig Umscheid (recruiting clinical coauthors, key informants, and technical experts and reviewing the protocol and portions of the final draft). Key Informants In designing the study questions, the EPC consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of t heir role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who participated in developing this report follows: Elliot K. Fishman, M.D., FACR Professor of Radiology, Surgery and Oncology Director, Diagnostic Imaging and Body CT Johns Hopkins Hospital Baltimore, MD Juliet Jegasothy, M.D. Medical Advisor, Department of Medical Management University of Pittsburgh Medical Center Health Plan Pittsburgh, PA Michael L. Kochman, M.D., FAP C Wilmott Family Professor of Medicine Vice-Chair of Medicine for Clinical Services Center for Endoscopic Innovation, Research, and Training Gastroenterology Division University of Pennsylvania Health System Philadelphia, PA Jeffrey E. Lee, M.D. Department Chair, Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston, TX iv Evan Siegelman, M.D. Associate Professor of Radiology Chief, MRI Section Hospital of the University of Pennsylvania Philadelphia, PA Anitra Talley Director of Patient Services and Medical Relations Pancreatic Cancer Action Network Manhattan Beach, CA Margaret Tempero, M.D. Director, University of California, San Francisco Pancreas Center Helen Diller Family Comprehensive Cancer Center San Francisco, CA Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The Task Order Officer (TOO) and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who participated in developing this report follows: Jeffrey A. Drebin, M.D., Ph.D., FACS Chair, Department of Surgery University of Pennsylvania Perelman School of Medicine Philadelphia, PA Elliot K. Fishman, M.D., FACR Professor of Radiology, Surgery and Oncology Director, Diagnostic Imaging and Body CT Johns Hopkins Hospital Baltimore, MD Matthew H.G. Katz, M.D., FACS Assistant