• Jane Wang, Amir Ashraf Ganjouei, Fernanda Romero-Hernandez, Laleh Foroutani, Dorukhan Bahceci, Aletta Deranteriassian, Megan Casey, Po-Yi Li, Sina Houshmand, Spencer Behr, Neema Jamshidi, Sharmila Majumdar, Timothy Donahue, Grace E Kim, Zhen Jane Wang, Lucas W Thornblade, Mohamed Adam, and Adnan Alseidi.
• Department of Surgery, University of California, San Francisco, CA.
• Ann. Surg. 2024 Aug 23.

ObjectiveTo evaluate the feasibility of developing a computer vision algorithm that uses preoperative computed tomography (CT) scans to predict superior mesenteric artery (SMA) margin status in patients undergoing Whipple for pancreatic ductal adenocarcinoma (PDAC), and to compare algorithm performance to that of expert abdominal radiologists and surgical oncologists.Summary Background DataComplete surgical resection is the only chance to achieve a cure for PDAC; however, current modalities to predict vascular invasion have limited accuracy.MethodsAdult patients with PDAC who underwent Whipple and had preoperative contrast-enhanced CT scans were included (2010-2022). The SMA was manually annotated on the CT scans, and we trained a U-Net algorithm for SMA segmentation and a ResNet50 algorithm for predicting SMA margin status. Radiologists and surgeons reviewed the scans in a blinded fashion. SMA margin status per pathology reports was the reference.ResultsTwo hundred patients were included. Forty patients (20%) had a positive SMA margin. For the segmentation task, the U-Net model achieved a Dice Similarity Coefficient of 0.90. For the classification task, all readers demonstrated limited sensitivity, although the algorithm had the highest sensitivity at 0.43 (versus 0.23 and 0.36 for the radiologists and surgeons, respectively). Specificity was universally excellent, with the radiologist and algorithm demonstrating the highest specificity at 0.94. Finally, the accuracy of the algorithm was 0.85 versus 0.80 and 0.76 for the radiologists and surgeons, respectively.ConclusionsWe demonstrated the feasibility of developing a computer vision algorithm to predict SMA margin status using preoperative CT scans, highlighting its potential to augment the prediction of vascular involvement.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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