Value addition by subspecialty trained radiologists in multidisciplinary tumor boards for pancreatic adenocarcinoma: a systematic review and meta-analysis.

[OBJECTIVE] To perform a systematic review assessing the role of subspecialty radiologist in a multidisciplinary team (MDT) focused on pancreatic adenocarcinoma (PDAC) and the impact on patient outcomes.

[METHODS AND MATERIALS] Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science searched until August 31, 2023, for studies including radiology review in PDAC MDT. Data extraction, risk of bias, and applicability assessment were performed by two authors. Random-effects meta-analysis was performed.

[RESULTS] Ten studies (four retrospective, six prospective, and four multi-center vs. six single center), including 2,067 patients, met inclusion criteria in a pool of 13,043 studies. Three studies including 977 patients demonstrated succinct changes in patient management (average estimate 0.53 (95% CI 0.50-0.56)) after a radiology review at the MDT. A random-effects meta-analysis of these studies show that approximately 44% of patients had their treatment plans changed after a meeting at the MDT that included a subspecialty trained radiologist, but there is a large range of uncertainty (18%-74%) due to differences in the studies' groups, what they considered a "change" and local practices. Two studies highlighted an important nuance: while MDT input is valuable, the interpretations can vary between teams or even within the same team over time, reflecting the complex nature of PDAC. None of the studies showed a statistically significant survival advantage solely from MDT involvement, likely because overall survival depends on many downstream factors.

[CONCLUSIONS] The presence of radiology review in the setting of multidisciplinary team meetings provides crucial information, leading to management changes. Future studies could explore advanced imaging modalities such as PET-MRI and establish the impact of intra/interobserver variability within the multidisciplinary team.

[CLINICAL RELEVANCE/APPLICATION] This work highlights the ongoing involvement of subspecialty trained radiologists in the multidisciplinary team for PDAC, and it significantly influences clinical decisions. Applicability concerns exist due to a potential lack of resources for robust MDT initiatives outside of tertiary centers.