Time Interval Between Abnormalities Seen on CT and the Clinical Diagnosis of Pancreatic Cancer: Retrospective Review of CT Scans Obtained Before Diagnosis

Abstract

CT can detect a significant proportion of asymptomatic incident pancreatic cancers before the clinical diagnosis of pancreatic cancer. CT should be considered in screening at-risk patient populations. Pancreatic duct dilatation and cutoff are early findings associated with the development of pancreatic cancer and can be detected on CT with a high degree of reproducibility.

Detecting Early Pancreatic Cancer: Problems and Prospects

“…The two radiologists agreed that CT findings definite or suspicious for pancreatic cancer were present in 50% of scans performed 2 to 6 months and 6 to 18 months prior to the diagnosis of pancreatic cancer (3/6 and 4/8 scans, respectively), but in only 7% (1/15) of scans performed greater than 18 months prior to diagnosis (18). Pancreatic ductal dilation and cutoff were early CT findings identified by both radiologists, and associated with near-perfect and substantial interobserver agreement (κ = 0.84 and 0.76, respectively).…”

“…Pancreatic ductal dilation and cutoff were early CT findings identified by both radiologists, and associated with near-perfect and substantial interobserver agreement (κ = 0.84 and 0.76, respectively). 95% confidence intervals of specificity for tumor absence ranged from 92% to 100% (18).…”

“…To further understand the natural history of invasive cancer we did a study in which two radiologists blindly interpreted 62 CTs performed prior to clinical diagnosis (usually for reasons other than pancreas related symptoms) in 28 pancreatic cancer patients and 89 CTs in 89 controls, noting specific CT findings (18). The two radiologists agreed that CT findings definite or suspicious for pancreatic cancer were present in 50% of scans performed 2 to 6 months and 6 to 18 months prior to the diagnosis of pancreatic cancer (3/6 and 4/8 scans, respectively), but in only 7% (1/15) of scans performed greater than 18 months prior to diagnosis (18).…”

Impact of tumor size on survival outcome of pancreatic carcinoma following pancreatic resection: A systematic review and meta-analysis

“…This can be reasoned as many pancreatic cancer patients remain asymptomatic until late and CT or MRI findings of very small tumors are often understated and easily overlooked. 59 Thus, most of the patients are easily misdiagnosed and usually present late with the classical symptoms and larger tumor diameters. Therefore, a more practical and innovative approach towards early detection of pancreatic cancer is a necessity and may be the only approach to improve the current long term effectiveness of pancreatic carcinoma.…”

“…In addition, radiological finding of early pancreatic cancer is not adequate to support for performing major surgery like PD, particularly if patient is asymptomatic. 60,61 Gangi et al 59 described the presence of pancreatic ductal dilation without any identifiable mass several months before final diagnosis of pancreatic cancer. Endoscopic ultrasound-guided FNA (EUS-FNA) is believed to provide cytological diagnosis with specificity of around 100%.…”