Imaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy

Toft, James A; Hadden, William J.; Laurence, Jerome M.; Lam, Vincent; Yuen, Lawrence; Janssen, Anna; Pleass, Henry

doi:10.1016/j.ejrad.2017.04.009

Cited by 92 publications

(65 citation statements)

References 62 publications

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“…7,8,24 Limitations and Strengths given lack of data on the potential effectiveness of currently available early detection strategies based on either cross-sectional imaging or endosonography to improve survival in pancreatic cancer. [25][26][27] Despite the study limitations, the present study has multiple strengths. These include the relatively large sample size and racially/ethnically diverse study population.…”

Section: Discussionmentioning

confidence: 98%

Association of Glycated Hemoglobin Levels With Risk of Pancreatic Cancer

Butler

Lustigova

et al. 2020

JAMA Netw Open

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IMPORTANCE New-onset diabetes after the age of 50 years is a potential indicator of pancreatic cancer. Understanding the associations between hyperglycemia, diabetes, and pancreatic cancer, including pancreatic ductal adenocarcinoma, is key to developing an approach to early detection. OBJECTIVE To assess the association of elevation in glycated hemoglobin (HbA 1c) with the risk of pancreatic cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data collected from an integrated health care system in California. A total of 851 402 patients aged 50 to 84 years who had HbA 1c measurements taken between 2010 and 2014 were identified as the base cohort, with 12 contemporaneous cohorts created based on varying HbA 1c thresholds (ie, 6.1%, 6.3%, 6.5%, and 6.7%) and prior diabetes status. Data analysis was conducted from August 2018 to September 2019. MAIN OUTCOMES AND MEASURES New cases of pancreatic cancer identified through cancer registry and California death files during a 3-year period. Three-year risk, incidence rate, sensitivity, number of patients needed to screen to detect 1 case, timing, and stage at diagnosis were determined. RESULTS Among 851 402 patients in the base cohort, 447 502 (52.5%) were women, 255 441 (30.0%) were Hispanic participants, 383 685 (45.1%) were non-Hispanic white participants, 100 477 (11.8%) were Asian participants, and 88 969 (10.4%) were non-Hispanic black participants, with a median (interquartile range) age of 62 (56-69) years and a median (interquartile range) HbA 1c level of 6.0% (5.7%-6.6%). The incidence rate of pancreatic cancer was 0.45 (95% CI, 0.43-0.49) per 1000 person-years. After excluding prior diabetes as well as confirmation of new-onset hyperglycemia based on an HbA 1c level of 6.5%, a total of 20 012 patients remained, with 74 of 1041 pancreatic ductal adenocarcinoma cases (7.1%) from the base cohort included. The rate of pancreatic cancer was 0.72 (95% CI, 0.32-1.42) per 1000 person-years among Asian patients, 0.83 (95% CI, 0.35-1.71) per 1000 person-years among non-Hispanic black patients, 0.84 (95% CI, 0.48-1.37) per 1000 person-years among Hispanic patients, and 2.37 (95% CI, 1.75-3.14) per 1000 person-years among non-Hispanic white patients. Overall, 42 of 74 cancers (56.8%) were diagnosed within 1 year of the index laboratory test. Among 1041 total cases, 708 (68.0%) had staging information available, of whom 465 (65.7%) had stage III or IV disease at diagnosis. In the base cohort, the number needed to undergo evaluation to identify a single case of pancreatic ductal adenocarcinoma was 818 (95% CI, 770-869), with estimates ranging from 206 (95% CI, 160-264) to 600 (95% CI, 540-666) in the subcohorts. CONCLUSIONS AND RELEVANCE The findings of this study suggest that screening patients for pancreatic cancer based solely on elevation in HbA 1c level is unlikely to represent an effective (continued) Key Points Question What is the association of elevated glycated hemoglobin levels with the risk of pancreatic cancer? Findings In this coho...

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Section: Discussionmentioning

confidence: 98%

Association of Glycated Hemoglobin Levels With Risk of Pancreatic Cancer

Butler

Lustigova

et al. 2020

JAMA Netw Open

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“…A recent meta-analysis found that differences in sensitivity, specificity, and diagnostic accuracy between magnetic resonance imaging (MRI), CT, transabdominal ultrasound, and EUS failed to reach statistical significance [8] . Although the sensitivity of transabdominal ultrasound varies throughout the literature, it is still often used as an initial test because of its wide availability and relatively low cost; this is balanced by limitations caused by the technical demands and operator variability inherent to the procedure [8] , [9] , [10] , [11] . CT is the most commonly utilized modality for the evaluation of PDAC; its sensitivity ranges from 89% to 97% for tumors larger than 1.5 cm [12] .…”

Section: Discussionmentioning

confidence: 99%

Pancreatocolonic fistulization secondary to pancreatic adenocarcinoma presenting as unexplained halitosis

Manov

Langston

Roth

et al. 2018

Radiology Case Reports

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Pancreatic cancer is often detected in late stages, which contributes to its grim prognosis. Although the manifestations of pancreatic cancer most often include nonspecific gastrointestinal complaints, we report a case with the sole initial complaint of halitosis and subsequent diagnostic workup demonstrating a pancreatic mass with secondary pancreatocolonic fistulization. The etiologies of and the radiological findings pertaining to halitosis, the presenting symptoms and imaging studies relevant to the diagnosis of pancreatic cancer, and the imaging and clinical findings of pancreatic fistulization are discussed.

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“…With respect to mass screening for pancreatic cancer using CT, one of the advantages of CT is the short exam time, which enables the acquisition of many images. A recent meta-analysis of 15 studies including 815 PDAC patients reported that sensitivities for the CT-based detection of PDAC are 90% (95% CI, 87–93%), whereas specificities and accuracy were 87% (95% CI, 79–93%) and 89% (95% CI, 85–93%), respectively [ 118 ]. Obviously, smaller tumors are harder to detect and diagnose; therefore, the detection of small PDAC tumors requires an expert review of the imaging data [ 119 ].…”

Section: Possible Non-invasive Imaging Modalities For Early Detectmentioning

confidence: 99%

“…The reported sensitivity of MRI for the detection of PDAC is 93% (95% CI, 88–96%), as calculated from pooled data from 11 studies that included 349 PDAC patients, whereas the specificity and accuracy were 89% (95% CI, 82–94%) and 90% (95% CI, 86–94%), respectively [ 118 ]. However, compared to CT, MRI has greatly benefited from recent technological advances [ 125 ] that are not well reflected in older studies.…”

Section: Possible Non-invasive Imaging Modalities For Early Detectmentioning

confidence: 99%

Use of Biomarkers and Imaging for Early Detection of Pancreatic Cancer

Kato

Honda

2020

Cancers

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Pancreatic cancer remains one of the deadliest cancers worldwide, and it is typically diagnosed late, with a poor prognosis. Early detection is the most important underlying factor for improving the prognosis of pancreatic cancer patients. One of the most effective strategies for detecting cancers at an early stage is screening of the general population. However, because of the low incidence of pancreatic cancer in the general population, the stratification of subjects who need to undergo further examinations by invasive and expensive modalities is important. Therefore, minimally invasive modalities involving biomarkers and imaging techniques that would facilitate the early detection of pancreatic cancer are highly needed. Multiple types of new blood biomarkers have recently been developed, including unique post-translational modifications of circulating proteins, circulating exosomes, microRNAs, and circulating tumor DNA. We previously reported that circulating apolipoprotein A2 undergoes unique processing in the bloodstream of patients with pancreatic cancer and its precancerous lesions. Additionally, we recently demonstrated a new method for measuring pancreatic proton density in the fat fraction using a fat–water magnetic resonance imaging technique that reflects pancreatic steatosis. In this review, we describe recent developments in potential biomarkers and imaging modalities for the early detection and risk stratification of pancreatic cancer, and we discuss current strategies for implementing screening programs for pancreatic cancer.

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Imaging modalities in the diagnosis of pancreatic adenocarcinoma: A systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy

Cited by 92 publications

References 62 publications

Association of Glycated Hemoglobin Levels With Risk of Pancreatic Cancer

Association of Glycated Hemoglobin Levels With Risk of Pancreatic Cancer

Pancreatocolonic fistulization secondary to pancreatic adenocarcinoma presenting as unexplained halitosis

Use of Biomarkers and Imaging for Early Detection of Pancreatic Cancer

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