The diagnostic pathway for solid pancreatic neoplasms: are we applying too many tests?

Driedger, Michael; Dixon, Elijah; Mohamed, Rachid; Sutherland, Francis; Bathe, Oliver F.; Ball, Chad G.

doi:10.1016/j.jss.2015.04.026

Cited by 12 publications

(11 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A well-defined patient vs. diagnostic interval is crucial, to be able to contextualize findings such as Lyratzopoulos et al observing that 41% of patients eventually diagnosed with pancreatic cancer, visited their general practitioner three or more times before hospital referral; second only to multiple myeloma amongst major cancers (9). This parallels findings in previous investigations, observing that PDAC patients are often subject to a large variance in the diagnostic workup of testing that they receive, and this often has correlates to greater delays and higher healthcare costs (10,11). …”

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Deshwar¹,

Sugar²,

Torto³

et al. 2018

Ann Pancreat Cancer

View full text Add to dashboard Cite

Background Pancreatic ductal adenocarcinoma (PDAC) often presents with nonspecific symptoms and the workup is not standardized. To study the impact of delays in diagnosis and in the initiation of treatment, we investigated the relationship between length of diagnostic intervals and surgical resectability. Methods We performed a retrospective chart review of patients evaluated for PDAC at Johns Hopkins in 2014. Data were collected on the patient (date of first symptoms—first medical appointment), diagnostic (first medical appointment—diagnosis of PDAC), and treatment (diagnosis of PDAC—1st day of treatment) time intervals, and the upfront treatment received. Asymptomatic patients diagnosed incidentally, or for whom records were incomplete, were excluded from analysis. Results Of 453 charts reviewed, 116 patients met inclusion criteria. The median patient interval was 14 days [interquartile range (IQR): 6–30 days], the median diagnostic interval was 22 days (IQR: 8–46 days), and the median treatment interval was 26 days (IQR: 15–35 days). Thirty-eight patients (33%) received upfront surgery and 78 (67%) received nonsurgical treatment. After adjusting for multiple factors, the odds of receiving surgery significantly increased for individuals with a patient interval of 30 days or less [adjusted odds ratio (aOR): 3.41; 95% confidence interval (CI): 1.08–13.20; P=0.050] and with a diagnostic interval of 60 days or less (aOR: 15.68; 95% CI: 2.95–291.00, P=0.009). Conclusions A patient interval less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC are associated with increased odds of upfront surgical resection. These data provide initial evidence that reducing diagnostic delays may lead to improved outcomes in PDAC.

show abstract

Section: Discussionsupporting

confidence: 86%

“…The workup for patients is not standardized and multiple follow-up appointments and studies are often required before a final diagnosis is reached (9). These factors are thought to contribute to diagnostic delays and unnecessary healthcare expenditures in the workup of PDAC (10,11). …”

Section: Introductionmentioning

confidence: 99%

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Deshwar¹,

Sugar²,

Torto³

et al. 2018

Ann Pancreat Cancer

View full text Add to dashboard Cite

show abstract

“…This study was approved by the institutional review board, and written informed consent was obtained from all participants. validated imaging modality for the diagnosis and staging of pancreatic cancer (3,7). However, several studies have shown that contrast-enhanced magnetic resonance (MR) imaging with MR cholangiopancreatography can provide superior tumor conspicuity and similar diagnostic performance in evaluating the tumor resectability of pancreatic cancers compared with multidetector CT (8,9).…”

Section: Methodsmentioning

confidence: 99%

“…Another modality that has shown potential is fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, which has been reported to improve the detection of occult metastases when combined with contrast-enhanced CT in patients with locally resectable pancreatic cancer, ultimately sparing these patients from unnecessary surgery (10)(11)(12). Thus, at present, because of the different advantages of each imaging modality, multimodality imaging studies are being increasingly used in patients with pancreatic cancer at the cost of delayed surgical treatment for resectable diseases owing to this multistep process (3,7,13).…”

Section: Methodsmentioning

confidence: 99%

Preoperative Assessment of Pancreatic Cancer with FDG PET/MR Imaging versus FDG PET/CT Plus Contrast-enhanced Multidetector CT: A Prospective Preliminary Study

Joo¹,

Lee²,

Lee³

et al. 2017

Radiology

View full text Add to dashboard Cite

Purpose To determine the diagnostic performance of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) imaging in the preoperative assessment of pancreatic cancer in comparison with that of FDG PET/computed tomography (CT) plus contrast material-enhanced multidetector CT. Materials and Methods This prospective study was approved by the institutional review board; written informed consent was obtained. Thirty-seven patients with 39 pancreatic tumors underwent preoperative FDG PET/MR imaging, PET/CT, and contrast-enhanced multidetector CT. The authors measured maximal and mean standardized uptake values (SUV and SUV, respectively) of pancreatic cancer at PET/MR imaging and PET/CT. Two radiologists independently reviewed the two imaging sets (set 1, PET/MR imaging; set 2, PET/CT plus multidetector CT) to determine tumor resectability according to a five-point scale, N stage (N0 or N positive), and M stage (M0 or M1). With use of clinical-surgical-pathologic findings as the standard of reference (n = 20), diagnostic performances of the two imaging sets were compared by using the McNemar test. Results Both SUV and SUV of pancreatic tumors showed strong correlations between PET/MR imaging and PET/CT (r = 0.897 and 0.890, respectively; P < .001). The diagnostic performance of PET/MR imaging was not significantly different from that of PET/CT plus multidetector CT in the assessment of tumor resectability (area under the receiver operating characteristic curve: 0.891 vs 0.776, respectively, for reviewer 1 [P = .109] and 0.859 vs 0.797 for reviewer 2 [P = .561]), N stage (accuracy: 54% [seven of 13 patients] vs 31% [four of 13 patients]; P = .250 for both reviewers), and M stage (accuracy: 94% [16 of 17 patients] vs 88% [15 of 17 patients] for reviewer 1 [P > .999] and 94% [16 of 17 patients] vs 82% [14 of 17 patients] for reviewer 2 [P = .500]). Conclusion FDG PET/MR imaging showed a diagnostic performance similar to that of PET/CT plus contrast-enhanced multidetector CT in the preoperative evaluation of the resectability and staging of pancreatic tumors. RSNA, 2016 Online supplemental material is available for this article.

show abstract

“…As long as there is no additional delay in the interval between the initial diagnosis on a CT scan and subsequent evaluation by an experienced pancreatic surgeon, some patients will benefit from undergoing EUS. [ 50 51 ]…”

Section: What Should the Multidisciplinary Team Consider With Respectmentioning

confidence: 99%

A proposal for the ideal algorithm for the diagnosis, staging, and treatment of pancreas masses suspicious for pancreatic adenocarcinoma: Results of a working group of the Canadian Society for Endoscopic Ultrasound

et al. 2020

View full text Add to dashboard Cite

The diagnostic pathway for solid pancreatic neoplasms: are we applying too many tests?

Cited by 12 publications

References 24 publications

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Preoperative Assessment of Pancreatic Cancer with FDG PET/MR Imaging versus FDG PET/CT Plus Contrast-enhanced Multidetector CT: A Prospective Preliminary Study

A proposal for the ideal algorithm for the diagnosis, staging, and treatment of pancreas masses suspicious for pancreatic adenocarcinoma: Results of a working group of the Canadian Society for Endoscopic Ultrasound

Contact Info

Product

Resources

About