High-Percentage of Early Resectable Pancreatic Ductal Adenocarcinoma is Unidentified on Abdominal CT Obtained for Unrelated Diagnosis
Talayna Leonard Robert Lemme Cati Kral Briana Santiago Chris Elberts Stephanie Dewald Patrick McGonagill Paul Waclawski Curt Bay Phillip J Koo Megan Papesh Stephen Goldinger Vikram Kodibagkar Tomislov Dragovich Michael Choti Hongzhi Wang Madappa Kundranda John C. Chang
Corresponding AuthorJohn C. Chang
Department of Radiology, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
A B S T R A C T
Objective: Pancreatic ductal adenocarcinoma (PDAC) has the best survival when detected early with 5-year survival near 40% for small, resectable PDAC. We evaluate the undiagnosed PDAC imaging features on routine CT and their impact on resectability. Methods: 76 of the screened 134 CTs from 1/1/2012 to 12/31/2018 using our tumor registry were obtained prior to PDAC diagnosis for other indications at least one month before presentation. Each cross-sectional study was reviewed for features of early PDAC: pancreatic mass, pancreatic ductal dilatation, perivascular/peripancreatic soft-tissue infiltration, omental lesions/ascites, and lymphadenopathy. When such features were detectible by the reviewing radiologists, the original CT readings were classified as concordant/discrepant. Descriptive statistics are reported for discrepant reads, tumor resectability, and tumor size. Results: Of the 76 cases from 46 unique subjects (30 male/16 female), 25 CTs (33%) had undetected PDAC imaging features: masses (15/19 unreported), ductal dilatation (16/20 unreported), and peripancreatic/perivascular soft-tissue infiltration (20/36 unreported). 63% of early PDAC features were not identified initially. One year before clinical diagnosis, 75-80% of the PDAC cases were resectable; at < 6 months before clinical diagnosis, only 29% were resectable. Conclusion: Improving early detection of key PDAC features on routine CT examinations can potentially improve patient outcomes.
Article TypeResearch Article
Publication historyReceived: Thu 09, Dec 2021
Accepted: Mon 27, Dec 2021
Published: Fri 31, Dec 2021
Copyright© 2021 John C. Chang. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.