Signs of pancreatic cancer missed on previous imaging scans represent a “huge chance of missed opportunities,” say British researchers reporting a new analysis.
The study aimed to identify the incidence and underlying causes of missed pancreatic cancer diagnoses on CT and MRI scans, the researchers explained at United European Gastroenterology (UEG) Week 2022.
The team studied 600 cases of pancreatic cancer (PC), including 46 cases (7.7%) categorized as post-imaging pancreatic cancer (PIPC) — cases that were not detected on imaging performed 3-18 months prior to diagnosis.
They also reviewed 46 CT scans and 4 MRI scans performed on PIPC patients.
The detailed analysis showed that 36% of PIPC cases were potentially preventable, reported first author Nosheen Umar, MD, a gastroenterology researcher at the University of Birmingham, Birmingham, UK.
In 10% of PIPC patients, imaging manifestations associated with pancreatic cancer, such as dilated bile or pancreatic ducts, were not recognized as such and were not further investigated. In 26% of the scans, the signs of a mass lesion were not noticed by the radiologist.
The findings are notable because the time window for curative PC surgery is often short, and missing the diagnosis on cross-sectional imaging can lead to poorer clinical outcomes for patients already dealing with a challenging cancer who generally have poor outcomes. has, Umar said. Medscape medical news.
In fact, pancreatic cancer has the lowest survival rate of all cancers in Europe, the UEG noted in a press release. Life expectancy at the time of diagnosis is only 4.6 months and the 5-year survival rate is less than 10%, Umar said.
Pancreatic cancer causes 95,000 deaths in the European Union each year, the UEG noted, adding that by 2035, the number of cases is expected to rise by nearly 40%.
Details of missed picture characters
The aim of this study was to establish the most plausible explanations for missed PC imaging marks, Umar explained, adding that early diagnosis is vital to give patients the best chance of survival.
Cases analyzed for the study were identified from electronic health records of adults diagnosed with PC between 2016 and 2021 at two national health services. An algorithm has been developed to categorize PIPC and assess possible causes of the missed diagnoses.
The PIPC cases are classified by type:
Type 1 – A focal lesion reported on previous imaging in the same pancreatic segment as PIPC (0% of cases)
Type 2 – Imaging changes that may be associated with PC reported with prior imaging (20% of cases)
Type 3 – No lesion or imaging changes associated with PC reported with prior imaging in the same pancreatic segment as PIPC, but lesion or imaging changes noted on assessment after PIPC diagnosis (26% of cases)
Type 4 – No lesion or imaging changes associated with PC reported with prior imaging in the same pancreatic segment as PIPC and no lesion or imaging changes on assessment after PIPC diagnosis (54% of cases)
“We hope this study will raise awareness of the problem of pancreatic cancer after imaging and common reasons why pancreatic cancer may be missed in the first place,” Umar said in the UEG press release. “This will help standardize future studies on this issue and guide quality improvement efforts so that we can increase the likelihood of early diagnosis of pancreatic cancer, improve patient survival and ultimately save lives.”
The authors reported no relevant financial relationships.
United European Gastroenterology (UEG) 2022: Abstract 2785. Presented October 11, 2022.
Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, who writes for Medscape, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and health topics. She can be reached at email@example.com or on Twitter: @SW_MedReporter.
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