Detection of Europe´s deadliest cancer: much room for improvement

A British analysis of 600 pancreatic cancer cases showed that 46 cases (7.7%) were not detected on imaging scans performed 3 to 18 months prior to diagnosis. An analysis of these cases further revealed that 36.0% were potentially avoidable.

Pancreatic cancer is responsible for 95,000 deaths in the European Union every year and has the lowest survival rate of all cancers in Europe. Life expectancy at the time of diagnosis is just 4.6 months [1]. “There is often only a very short window for curative surgery in pancreatic cancer, meaning it is vital that patients are diagnosed with the disease as early as possible to give them the best chance of survival,” said Dr Nosheen Umar (University of Birmingham, UK) [2].

In this retrospective study, Dr Umar and colleagues investigated records of 600 patients diagnosed with pancreatic cancer between 2016 and 2021 to determine whether imaging signs of pancreatic cancer were missed. Pancreatic cancer diagnosed 3 to 8 months after imaging that did not lead to a diagnosis was termed post-imaging pancreatic cancer (PIPC). CT and MRI images were independently reviewed by 2 radiologists to develop an algorithm that categorised the missed cases and identified the most likely explanation for PIPC cases.

The results revealed that 7.7% of the 600 cases were categorised as PIPC and almost half of them were located in the pancreatic head. PIPC were categorised in 5 different ways: 1) signs of pancreatic cancer that were not recognised and further investigated (10.6%), 2) signs of mass lesion were not picked up by radiologist (25.5%), 3) pancreatic cancer associated abnormalities detected but inadequate follow-up plan (10.6%), 4) pancreatic cancer associated abnormalities detected and adequate follow-up plan but still PIPC (12.8%), and 5) genuine new pancreatic cancer lesions, no abnormalities were detected on initial imaging (40.4%). Missed opportunities to potentially avoid PIPC were identified in 36.0% of PIPC cases.

“We hope this study will raise awareness of the issue of PIPC and common reasons why pancreatic cancer can be initially missed,” Dr Umar said. “This will help to standardise future studies on this issue and guide quality improvement efforts, so we can increase the likelihood of an early diagnosis of pancreatic cancer, increase the chances of patient survival and, ultimately, save lives.”

1. Michl P, et al. United European Gastroenterol J. 2021;9:860–871.
2. Umar N, et al. How often is pancreatic cancer missed on CT or MRI imaging? A novel root cause analysis system to establish the most plausible explanation for post-imaging pancreatic cancer. OP192, UEG Week 2022, 8–11 October, Vienna, Austria.

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Posted on 2 December, 2022