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 . “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) .
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.”
- Michl P, et al. United European Gastroenterol J. 2021;9:860–871.
- 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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Table of Contents: UEGW 2022
Letter from the Editor
UEGW 2022 Highlights Podcast
IBD in 2022
Fast recapture of response with ozanimod after withdrawal in UC
Ozanimod treatment prompted substantial response after failure of response to induction
Etrasimod shows advantage over placebo in UC
Etrasimod reduces adaptive immune cells in the periphery in UC
Favourable maintenance rates for risankizumab also in delayed responders with CD
IL-23 inhibition reduces inflammatory biomarkers in pre-treated UC
Maintained symptom control with mirikizumab in UC
Mirikizumab successfully resolves active histologic inflammation in UC
Upadacitinib for CD: remarkable efficacy in induction therapy
Sustained maintenance results with upadacitinib in UC
Start low with brepocitinib and ritlecitinib in UC
Another chance for TYK2 inhibition in UC
Small molecule obefazimod shows promise in UC
Pivotal results of etrolizumab for CD partly disappointing
Better results for vedolizumab in early CD
Some patients with limited CD may benefit from an early surgical intervention
Dose-interval of adalimumab might be prolonged in CD patients in stable remission
What Is Hot in Upper GI Disorders?
Less ulcer bleeds early after H. pylori eradication in aspirin users
Dupilumab effective in paediatric patients with eosinophilic oesophagitis
Neoplasia in Barrett’s oesophagus: the earlier the intervention, the better the long-term outcome
Hepatology in 2022
Favourable pancreatitis outcomes with procalcitonin-based algorithm to guide antibiotic use
Portal hypertension is associated with poor prognosis in cirrhotic patients
Chances of transplant-free survival in PSC enhanced by colectomy with ileostomy
SARS-CoV-2: Booster doses of key importance for cirrhotic patients
What Is New in Pancreatic Cancer and Pancreatitis?
Fewer long-term interventions after delayed drainage in necrotising pancreatitis
Detection of Europe´s deadliest cancer: much room for improvement
Colorectal Carcinoma: Improving Diagnosis and Therapy
Immunotherapy response may be modulated by microbiome
Computer-aided colonoscopies improved adenoma detection rates
Screening-detected colorectal cancers may have superior surgical outcomes