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,
High-Percentage of Early Resectable Pancreatic Ductal Adenocarcinoma is Unidentified on Abdominal CT Obtained for Unrelated Diagnosis
Annals of Clinical Oncology
2021
2674-3248
http://dx.doi.org/10.31487/j.ACO.2021.02.03
https://www.sciencerepository.org/high-percentage-of-early_ACO-2021-2-103 
Abstract: 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.Keywords: Pancreatic cancer, early detection, staging