CT Abnormalities of the Pancreas Associated With the Subsequent Diagnosis of Clinical Stage I Pancreatic Ductal Adenocarcinoma More Than 1 Year Later: A Case-Control Study

AJR Am J Roentgenol. 2021 Dec;217(6):1353-1364. doi: 10.2214/AJR.21.26014. Epub 2021 Jun 23.


BACKGROUND. Pancreatic ductal adenocarcinoma (PDAC) is highly lethal, partly because of challenges in early diagnosis. However, the prognosis for earlier stages (carcinoma in situ or category T1a invasive carcinoma) is relatively favorable. OBJECTIVE. The purpose of this study was to investigate findings of an earlier diagnosis of PDAC on CT examinations performed at least 1 year before the diagnosis of clinical stage I PDAC. METHODS. This retrospective study included 103 patients with clinical stage I PDAC and a CT examination performed at least 1 year before the CT examination that detected PDAC, as well as 103 control patients without PDAC on CT examinations separated by at least 10 years. The frequency and temporal characteristics of focal pancreatic abnormalities (pancreatic mass, main pancreatic duct [MPD] change, parenchymal atrophy, faint parenchymal enhancement, cyst, and parenchymal calcification) seen on CT examinations conducted before diagnosis (prediagnostic CT) were determined. RESULTS. A focal pancreatic abnormality was present on the most recent prediagnostic CT examination in 55/103 (53.4%) patients with PDAC versus 21/103 (20.4%) control patients (p < .001). In patients with PDAC, the most common focal abnormalities on prediagnostic CT were atrophy (39/103, 37.9%), faint enhancement (17/65, 26.2%), and MPD change (14/103, 13.6%), which were all more frequent in patients with PDAC than in control patients (p < .05). In 54/55 (98.2%) patients with PDAC, the PDAC corresponded to the site of a focal abnormality (exact location or the abnormality's upstream or downstream edge) on prediagnostic CT. Frequency of focal abnormalities decreased with increasing time before CT that detected PDAC (> 1 to ≤ 2 years before diagnosis, 64.9%; > 2 to ≤ 3 years, 49.2%; > 3 to ≤ 5 years, 41.8%; > 5 to ≤ 7 years, 29.7%; > 7 to ≤ 10 years, 18.5%; more than 10 years, 0%). Mean duration from the finding's initial appearance to diagnosis of PDAC was 4.6 years for atrophy, 3.3 years for faint enhancement, and 1.1 years for MPD change. CONCLUSION. Most patients with clinical stage I PDAC showed focal pancreatic abnormalities on CT performed at least 1 year before diagnosis. Focal MPD change exhibited the shortest duration from its development to subsequent diagnosis, whereas atrophy and faint enhancement exhibited a relatively prolonged course. CLINICAL IMPACT. These findings could facilitate earlier PDAC diagnosis and thus improve prognosis.

Keywords: CT; carcinoma in situ; pancreatic ductal adenocarcinoma; pancreatic intraepithelial neoplasm.

MeSH terms

  • Adenocarcinoma / diagnostic imaging*
  • Adenocarcinoma / pathology
  • Aged
  • Aged, 80 and over
  • Carcinoma, Pancreatic Ductal / diagnostic imaging*
  • Carcinoma, Pancreatic Ductal / pathology
  • Case-Control Studies
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pancreas / diagnostic imaging
  • Pancreas / pathology
  • Pancreatic Ducts / diagnostic imaging
  • Pancreatic Ducts / pathology
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / pathology
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*