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Gonda M, Masuda A, Kobayashi T, Iemoto T, Kakuyama S, Ezaki T, Ikegawa T, Hirata Y, Tsumura H, Ogisu K, Nakano R, Fujigaki S, Nakagawa T, Takagi M, Yamanaka K, Sato Y, Fujita K, Furumatsu K, Kato T, Sakai A, Shiomi H, Sanuki T, Arisaka Y, Okabe Y, Toyama H, Sofue K, Kodama Y. Temporal progression of pancreatic cancer computed tomography findings until diagnosis: A large-scale multicenter study. United European Gastroenterol J 2024; 12:761-771. [PMID: 38451583 PMCID: PMC11250140 DOI: 10.1002/ueg2.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Focal parenchymal atrophy and main pancreatic duct (MPD) dilatation have been identified as early signs of pancreatic ductal adenocarcinoma. However, limited evidence exists regarding their temporal progression due to previous study limitations with restricted case numbers. OBJECTIVE To ascertain a more precise frequency assessment of suspicious pancreatic ductal adenocarcinoma findings as well as delineate the temporal progression of them. METHODS A multicenter retrospective study was conducted on patients diagnosed with pancreatic ductal adenocarcinoma between 2015 and 2021. We included patients who had undergone at least one computed tomography (CT) scan ≥6 months before diagnosing pancreatic ductal adenocarcinoma. The temporal progression of suspicious pancreatic ductal adenocarcinoma findings on CT was investigated. RESULTS Out of 1832 patients diagnosed with pancreatic ductal adenocarcinoma, 320 had a previous CT before their diagnosis. Suspicious pancreatic ductal adenocarcinoma findings were detected in 153 cases (47.8%), with focal parenchymal atrophy (26.6%) being the most common followed by MPD dilatation (11.3%). Focal parenchymal atrophy was the earliest detectable sign among all suspicious findings and became visible on average 2.7 years before diagnosis, and the next most common, MPD dilatation, 1.1 years before diagnosis. Other findings, such as retention cysts, were less frequent and appeared around 1 year before diagnosis. Focal parenchymal atrophy followed by MPD dilatation was observed in 10 patients but not in reverse order. Focal parenchymal atrophy was more frequently detected in the pancreatic body/tail. No significant relationship was found between the pathological pancreatic ductal adenocarcinoma differentiation or tumor stage and the time course of the CT findings. All cases of focal parenchymal atrophy progressed just prior to diagnosis, and the atrophic area was occupied by tumor at diagnosis. Main pancreatic duct dilatation continued to progress until diagnosis. CONCLUSION This large-scale study revealed that the temporal progression of focal parenchymal atrophy is the earliest detectable sign indicating pancreatic ductal adenocarcinoma. These results provide crucial insights for early pancreatic ductal adenocarcinoma detection.
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Affiliation(s)
- Masanori Gonda
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
| | - Atsuhiro Masuda
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
| | - Takashi Kobayashi
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
| | - Takao Iemoto
- Department of GastroenterologyKitaharima Medical CenterOnoHyogoJapan
| | - Saori Kakuyama
- Department of GastroenterologyTakatsuki General HospitalTakatsukiOsakaJapan
| | - Takeshi Ezaki
- Department of GastroenterologyNational Hospital Organization Kobe Medical CenterKobeHyogoJapan
| | - Takuya Ikegawa
- Department of GastroenterologyJapanese Red Cross Kobe HospitalKobeHyogoJapan
| | - Yuichi Hirata
- Department of GastroenterologyKakogawa Central City HospitalKakogawaHyogoJapan
| | - Hidetaka Tsumura
- Department of GastroenterologyHyogo Cancer CenterAkashiHyogoJapan
| | - Kyohei Ogisu
- Department of GastroenterologyNippon Life HospitalOsakaOsakaJapan
| | - Ryota Nakano
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
- Division of Gastroenterology and Hepatobiliary and Pancreatic DiseasesDepartment of Internal MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Seiji Fujigaki
- Department of GastroenterologyHyogo Prefectural Harima‐Himeji General Medical CenterHimejiHyogoJapan
| | - Takashi Nakagawa
- Department of GastroenterologyChibune General HospitalOsakaOsakaJapan
| | - Megumi Takagi
- Department of GastroenterologyOsaka Saiseikai Nakatsu HospitalOsakaOsakaJapan
| | - Kodai Yamanaka
- Department of GastroenterologyKonan Medical CenterKobeHyogoJapan
| | - Yu Sato
- Department of Internal MedicineHyogo Prefectural Tamba Medical CenterTambaHyogoJapan
| | - Koichi Fujita
- Department of GastroenterologyYodogawa Christian HospitalOsakaOsakaJapan
| | - Keisuke Furumatsu
- Department of GastroenterologyAkashi Medical Association Akashi Medical CenterAkashiHyogoJapan
| | - Takao Kato
- Department of GastroenterologyHyogo Prefectural Awaji Medical CenterSumotoHyogoJapan
| | - Arata Sakai
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
| | - Hideyuki Shiomi
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
- Division of Gastroenterology and Hepatobiliary and Pancreatic DiseasesDepartment of Internal MedicineHyogo Medical UniversityNishinomiyaHyogoJapan
| | - Tsuyoshi Sanuki
- Department of GastroenterologyHyogo Prefectural Harima‐Himeji General Medical CenterHimejiHyogoJapan
| | | | - Yoshihiro Okabe
- Department of GastroenterologyKakogawa Central City HospitalKakogawaHyogoJapan
| | - Hirochika Toyama
- Department of Hepato‐Biliary‐Pancreatic SurgeryKobe University Graduate School of MedicineKobeHyogoJapan
| | - Keitaro Sofue
- Department of RadiologyKobe University Graduate School of Medicine and Kobe University HospitalKobeHyogoJapan
| | - Yuzo Kodama
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineKobeHyogoJapan
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Hoogenboom SA, Engels MML, Chuprin AV, van Hooft JE, LeGout JD, Wallace MB, Bolan CW. Prevalence, features, and explanations of missed and misinterpreted pancreatic cancer on imaging: a matched case-control study. Abdom Radiol (NY) 2022; 47:4160-4172. [PMID: 36127473 PMCID: PMC9626431 DOI: 10.1007/s00261-022-03671-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To characterize the prevalence of missed pancreatic masses and pancreatic ductal adenocarcinoma (PDAC)-related findings on CT and MRI between pre-diagnostic patients and healthy individuals. MATERIALS AND METHODS Patients diagnosed with PDAC (2010-2016) were retrospectively reviewed for abdominal CT- or MRI-examinations 1 month-3 years prior to their diagnosis, and subsequently matched to controls in a 1:4 ratio. Two blinded radiologists scored each imaging exam on the presence of a pancreatic mass and secondary features of PDAC. Additionally, original radiology reports were graded based on the revised RADPEER criteria. RESULTS The cohort of 595 PDAC patients contained 60 patients with a pre-diagnostic CT and 27 with an MRI. A pancreatic mass was suspected in hindsight on CT in 51.7% and 50% of cases and in 1.3% and 0.9% of controls by reviewer 1 (p < .001) and reviewer 2 (p < .001), respectively. On MRI, a mass was suspected in 70.4% and 55.6% of cases and 2.9% and 0% of the controls by reviewer 1 (p < .001) and reviewer 2 (p < .001), respectively. Pancreatic duct dilation, duct interruption, focal atrophy, and features of acute pancreatitis is strongly associated with PDAC (p < .001). In cases, a RADPEER-score of 2 or 3 was assigned to 56.3% of the CT-reports and 71.4% of MRI-reports. CONCLUSION Radiological features as pancreatic duct dilation and interruption, and focal atrophy are common first signs of PDAC and are often missed or unrecognized. Further investigation with dedicated pancreas imaging is warranted in patients with PDAC-related radiological findings.
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Affiliation(s)
- Sanne A. Hoogenboom
- Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA ,Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Megan M. L. Engels
- Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA ,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Anthony V. Chuprin
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Jordan D. LeGout
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA
| | - Michael B. Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA ,Department of Gastroenterology and Hepatology, Sheikh Shakhbout Medical City, PO Box 11001, Abu Dhabi, UAE ,Khalifa University School of Medicine, PO Box 127788, Abu Dhabi, UAE
| | - Candice W. Bolan
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224 USA
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Yamao K, Tsurusaki M, Takashima K, Tanaka H, Yoshida A, Okamoto A, Yamazaki T, Omoto S, Kamata K, Minaga K, Takenaka M, Chikugo T, Chiba Y, Watanabe T, Kudo M. Analysis of Progression Time in Pancreatic Cancer including Carcinoma In Situ Based on Magnetic Resonance Cholangiopancreatography Findings. Diagnostics (Basel) 2021; 11:diagnostics11101858. [PMID: 34679556 PMCID: PMC8534569 DOI: 10.3390/diagnostics11101858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer (PC) exhibits extremely rapid growth; however, it remains largely unknown whether the early stages of PC also exhibit rapid growth speed equivalent to advanced PC. This study aimed to investigate the natural history of early PCs through retrospectively assessing pre-diagnostic images. METHODS We examined the data of nine patients, including three patients with carcinoma in situ (CIS), who had undergone magnetic resonance cholangiopancreatography (MRCP) to detect solitary main pancreatic duct (MPD) stenosis >1 year before definitive PC diagnosis. We retrospectively analyzed the time to diagnosis and first-time tumor detection from the estimated time point of first-time MPD stenosis detection without tumor lesion. RESULTS The median tumor size at diagnosis and the first-time tumor detection size were 14 and 7.5 mm, respectively. The median time to diagnosis and first-time tumor detection were 26 and 49 months, respectively. CONCLUSIONS No studies have investigated the PC history, especially that of early PCs, including CIS, based on the initial detection of MPD stenosis using MRCP. Assessment of a small number of patients showed that the time to progression can take several years in the early PC stages. Understanding this natural history is very important in the clinical setting.
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Affiliation(s)
- Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
- Correspondence: ; Tel.: +81-72-366-0221; Fax: +81-72-367-2880
| | - Masakatsu Tsurusaki
- Department of Diagnostic Radiology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan;
| | - Kota Takashima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Hidekazu Tanaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Akihiro Yoshida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Ayana Okamoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Tomohiro Yamazaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Takaaki Chikugo
- Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan;
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan;
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan; (K.T.); (H.T.); (A.Y.); (A.O.); (T.Y.); (S.O.); (K.K.); (K.M.); (M.T.); (T.W.); (M.K.)
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Moradi F, Iagaru A. The Role of Positron Emission Tomography in Pancreatic Cancer and Gallbladder Cancer. Semin Nucl Med 2020; 50:434-446. [PMID: 32768007 DOI: 10.1053/j.semnuclmed.2020.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
18F-FDG-PET is complementary to conventional imaging in patients with clinical suspicion for exocrine pancreatic malignancies. It has similar if not superior sensitivity and specificity for detection of cancer, and when combined with contrast enhanced anatomic imaging of the abdomen, can improve diagnostic accuracy and aid in staging, assessment for resectability, radiation therapy planning, and prognostication. Various metabolic pathways affect FDG uptake in pancreatic ductal adenocarcinoma. The degree of uptake reflects histopathology, aggressiveness, metastatic potential, and metabolic profile of malignant cell and their interaction with cancer stroma. After treatment, FDG-PET is useful for detection of residual or recurrent cancer and can be used to assess and monitor response to therapy in unresectable or metastatic disease. The degree and pattern of uptake combined with other imaging features are useful in characterization of incidental pancreatic lesions and benign processes such as inflammation. Several novel PET radiopharmaceuticals have been developed to improve detection and management of pancreatic cancer. Gallbladder carcinoma is typically FDG avid and when anatomic imaging is equivocal PET can be used to assess metastatic involvement with high specificity and inform subsequent management.
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Affiliation(s)
- Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA.
| | - Andrei Iagaru
- Division of Nuclear Medicine, Department of Radiology, Stanford University, Stanford, CA
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