Computerized tomography scan in pre-diagnostic pancreatic ductal adenocarcinoma: Stages of progression and potential benefits of early intervention: A retrospective study

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 20; no. 7; pp. 1495 - 1501
• Main Authors: Singh, Dhruv Pratap, Sheedy, Shannon, Goenka, Ajit H., Wells, Michael, Lee, Nam Ju, Barlow, John, Sharma, Ayush, Kandlakunta, Harika, Chandra, Shruti, Garg, Sushil Kumar, Majumder, Shounak, Levy, Michael J., Takahashi, Naoki, Chari, Suresh T.
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier B.V 01.10.2020; Elsevier Limited
• Subjects: Abdomen; Adenocarcinoma; Anorexia; Back pain; Computed tomography; CT timeline; Diabetes; Diagnosis; Early detection; Lead time; Medical diagnosis; Medical imaging; Medical screening; Metastases; Narcotics; Natural history; Pancreas; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Patients; Survival; Survival analysis; Veins & arteries; EUS; NOD; CTS; Pancreatic ductal adenocarcinoma; CI; AI; CT timeline; Early detection; Lead time; CT; PDAC; CHA; ENDPAC
• ISSN: 1424-3903; 1424-3911; 1424-3911
• DOI: 10.1016/j.pan.2020.07.410

The frequency, nature and timeline of changes on thin-slice (≤3 mm) multi-detector computerized tomography (CT) scans in the pre-diagnostic phase of pancreatic ductal adenocarcinoma (PDAC) are unknown. It is unclear if identifying imaging changes in this phase will improve PDAC survival beyond lead time. From a cohort of 128 subjects (Cohort A) with CT scans done 3–36 months before diagnosis of PDAC we developed a CTgram defining CT Stages (CTS) I through IV in the radiological progression of pre-diagnostic PDAC. We constructed Cohort B of PDAC resected at CTS I and II and compared survival in CTS I and II in Cohort A (n = 22 each; control natural history cohort) vs Cohort B (n = 33 and 72, respectively; early interception cohort). CTs were abnormal in 16% and 85% at 24–36 and 3–6 months respectively, before PDAC diagnosis. The PDAC CTgram stages, findings and median lead times (months) to clinical diagnosis were: CTS I: Abrupt duct cut-off/duct dilatation (−12.8); CTS II: Low density mass confined to pancreas (−9.5), CTS III: Peri-pancreatic infiltration (−5.8), CTS IV: Distant metastases (only at diagnosis). PDAC survival was better in cohort B than in cohort A despite inclusion of lead time in Cohort A: CTS I (36 vs 17.2 months, p = 0.03), CTS II (35.2 vs 15.3 months, p = 0.04). Starting 12–18 months before PDAC diagnosis, progressive and increasingly frequent changes occur on CT scans. Resection of PDAC at the time of pre-diagnostic CT changes is likely to provide survival benefit beyond lead time.