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Computerized tomography scan in pre-diagnostic pancreatic ductal adenocarcinoma: Stages of progression and potential benefits of early intervention: A retrospective study
Institution:1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA;2. Division of Internal Medicine, Staten Island University Hospital, New York, Staten Island, USA;3. Department of Radiology, Mayo Clinic, Rochester, MN, USA;4. Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Department of Radiology, Mayo Clinic, Rochester, MN, USA;2. Department of Surgery, Mayo Clinic, Rochester, MN, USA;3. Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA;1. Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;2. Clinic of Nuclear Medicine, Istanbul Research and Training Hospital, Istanbul, Turkey;3. Department of Gastroenterology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;4. Department of Radiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;5. Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey;1. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida;3. Center for Digestive Health, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona;1. Department of Medicine, School of Medicine, West Virginia University, USA;2. Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, USA;3. School of Mathematics and Natural Sciences, Tadulako University, Indonesia;4. Section of Gastroenterology & Hepatology, West Virginia University, Morgantown, West Virginia, USA;1. Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, China;2. Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany;3. Division of Gastroenterology, CHUM, Hopital Saint Luc, Montreal, Quebec, Canada;4. Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy;5. SRH Wald Klinikum Gera, Germany;6. PancreatoBiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy;7. Medical Department, Helios Klinikum Meiningen, Meiningen, Germany;8. Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom;9. Medical Department I, Sana Hospital Lübeck, Lübeck, Germany;10. Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany;11. Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania;12. Endoscopy Department, Gastrointestinal Unit, Copenhagen University Hospital Herlev, Herlev, Denmark;13. Gastroenterology, Hepatology und Endocrinology, Hannover Medical School, Hannover, Germany;14. Gastroenterology and Hepatology Department, Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain;15. Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna and Hospital of Imola, Imola, Italy;16. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China;17. Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Germany;1. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No 300, Guangzhou Road, Nanjing, 210009, Jiangsu Province, China;2. Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, No 300, Guangzhou Road, Nanjing, 210009, Jiangsu Province, China
Abstract:BackgroundThe 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.MethodsFrom 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).ResultsCTs 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).ConclusionStarting 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.
Keywords:Pancreatic ductal adenocarcinoma  CT timeline  Early detection  Lead time  AI"}  {"#name":"keyword"  "$":{"id":"kwrd0035"}  "$$":[{"#name":"text"  "_":"Artificial Intelligence  CHA"}  {"#name":"keyword"  "$":{"id":"kwrd0045"}  "$$":[{"#name":"text"  "_":"Common Hepatic Artery  CI"}  {"#name":"keyword"  "$":{"id":"kwrd0055"}  "$$":[{"#name":"text"  "_":"Confidence Interval  CT"}  {"#name":"keyword"  "$":{"id":"kwrd0065"}  "$$":[{"#name":"text"  "_":"Computed Tomography  CTS"}  {"#name":"keyword"  "$":{"id":"kwrd0075"}  "$$":[{"#name":"text"  "_":"Computed Tomography Stage  ENDPAC"}  {"#name":"keyword"  "$":{"id":"kwrd0085"}  "$$":[{"#name":"text"  "_":"Enrichment of New onset Diabetes in Pancreatic Cancer  EUS"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"Endoscopic Ultrasound  NOD"}  {"#name":"keyword"  "$":{"id":"kwrd0105"}  "$$":[{"#name":"text"  "_":"New Onset Diabetes  PDAC"}  {"#name":"keyword"  "$":{"id":"kwrd0115"}  "$$":[{"#name":"text"  "_":"Pancreatic Ductal Adenocarcinoma
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