Difficulty in the diagnosis of pancreatic cancer based on the initial CT report: A retrospective study

Abstract

Abstract Background The role of computed tomography (CT) in the initial diagnosis of pancreatic cancer (PC) is well-known. CT reports made by radiologists are important as not all patients with PC are examined by specialists; however, some cases are not identified based on CT reports. Diagnosis via imaging of PC is sometimes difficult, and the diagnostic rate of PC and other pancreatic diseases can vary across radiologists. This study examined the diagnostic rate of PC in initial CT reports and the details of cases with diagnostic difficulties. Methods Clinical data of 198 patients with histologically diagnosed PC were retrospectively collected between January 2018 and April 2022. Out of these contrast-enhanced CT was performed in 192 cases (124 men and 68 women) and these cases were examined. Results In the reports, PC was not reported as the main diagnosis in 18 patients (9.4%; 11 men and 7 women; mean age, 69.7 years). Among these 18 cases, intrapancreatic mass lesions were detected in 3 (1.6%), indirect findings such as bile duct/pancreatic duct stenosis or dilation were detected in 5 (2.6%), and no PC-related findings were found in 10 (5.2%). The specialists suspected PC in 15 of these 18 cases based on initial CT reports. Seventeen cases were confirmed by endoscopic ultrasound-fine needle aspiration (EUS-FNA) and one by biopsy after upper gastrointestinal endoscopy. Conclusions To improve accuracy of the diagnosis of the PC, it is important that specialists provide feedback to diagnostic radiologists regarding the findings they did not report. Additionally, non-specialists should be aware of the importance to seek the advice of specialists when such indirect findings or any kind of pancreatic mass are present. EUS-FNA should be performed by specialists when there is clinical information which indicates pancreatic disease of any kind.