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The implications of missed or misinterpreted cases of pancreatic ductal adenocarcinoma on imaging: a multi-centered population-based study

  • Gastrointestinal
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Abstract

Objectives

To assess the proportion of missed/misinterpreted imaging examinations of pancreatic ductal adenocarcinoma (PDAC), and their association with the diagnostic interval and survival.

Methods

Two hundred fifty-seven patients (mean age, 71.8 years) diagnosed with PDAC in 2014–2015 were identified from the Nova Scotia Cancer Registry. Demographics, stage, tumor location, and dates of initial presentation, diagnosis, and, if applicable, surgery and death were recorded. US, CT, and MRI examinations during the diagnostic interval were independently graded by two radiologists using the RADPEER system; discordance was resolved in consensus. Mean diagnostic interval and survival were compared amongst RADPEER groups (one-way ANOVA). Kaplan-Meier analysis was performed for age (< 65, 65–79, ≥ 80), sex, tumor location (proximal/distal), stage (I–IV), surgery (yes/no), chemotherapy (yes/no), and RADPEER score (1–3). Association between these covariates and survival was assessed (multivariate Cox proportion hazards model).

Results

RADPEER 1–3 scores were assigned to 191, 27, and 39 patients, respectively. Mean diagnostic intervals were 53, 86, and 192 days, respectively (p = 0.018). There were only 3/257 (1.2%) survivors. Mean survival was not different between groups (p = 0.43). Kaplan-Meier analysis showed worse survival in RADPEER 1–2 (p = 0.007), older age (p < 0.001), distal PDAC (p = 0.016), stage (p < 0.0001), and no surgery (p < 0.001); survival was not different with sex (p = 0.083). Cox analysis showed better survival in RADPEER 3 (p = 0.005), women (p = 0.002), surgical patients (p < 0.001), and chemotherapy (p < 0.001), and worse survival in stage IV (p = 0.006).

Conclusion

Imaging-related delays occurred in one-fourth of patients and were associated with longer diagnostic intervals but not worse survival, potentially due to overall poor survival in the cohort.

Key Points

• One-fourth of patients (66/257, 25.7%) with pancreatic ductal adenocarcinoma (PDAC) underwent imaging examinations that demonstrated manifestations of the disease, but findings were either missed or misinterpreted; RADPEER 2 and 3 scores were assigned to 10.5% and 15.2% of patients, respectively.

• Patients with imaging examinations assigned RADPEER 3 scores were associated with significantly longer diagnostic intervals (192 ± 323 days) than RADPEER 1 (53 ± 86 days) and RADPEER 2 (86 ± 120 days) (p < 0.001).

• Imaging-related diagnostic delays were not associated with worse survival; however, this may have been confounded by the overall poor survival in our cohort (only 3/257 (1.2%) survivors).

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PDAC:

Pancreatic ductal adenocarcinoma

US:

Ultrasound

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Acknowledgments

The authors thank Candice Crocker, PhD, for assistance with institutional research ethics board submission.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada

    Jessie Kang, Sharon E. Clarke, Mohammed Abdolell, Jennifer Payne & Andreu F. Costa

  2. Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Suite 456, Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    Ravi Ramjeesingh

Authors
  1. Jessie Kang
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  2. Sharon E. Clarke
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  3. Mohammed Abdolell
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  4. Ravi Ramjeesingh
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  5. Jennifer Payne
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  6. Andreu F. Costa
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Corresponding author

Correspondence to Andreu F. Costa.

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Guarantor

The scientific guarantor of this publication is Dr. Andreu Costa, MD MSc FRCPC.

Conflict of interest

Jessie Kang, Sharon Clarke, Mohammed Abdolell, Ravi Ramjeesingh, Jennifer Payne, and Andreu Costa declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Statistical analysis was performed by a biostatistician, Mohammed Abdolell.

Informed consent

The need for informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• observational

• Multi-institutional

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Kang, J., Clarke, S.E., Abdolell, M. et al. The implications of missed or misinterpreted cases of pancreatic ductal adenocarcinoma on imaging: a multi-centered population-based study. Eur Radiol 31, 212–221 (2021). https://doi.org/10.1007/s00330-020-07120-0

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  • DOI: https://doi.org/10.1007/s00330-020-07120-0

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