Pancreatic Adenocarcinoma: Diagnostic Errors, Contributing Factors and Solutions

  • Author Footnotes
    # Department of Radiology, Division of Neuro Radiology, Wake Forest, Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157, Ph no: 336-716-1066
    Bhavana Budigi
    Correspondence
    Address correspondence to: B.B.
    Footnotes
    # Department of Radiology, Division of Neuro Radiology, Wake Forest, Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157, Ph no: 336-716-1066
    Affiliations
    Department of Radiology, Division of Abdominal Imaging, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157
    Search for articles by this author
  • Michael Oliphant
    Affiliations
    Department of Radiology, Division of Abdominal Imaging, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157
    Search for articles by this author
  • Jason Itri
    Affiliations
    Department of Radiology, Division of Abdominal Imaging, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157
    Search for articles by this author
  • Author Footnotes
    # Department of Radiology, Division of Neuro Radiology, Wake Forest, Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157, Ph no: 336-716-1066
Published:November 24, 2021DOI:https://doi.org/10.1016/j.acra.2021.10.025
      The purpose of this article is to review diagnostic errors in preoperative and post-operative imaging for pancreatic ductal adenocarcinoma (PDAC), discuss contributing factors, and provide solutions that minimize errors. Accurate radiological staging and restaging of PDAC dictates surgical management and errors can have significant negative effects on patient care, such as missed vessel involvement or metastatic disease that would preclude surgery. Familiarity with these errors and their contributing factors improves diagnostic accuracy and ultimately leads to improved patient outcomes.

      Keyword

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

      1. society Ac. Cancer facts & Figures In. Atlanta 2021

        • Rawla P
        • Sunkara T
        • V G
        Epidemiology of pancreatic cancer: global trends, etiology and risk factors.
        World J Oncol. 2019; 10: 10-27
        • Rahib L
        • Smith BD
        • Aizenberg R
        • Rosenzweig AB
        • Fleshman JM
        • Matrisian LM
        Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States.
        Cancer Res. 2014; 74: 2913-2921
      2. Coverys. Red signal report. Radiology In 2018:2-4

        • Dalrymple NC
        • Leyendecker JR
        • Oliphant M
        Problem solving in abdominal imaging.
        1st edition. Elsevier, Philadelphia2009
        • Yachida S
        • Iacobuzio-Donahue CA
        The pathology and genetics of metastatic pancreatic cancer.
        Arch Pathol Lab Med. 2009; 133: 413-422
        • Patel BN
        • Olcott EW
        • Jeffrey RB
        Duodenal invasion by pancreatic adenocarcinoma: MDCT diagnosis of an aggressive imaging phenotype and its clinical implications.
        Abdom Radiol (NY). 2018; 43: 332-339
        • Khristenko E
        • Shrainer I
        • Setdikova G
        • Palkina O
        • Sinitsyn V
        • Lyadov V
        Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer.
        Sci Rep. 2021; 11: 1800
        • Schorn S
        • Demir IE
        • Haller B
        • et al.
        The influence of neural invasion on survival and tumor recurrence in pancreatic ductal adenocarcinoma – a systematic review and meta-analysis.
        Surg Oncol. 2017; 26: 105-115
        • Elbanna KY
        • Jang HJ
        • Kim TK
        Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review.
        Insights Imaging. 2020; 11: 58
        • Zaky AM
        • Wolfgang CL
        • Weiss MJ
        • Javed AA
        • Fishman EK
        • Zaheer A
        Tumor-vessel relationships in pancreatic ductal adenocarcinoma at multidetector ct: different classification systems and their influence on treatment planning.
        Radio Graphics. 2017; 37: 93-112
        • Prokesch RW
        • Chow LC
        • Beaulieu CF
        • Bammer R
        • Jeffrey RB
        Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs.
        Radiology. 2002; 224: 764-768
        • Jha P
        • Yeh BM
        • Zagoria R
        • Collisson E
        • Wang ZJ
        The role of MR imaging in pancreatic cancer.
        Magn Reson Imaging Clin N Am. 2018; 26: 363-373
        • Chari ST
        Detecting early pancreatic cancer: problems and prospects.
        Semin Oncol. 2007; 34: 284-294
        • Ahualli J
        The double duct sign.
        Radiology. 2007; 244: 314-315
        • Oterdoom LH
        • van Weyenberg SJ
        • de Boer NK
        Double-duct sign: do not forget the gallstones.
        J Gastrointestin Liver Dis. 2013; 22: 447-450
        • Beker K
        • Lee KS
        • Tsai LL
        • et al.
        Differentiation of pancreatic head ductal adenocarcinoma from inflammatory pancreatic pseudomass by MR cholangio-pancreatography: utility of the duct-interrupted, corona, and attraction signs.
        Abdom Radiol. 2019; 44: 4048-4056
        • Healy JC
        Detection of peritoneal metastases.
        Cancer Imaging. 2001; 1: 4-12
        • Maire F
        • Sauvanet A
        • Trivin F
        • et al.
        Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy.
        Pancreatology. 2004; 4: 436-440
        • Somers I
        • Bipat S
        Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT.
        Eur Radiol. 2017; 27: 3408-3435
        • Heinrich S
        • Goerres GW
        • Schäfer M
        • et al.
        Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness.
        Ann Surg. 2005; 242: 235-243
        • Tempero MA
        • Arnoletti JP
        • Behrman SW
        • et al.
        Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines.
        J Natl Compr Canc Netw. 2012; 10: 703-713
        • Elnahal SM
        • Shinagare AB
        • Szymonifka J
        • Hong TS
        • Enzinger PC
        • Mamon HJ
        Prevalence and significance of subcentimeter hepatic lesions in patients with localized pancreatic adenocarcinoma.
        Pract Radiat Oncol. 2012; 2: e89-e94
        • Jeon SK
        • Lee JM
        • Joo I
        • et al.
        Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT.
        Eur Radiol. 2018; 28: 3484-3493
        • Tempero MA
        • Malafa MP
        • Al-Hawary M
        • et al.
        Pancreatic Adenocarcinoma, Version 2.2017, NCCN clinical practice guidelines in oncology.
        J Natl Compr Canc Netw. 2017; 15: 1028-1061
        • Valls C
        • Andía E
        • Sanchez A
        • et al.
        Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery.
        AJR Am J Roentgenol. 2002; 178: 821-826
        • Nakai H
        • Arizono S
        • Isoda H
        • Togashi K
        Imaging characteristics of liver metastases overlooked at contrast-enhanced CT.
        Am J Roentgenol. 2019; 212: 782-787
        • Siewert B
        • Sosna J
        • McNamara A
        • Raptopoulos V
        • Kruskal JB
        Missed lesions at abdominal oncologic CT: lessons learned from quality assurance.
        Radiographics. 2008; 28: 623-638
        • Marion-Audibert AM
        • Vullierme MP
        • Ronot M
        • et al.
        Routine MRI With DWI sequences to detect liver metastases in patients with potentially resectable pancreatic ductal carcinoma and normal liver CT: a prospective multicenter study.
        AJR Am J Roentgenol. 2018; 211: W217-w225
        • Kim HW
        • Lee JC
        • Paik KH
        • et al.
        Adjunctive role of preoperative liver magnetic resonance imaging for potentially resectable pancreatic cancer.
        Surgery. 2017; 161: 1579-1587
        • Ishigami K
        • Yoshimitsu K
        • Irie H
        • et al.
        Significance of perivascular soft tissue around the common hepatic and proximal superior mesenteric arteries arising after pancreaticoduodenectomy: evaluation with serial MDCT studies.
        Abdom Imaging. 2008; 33: 654-661
        • Javadi S
        • Karbasian N
        • Bhosale P
        • et al.
        Imaging findings of recurrent pancreatic cancer following resection.
        Abdom Radiol (NY). 2018; 43: 489-496
        • Ruf J
        • Lopez Hänninen E
        • Oettle H
        • et al.
        Detection of recurrent pancreatic cancer: comparison of FDG-PET with CT/MRI.
        Pancreatology. 2005; 5: 266-272
        • Rayamajhi S
        • Balachandran A
        • Katz M
        • Reddy A
        • Rohren E
        • Bhosale P
        Utility of (18) F-FDG PET/CT and CECT in conjunction with serum CA 19-9 for detecting recurrent pancreatic adenocarcinoma.
        Abdom Radiol (NY). 2018; 43: 505-513
      3. network Ncc. Pancreatic adenocarcinoma (version 1.2020). In:

        • Sun L
        • Zhou Q
        • Brigstock DR
        • et al.
        Focal autoimmune pancreatitis and chronic sclerosing sialadenitis mimicking pancreatic cancer and neck metastasis.
        World J Gastroenterol. 2014; 20: 17674-17679
        • Hoshimoto S
        • Aiura K
        • Tanaka M
        • Shito M
        • Kakefuda T
        • Sugiura H
        Mass-forming type 1 autoimmune pancreatitis mimicking pancreatic cancer.
        J Dig Dis. 2016; 17: 202-209
        • Lee JH
        • Min JH
        • Kim YK
        • et al.
        Usefulness of non-contrast MR imaging in distinguishing pancreatic ductal adenocarcinoma from focal pancreatitis.
        Clin Imaging. 2019; 55: 132-139
        • Hsu WL
        • Chang SM
        • Wu PY
        • Chang CC
        Localized autoimmune pancreatitis mimicking pancreatic cancer: case report and literature review.
        J Int Med Res. 2018; 46: 1657-1665
        • Dede K
        • Salamon F
        • Taller A
        • Teknős D
        • Bursics A
        Autoimmune pancreatitis mimicking pancreatic tumor.
        J Surg Case Rep. 2012; 2012: rjs012https://doi.org/10.1093/jscr/rjs012
        • Li J
        • Liu F
        • Fang X
        • et al.
        CT radiomics features in differentiation of focal-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma: a propensity score analysis.
        Acad Radiol. 2021; (S1076-6332(21)00209-9. https://doi.org/10.1016/j.acra.2021.04.014)
        • Kim SS
        • Choi GC
        • Jou SS
        Pancreas ductal adenocarcinoma and its mimics: review of cross-sectional imaging findings for differential diagnosis.
        J Belg Soc Radiol. 2018; 102: 71
        • Yu H
        • Huang Z
        • Li M
        • et al.
        Differential diagnosis of nonhypervascular pancreatic neuroendocrine neoplasms from pancreatic ductal adenocarcinomas, based on computed tomography radiological features and texture analysis.
        Acad Radiol. 2020; 27: 332-341
        • Mohamed A
        • Ayav A
        • Belle A
        • Orry X
        • Chevaux JB
        • Laurent V
        Pancreatic cancer in patients with chronic calcifying pancreatitis: computed tomography findings - a retrospective analysis of 48 patients.
        Eur J Radiol. 2017; 86: 206-212
        • Coakley FV
        • Hanley-Knutson K
        • Mongan J
        • Barajas R
        • Bucknor M
        • Qayyum A
        Pancreatic Imaging mimics: part 1, imaging mimics of pancreatic adenocarcinoma.
        Am J Roentgenol. 2012; 199: 301-308
        • Koshy AK
        • Harshavardhan RB
        • Siyad I
        • Venu RP
        Impact of calcifications on diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration for pancreatic ductal adenocarcinoma.
        Indian J Gastroenterol. 2019; 38: 128-133