OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death. Although CT/MRI are used for initial evaluation, early imaging findings suggesting PDAC may be unappreciated, resulting in diagnostic delays. We aimed to determine the prevalence and types of pancreatic abnormalities on pre-diagnostic imaging in patients later diagnosed with PDAC. METHODS: We identified patients diagnosed with PDAC between 2022 and 2025 who had a pre-diagnostic abdominal CT/MRI performed 3-36 months before diagnostic imaging. These patients were compared to a non-PDAC cohort who underwent pancreas cancer screening but did not develop PDAC after 5 years of follow-up. The primary outcome was the prevalence and type of pancreatic abnormalities on pre-diagnostic scans. RESULTS: Among 733 PDAC patients, 151 (20.6%) had pre-diagnostic imaging (mean age 72.6y, 53.6% F). At diagnosis, mean tumor size was 3.1 cm and 42.4% had metastatic disease. The mean (±SD) interval between pre-diagnostic and diagnostic scans was 15.9±9.5 months. Abnormal pancreaticobiliary findings were reported in 27.2% of pre-diagnostic scans. Pancreatic cyst prevalence was similar between pre-diagnostic and non-PDAC groups (P=0.07). However, non-cyst pancreatic abnormalities were more frequent in PDAC pre-diagnostic scans (P=0.04), including pancreatic duct dilation (P=0.07) and pancreatic atrophy (P=0.05). CONCLUSIONS: While >20% of PDAC patients had pre-diagnostic imaging, most pre-diagnostic scans reported no pancreas abnormalities, despite eventual advanced disease at diagnosis. Subtle findings suggesting PDAC such as duct dilation and pancreatic atrophy were uncommon on pre-diagnostic scans but more frequent than in non-PDAC scans. These findings may represent early signs of PDAC and warrant closer surveillance.
Moy et al. (Mon,) studied this question.
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