Department of Diagnostic Radiology, QEII Health Sciences Centre, Victoria General Hospital, Dalhousie University, Victoria Building, Room 319, North Wing, 1276 South Park Street, PO BOX 9000, Halifax, NS, B3H 2Y9, Canada.
Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Canada.
Eur Radiol. 2021 Apr;31(4):2422-2432. doi: 10.1007/s00330-020-07307-5. Epub 2020 Sep 30.
To retrospectively examine US, CT, and MR imaging examinations of missed or misinterpreted pancreatic ductal adenocarcinoma (PDAC), and identify factors which may have confounded detection or interpretation.
We reviewed 107 examinations in 66/257 patients (26%, mean age 73.7 years) diagnosed with PDAC in 2014 and 2015, with missed or misinterpreted imaging findings as determined by a prior study. For each patient, images and reports were independently reviewed by two radiologists, and in consensus, the following factors which may have confounded assessment were recorded: inherent tumor factors, concurrent pancreatic pathology, technical limitations, and cognitive biases. Secondary signs of PDAC associated with each examination were recorded and compared with the original report to determine which findings were missed.
There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively. A significant number of missed tumors were < 2 cm (45/107, 42%), isoattenuating on CT (32/72, 44%) or non-contour deforming (44/107, 41%). Most (29/49, 59%) misinterpreted examinations were reported as uncomplicated pancreatitis. Almost all examinations (94/107, 88%) demonstrated secondary signs; pancreatic duct dilation was the most common (65/107, 61%) and vascular invasion was the most commonly missed 35/39 (90%). Of the CT and MRIs, 28 of 88 (32%) had suboptimal contrast dosing. Inattentional blindness was the most common cognitive bias, identified in 55/107 (51%) of the exams.
Recognizing pitfalls of PDAC detection and interpretation, including intrinsic tumor features, secondary signs, technical factors, and cognitive biases, can assist radiologists in making an early and accurate diagnosis.
• There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively, with tumoral, technical, and cognitive factors leading to the misdiagnosis of pancreatic ductal adenocarcinoma. • The majority (29/49, 59%) of misinterpreted cases of pancreatic ductal adenocarcinoma were mistaken for pancreatitis, where an underlying mass or secondary signs were not appreciated due to inflammatory changes. • The most common missed secondary sign of pancreatic ductal adenocarcinoma was vascular encasement, missed in 35/39 (90%) of cases, indicating the importance of evaluating the peri-pancreatic vasculature.
回顾性分析漏诊或误诊的胰腺导管腺癌（PDAC）的 US、CT 和 MR 影像学检查，并确定可能影响检测或诊断的因素。
我们回顾了 2014 年和 2015 年在 257 例 PDAC 患者中诊断出的 66/107 例（26%，平均年龄 73.7 岁）患者的 107 项检查，其影像学结果漏诊或误诊由之前的研究确定。对于每位患者，两位放射科医生分别独立对图像和报告进行了审查，并在共识的基础上记录了可能影响评估的以下因素：固有肿瘤因素、同时存在的胰腺病变、技术限制和认知偏见。记录了与每个检查相关的 PDAC 的次要征象，并与原始报告进行比较，以确定遗漏了哪些发现。
分别有 66/107（62%）和 49/107（46%）例存在漏诊和误诊的影像学表现。大量漏诊的肿瘤<2cm（45/107，42%），CT 等密度（32/72，44%）或非轮廓变形（44/107，41%）。大多数（29/49，59%）误诊的检查被报告为单纯性胰腺炎。几乎所有检查（94/107，88%）均显示出次要征象；胰管扩张最常见（65/107，61%），血管侵犯最易漏诊（35/39，90%）。在 CT 和 MRI 中，88 项中有 28 项（32%）造影剂剂量不足。注意力不集中是最常见的认知偏差，在 107 项检查中的 55 项（51%）中发现。
认识到 PDAC 检测和诊断中的陷阱，包括固有肿瘤特征、次要征象、技术因素和认知偏差，可帮助放射科医生尽早做出准确诊断。
分别有 66/107（62%）和 49/107（46%）例存在漏诊和误诊的影像学表现，肿瘤、技术和认知因素导致胰腺导管腺癌的误诊。
大多数（29/49，59%）误诊为胰腺炎的胰腺导管腺癌病例中，由于炎症变化，未能识别潜在的肿块或次要征象。
最常见的胰腺导管腺癌遗漏的次要征象是血管包绕，35/39 例（90%）漏诊，表明评估胰周血管的重要性。
