Abdominal Ultrasound Examination Considering High-risk Stigmata for Pancreatic Cancer

<p>Objective: Early detection of pancreatic cancer by abdominal ultrasound is dependent on the reliable detection of pancreatic cystic lesions and main pancreatic duct dilatation, which are high-risk stigmata for pancreatic cancer. Here, we aimed to identify future issues in ultrasound screening for pancreatic cancer by understanding the current state of ultrasound screening at our institution and reviewing ultrasound images based on detailed examination results.</p><p>Methods: A total of 33,113 abdominal ultrasound examinations were done at our center from April 2016 to March 2021 in a total of 15,784 patients (9,198 men and 6,586 women). Average age was 48.4 ± 9.7 years. We studied a retrospective investigation of the facility’s own inspection reports and detailed inspection results.</p><p>Results: Over the 5-year period, 389 patients were identified as having pancreatic lesions (identification rate 2.46%). The number (rate) of patients requiring detailed examination based on screening findings at the time of initial indications was 111 (0.70%) with main pancreatic duct dilatation, 25 (0.16%) with solid lesions, 167 patients (1.06%) with pancreatic cystic lesions, and 10 patients (0.06%) with others. Pancreatic cancer was detected in 4 patients, cancer detection rate was 0.025%, and the positive predictive value was 1.299%. All pancreatic cancers were Stage IA-IIA. Examination findings showed main pancreatic duct dilatation in all cases and solid pancreatic lesions in 2 cases. One of these patients had been examined every year and examination revealed no abnormalities. However, he was diagnosed with pancreatic cancer two years later. Of the 136 patients with pancreatic cystic lesions who underwent thorough examination, 58 (42.6%) had intraductal papillary mucinous neoplasm (IPMN) and 49 (36.0%) had pancreatic cyst.</p><p>Conclusion: The relatively early ultrasound findings of pancreatic cancer detected in this study were main pancreatic duct dilatation and solid lesions, which are both high-risk stigmata for pancreatic cancer. For patients who undergo annual examination, even if a thorough examination reveals no abnormalities, it is necessary to recommend a second examination if findings continue to be observed.</p>