TY - JOUR
T1 - Preoperative misdiagnosis of pancreatic and periampullary cancer in patients undergoing pancreatoduodenectomy
T2 - A multicentre retrospective cohort study
AU - van Roessel, Stijn
AU - Soer, Eline C.
AU - Daamen, Lois A.
AU - van Dalen, Demi
AU - Fariña Sarasqueta, Arantza
AU - Stommel, Martijn W. J.
AU - Molenaar, I. Quintus
AU - van Santvoort, Hjalmar C.
AU - van de Vlasakker, Vincent C. J.
AU - de Hingh, Ignace H. J. T.
AU - Groen, Jesse V.
AU - Mieog, J. Sven D.
AU - van Dam, Jacob L.
AU - van Eijck, Casper H. J.
AU - van Tienhoven, Geertjan
AU - Klümpen, Heinz-Josef
AU - Wilmink, Johanna W.
AU - Busch, Olivier R.
AU - Dutch Pancreatic Cancer Group
AU - Brosens, Lodewijk A. A.
AU - Groot Koerkamp, Bas
AU - Verheij, Joanne
AU - Besselink, Marc G.
N1 - Publisher Copyright: © 2021 The Authors
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Introduction: Whereas neoadjuvant chemo(radio)therapy is increasingly used in pancreatic cancer, it is currently not recommended for other periampullary (non-pancreatic) cancers. This has important implications for the relevance of the preoperative diagnosis for pancreatoduodenectomy. This retrospective multicentre cohort study aimed to determine the frequency of clinically relevant misdiagnoses in patients undergoing pancreatoduodenectomy for pancreatic or other periampullary cancer. Methods: Data from all consecutive patients who underwent a pancreatoduodenectomy between 2014 and 2018 were obtained from the prospective Dutch Pancreatic Cancer Audit. The preoperative diagnosis as concluded by the multidisciplinary team (MDT) meeting was compared with the final postoperative diagnosis at pathology to determine the rate of clinically relevant misdiagnosis (defined as missed pancreatic cancer or incorrect diagnosis of pancreatic cancer). Results: In total, 1244 patients underwent pancreatoduodenectomy of whom 203 (16%) had a clinically relevant misdiagnosis preoperatively. Of all patients with a final diagnosis of pancreatic cancer, 13% (87/679) were preoperatively misdiagnosed as distal cholangiocarcinoma (n = 41, 6.0%), ampullary cancer (n = 27, 4.0%) duodenal cancer (n = 16, 2.4%), or other (n = 3, 0.4%). Of all patients with a final diagnosis of periampullary (non-pancreatic) cancer, 21% (116/565) were preoperatively incorrectly diagnosed as pancreatic cancer. Accuracy of preoperative diagnosis was 84% for pancreatic cancer, 71% for distal cholangiocarcinoma, 73% for ampullary cancer and 73% for duodenal cancer. A prediction model for the preoperative likelihood of pancreatic cancer (versus other periampullary cancer) prior to pancreatoduodenectomy demonstrated an AUC of 0.88. Discussion: This retrospective multicentre cohort study showed that 16% of patients have a clinically relevant misdiagnosis that could result in either missing the opportunity of neoadjuvant chemotherapy in patients with pancreatic cancer or inappropriate administration of neoadjuvant chemotherapy in patients with non-pancreatic periampullary cancer. A preoperative prediction model is available on www.pancreascalculator.com.
AB - Introduction: Whereas neoadjuvant chemo(radio)therapy is increasingly used in pancreatic cancer, it is currently not recommended for other periampullary (non-pancreatic) cancers. This has important implications for the relevance of the preoperative diagnosis for pancreatoduodenectomy. This retrospective multicentre cohort study aimed to determine the frequency of clinically relevant misdiagnoses in patients undergoing pancreatoduodenectomy for pancreatic or other periampullary cancer. Methods: Data from all consecutive patients who underwent a pancreatoduodenectomy between 2014 and 2018 were obtained from the prospective Dutch Pancreatic Cancer Audit. The preoperative diagnosis as concluded by the multidisciplinary team (MDT) meeting was compared with the final postoperative diagnosis at pathology to determine the rate of clinically relevant misdiagnosis (defined as missed pancreatic cancer or incorrect diagnosis of pancreatic cancer). Results: In total, 1244 patients underwent pancreatoduodenectomy of whom 203 (16%) had a clinically relevant misdiagnosis preoperatively. Of all patients with a final diagnosis of pancreatic cancer, 13% (87/679) were preoperatively misdiagnosed as distal cholangiocarcinoma (n = 41, 6.0%), ampullary cancer (n = 27, 4.0%) duodenal cancer (n = 16, 2.4%), or other (n = 3, 0.4%). Of all patients with a final diagnosis of periampullary (non-pancreatic) cancer, 21% (116/565) were preoperatively incorrectly diagnosed as pancreatic cancer. Accuracy of preoperative diagnosis was 84% for pancreatic cancer, 71% for distal cholangiocarcinoma, 73% for ampullary cancer and 73% for duodenal cancer. A prediction model for the preoperative likelihood of pancreatic cancer (versus other periampullary cancer) prior to pancreatoduodenectomy demonstrated an AUC of 0.88. Discussion: This retrospective multicentre cohort study showed that 16% of patients have a clinically relevant misdiagnosis that could result in either missing the opportunity of neoadjuvant chemotherapy in patients with pancreatic cancer or inappropriate administration of neoadjuvant chemotherapy in patients with non-pancreatic periampullary cancer. A preoperative prediction model is available on www.pancreascalculator.com.
KW - Diagnosis
KW - Distal cholangiocarcinoma
KW - Epidemiology
KW - Neoadjuvant therapy
KW - Pancreatic cancer
KW - Pancreatoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=85109334751&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2021.03.228
DO - https://doi.org/10.1016/j.ejso.2021.03.228
M3 - Article
C2 - 33745791
SN - 0748-7983
VL - 47
SP - 2525
EP - 2532
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 10
ER -