文章：

胰腺癌患者在确诊前18个月内接受影像学检查但未得出癌症诊断的根本原因分析

Root Cause Analysis of Patients with Pancreatic Cancer Who Underwent Imaging Not Resulting in a Cancer Diagnosis in the 18 Months Prior to Diagnosis

原文发布日期：26 November 2025

DOI: 10.3390/cancers17233770

类型: Article

开放获取: 是

英文摘要：

Purpose:Root cause analysis carried out to establish the likely causes for pancreatic cancer not being diagnosed on previous imaging.Methods:Records of pancreatic cancer patients between 2016 and 2021 at two NHS providers were examined. Post-Imaging Pancreatic Cancer (PIPC) was defined as pancreatic cancer diagnosed 3–18 months after an index scan that did not report cancer. Index and diagnostic imaging were reviewed by two radiologists independently. An algorithm was developed to categorise PIPC.Results:46 of 600 patients (7.7%) were classified as having PIPC, with 43 CT and 3 MRI scans undertaken 3–18 months before cancer diagnosis. The median age was 75.9 (IQR 69.6–80.2) years, with 58.7% female. PIPCs were categorised as focal lesion reported on index scan in the same pancreatic segment as diagnostic scan (2.2%); imaging changes associated with pancreatic cancer reported on index scan (17.4%); missed focal lesion or imaging changes associated with pancreatic cancer on index scan (26.1%); no focal lesion or imaging changes associated with pancreatic cancer on index scan (54.3%). Following exclusion of two patients (one declined investigations and one was too unwell), 16 of 46 (35%) PIPC patients could have been diagnosed earlier. Twelve had a missed focal lesion, and four had duct dilatation or a focal lesion reported but were inadequately investigated.Conclusions:Approximately three out of 100 pancreatic cancer patients could have been diagnosed earlier due to a missed lesion or inadequately investigated lesion or duct dilatation on index imaging. There are opportunities for earlier diagnosis of pancreatic cancer on imaging.

摘要翻译： 

目的：开展根本原因分析以明确既往影像检查未能诊断胰腺癌的可能原因。方法：对两家英国国民医疗服务体系机构2016年至2021年间的胰腺癌患者记录进行审查。影像后胰腺癌定义为在未报告癌症的基准扫描后3-18个月内确诊的胰腺癌病例。由两名放射科医师独立复核基准影像与诊断影像。开发算法对影像后胰腺癌进行分类。结果：600例患者中46例（7.7%）被归类为影像后胰腺癌，其中43例CT扫描和3例MRI扫描在癌症诊断前3-18个月完成。中位年龄75.9岁（四分位距69.6-80.2），女性占58.7%。影像后胰腺癌分类如下：基准扫描报告与诊断扫描相同胰腺节段的局灶性病变（2.2%）；基准扫描报告与胰腺癌相关的影像学改变（17.4%）；基准扫描遗漏与胰腺癌相关的局灶性病变或影像学改变（26.1%）；基准扫描未见与胰腺癌相关的局灶性病变或影像学改变（54.3%）。排除2例患者（1例拒绝检查，1例病情危重）后，46例影像后胰腺癌患者中16例（35%）本可更早确诊，其中12例存在遗漏的局灶性病变，4例虽报告导管扩张或局灶性病变但未充分检查。结论：约3%的胰腺癌患者因基准影像中病变遗漏、检查不充分或导管扩张而延误诊断。影像学检查存在提升胰腺癌早期诊断率的改进空间。

原文链接：

Root Cause Analysis of Patients with Pancreatic Cancer Who Underwent Imaging Not Resulting in a Cancer Diagnosis in the 18 Months Prior to Diagnosis