Focal Parenchymal Atrophy of the Pancreas Is Frequently Observed on Pre-Diagnostic Computed Tomography in Patients with Pancreatic Cancer: A Case-Control Study

Abstract

Pancreatic ductal adenocarcinoma (PDAC) accounts for the majority of all pancreatic cancers and is highly lethal. Focal parenchymal atrophy (FPA) of the pancreas has been reported as a characteristic imaging finding of early PDAC. Here, we reviewed 76 patients with PDAC who underwent computed tomography (CT) between 6 months and 3 years before PDAC diagnosis, as well as 76 sex- and age-matched controls without PDAC on CT examinations separated by at least 5 years. FPA was observed corresponding to the location of the subsequent tumor on pre-diagnostic CT in 14/44 (31.8%) patients between 6 months and 1 year, 14/51 (27.5%) patients between 1 and 2 years, and 9/41 (22.0%) patients between 2 and 3 years before PDAC diagnosis. Overall, FPA was more frequently observed in patients with PDAC (26/76; 34.2%) on pre-diagnostic CT than that in controls (3/76; 3.9%) (p < 0.001). FPA was observed before the appearance of cut-off/dilatation of the main pancreatic duct, suggesting that FPA might be the earliest sign of PDAC. FPA was less frequently found in tumors in the pancreatic head (3/27; 11.1%) than in those in the body (14/30; 46.7%) or tail (9/19; 47.4%). FPA may predict the subsequent PDAC diagnosis, serving as an important imaging sign for the early diagnosis of pancreatic cancer.

Fatty Pancreas and Pancreatic Cancer: An Overlooked Association?

“…This finding is expected, as this finding is secondary to the PC-associated obstructive pancreatitis. A recent study showed that pancreatic atrophy was present in approximately 34% of patients with PC, as even the authors suggested that pancreatic atrophy might be an early sign of the development of PC [18]. In our study, we did not have data regarding the presence of pancreatic atrophy prior to the diagnosis of PC.…”

Diffuse pancreatic parenchymal atrophy, an imaging finding predictive of the development of pancreatic ductal adenocarcinoma: A case–control study

“…Recently, several reports have found a relationship between FPA and early pancreatic cancer 8–11 . FPA is thought to arise from low‐grade pancreatic intraepithelial neoplasm (PanIN) the pre‐cancerous stage of PDAC 12 .…”

Clinical features and prognostic impact of asymptomatic pancreatic cancer

“…In a multicenter study of early stage PDAC in Japan, MPD dilatation could be detected in approximately three-quarters of the Stage 0 cases (76.5% cases on US, 72.0% on CT, and 73.9% on MRI), whereas pancreatic tumors could only be detected in approximately 10% of cases (8.8% cases on US, 10.0% on CT, and 10.9% on MRI) 12 . In addition to MPD abnormalities, recent studies have shown that focal parenchymal atrophy of the pancreas on CT serves as an important imaging sign for the early diagnosis of PDAC 38 , 39 . Of note, Miura et al 39 reported that focal parenchymal atrophy might be the earliest sign of PDAC, which appears before MPD abnormalities.…”

“…In addition to MPD abnormalities, recent studies have shown that focal parenchymal atrophy of the pancreas on CT serves as an important imaging sign for the early diagnosis of PDAC 38 , 39 . Of note, Miura et al 39 reported that focal parenchymal atrophy might be the earliest sign of PDAC, which appears before MPD abnormalities. Novel biomarkers, such as non-coding RNAs, exosomes, and circulating DNA, have been reported to improve the accuracy of diagnosis 40 – 42 .…”