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The diagnostic pathway for solid pancreatic neoplasms: are we applying too many tests?
Michael R Driedger1, Elijah Dixon1, Rachid Mohamed2
1Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada.
The Journal of Surgical Research
|May 9, 2015
Summary
Optimizing pancreatic cancer diagnosis requires streamlined evaluation. Minimizing additional tests after initial imaging, like CT scans, significantly reduces delays in surgical consultation and treatment for pancreatic lesions.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Contrast-enhanced computed tomography (CT) is the primary diagnostic and staging tool for pancreatic cancer.
- It is often the sole imaging test needed before surgical resection of solid pancreatic lesions.
- Many patients experience delayed care due to unnecessary additional testing.
Purpose of the Study:
- To evaluate the impact of diagnostic test numbers and referral pathways on the time to surgical consultation and intervention for solid pancreatic lesions.
- To identify factors contributing to delays in definitive care for patients with pancreatic adenocarcinoma.
- To advocate for streamlined diagnostic algorithms and direct referrals to Hepato-Pancreato-Biliary (HPB) services.
Main Methods:
- Retrospective review of 130 patients with solid pancreatic lesions evaluated by an HPB service from 2008-2012.
- Analysis of time intervals between initial imaging, HPB consultation, and surgery.
- Comparison of outcomes based on the number of additional diagnostic tests and referral service (surgical vs. nonsurgical).
Main Results:
- Increasing the number of diagnostic tests after initial imaging significantly prolonged time to HPB consultation and surgery.
- Patients referred directly to HPB surgeons experienced shorter wait times for consultation and operation compared to those initially referred to nonsurgical services.
- Nonsurgical referrals led to more diagnostic tests and greater delays in care.
Conclusions:
- Heterogeneity in patient evaluation for solid pancreatic lesions leads to significant delays in care.
- Reducing the number of investigations post-initial imaging is crucial for expediting surgical consultation and intervention.
- Educational initiatives are needed to promote efficient diagnostic pathways and direct referrals to specialized HPB services.
