Prevalence and Imaging Characteristics of Chronic Calcific Pancreatitis in Patients With Newly Diagnosed Pancreatic Ductal Adenocarcinoma
Rubab F. Malik, Zahra Yousefli, Mahya Faghih, Hana Tujjar, Merve Gurakar, Jin He, Richard Burkhart, Khadija Sami, Thomas McPhaul, Javad R. Azadi, Satomi Kawamoto, Venkata S. Akshintala, Elham Afghani, Vikesh K. Singh, Atif ZaheerObjective:
Chronic pancreatitis (CP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC), with a cumulative risk of ~4% over 20 years. Most prior studies have evaluated the risk of PDAC among patients with CP. The frequency and imaging characteristics of chronic calcific pancreatitis (CCP) in patients presenting with PDAC are unknown.
Methods:
A retrospective review of the clinical history and staging computed tomography (CT) scans of patients diagnosed with resectable or borderline resectable/locally advanced PDAC between 2011 and 2022 was conducted. CCP and ductal dilatation were defined by the presence of pancreatic calcifications and a maximal pancreatic ductal diameter >5 mm on CT, respectively. Two independent radiologists reviewed all imaging studies, and discrepancies were adjudicated by a third radiologist.
Results:
Among 1008 patients with PDAC, CCP was found in 34 (3.4%), with a mean age of 69.9±8 years, 50% men, 91% White, and 59% with a history of smoking, with 26.95±18.5 pack-years. Only 7 (21%) patients had a documented history of chronic abdominal pain before PDAC diagnosis. The presence of ductal dilation, pseudocysts, or pancreatic atrophy was observed in nearly 40%, 10%, and 40% of patients, respectively, and 7 (21%) showed none of these features. Ductal dilation was associated with higher levels of CA 19-9 (349.8 U/mL [IQR; 238.3, 455.0] vs. 90.0 U/mL [IQR; 58.3, 162.2],
Conclusion:
CCP is found in 3% of patients presenting with PDAC, and most have primary painless disease. Further studies are required to determine optimal PDAC screening strategies and surveillance in patients found to have primary painless CCP.