Initial Misdiagnosis of Proximal Pancreatic Adenocarcinoma Is Associated with Delay in Diagnosis and Advanced Stage at Presentation.
BACKGROUND
Delay in diagnosis of pancreatic ductal adenocarcinoma (PDAC) is associated with decreased survival. The effect of an initial misdiagnosis on delay in diagnosis and stage of PDAC is unknown.


METHODS
This study is a retrospective review (2000-2010) from a University-based cancer center of new diagnoses of proximal PDAC.


RESULTS
Of 313 patients, 98 (31.3 %) had an initial misdiagnosis. Misdiagnosed patients were younger, 62.8 ± 12.6 vs. 68.0 ± 10.1 (p < 0.001). The most common initial misdiagnoses were: gallbladder disease, gastroesophageal reflux disease, and peptic ulcer disease. After excluding patients with prior cholecystectomy, 14.2 % were misdiagnosed with gallbladder disease and underwent cholecystectomy before PDAC diagnosis. Misdiagnosed patients had higher rates of abdominal pain (p < 0.001), weight loss (p = 0.04), and acute pancreatitis (p < 0.001) and lower rate of jaundice (p < 0.001). Median time between symptoms to PDAC diagnosis was longer in misdiagnosed: 4.2 months vs. 1.4 (p < 0.001). Median time from contact with medical provider to axial imaging was longer in misdiagnosed (p < 0.001). Rate of stages III-IV disease at diagnosis was higher in misdiagnosed: 61.2 vs. 43.7 % (p = 0.004), with a 1.4 (95 % confidence interval (CI), 1.12-1.74) higher risk of stages III-IV disease at diagnosis; however, there was no difference in median overall survival in misdiagnosed patients (9.6 months in misdiagnosed vs. 10.3 months in correctly diagnosed, p = 0.69).


CONCLUSIONS
Initial misdiagnosis of patients with proximal PDAC is associated with delay in diagnosis and higher risk of locally advanced or advanced disease at time of PDAC diagnosis.
Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA. douglas.swords@hsc.utah.edu.
Douglas S
DS
Swords
Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Mary C
MC
Mone
Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Chong
C
Zhang
Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Angela P
AP
Presson
Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Sean J
SJ
Mulvihill
Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Courtney L
CL
Scaife
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000473:pathology*; D002763:Cholecystectomy; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology*; D010195:Pancreatitis / Q000209:etiology; D010437:Peptic Ulcer / Q000175:diagnosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D015431:Weight Loss
Delay diagnosis; Misdiagnosis; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Stage