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

<b>Purpose:</b> Root cause analysis carried out to establish the likely causes for pancreatic cancer not being diagnosed on previous imaging. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.