BACKGROUND: About 30-40% of PDAs can be missed on CTs due to subtle imaging findings. Unfortunately, PDA can advance from being undetectable to widely metastatic in a matter of months which underscores the critical need to develop novel tools such as AI to improve its detection. Most current AI-based PDA detection approaches require manual segmentations that are not clinically scalable. Our objective was to develop a 3D Convolutional Neural Network (CNN) for fully automated detection of PDA on standard-of-care CTs.

METHODS: A fully-automated 3D-CNN was trained on a dataset of 696 portal venous phase diagnostic CTs with PDA and 1080 control CTs with normal pancreas. Model was evaluated on (a) test subset of 409 PDA and 829 control CTs; (b) simulated cohort with high pre-test probability of PDA (1-5% over 3-years), which matched the case-control distribution in high-risk groups (glycemically-defined new-onset diabetes and high ENDPAC score); (c) multi-institutional public dataset of 194 PDA and 80 control CTs; and (d) a cohort of 102 prediagnostic CTs (i.e. CTs with normal-appearing pancreas incidentally acquired 3–36 months before clinical diagnosis of PDA) and 134 control CTs.

RESULTS: In the test subset, the model correctly classified 360 (88%) PDA CTs and 783 (94%) normal CTs [accuracy (mean; 95% CI) 0·92 (0·91-0·94); AUROC 0·97 (0·96-0·98), sensitivity 0·88 (0·85-0·91), specificity 0·95 (0·93-0·96)]. Performance was comparable across tumor stages (sensitivity 0·80, 0·87, 0·95 and 1 on T1 through T4 stages, respectively), hypodense versus isodense tumors (sensitivity: 0·90 vs. 0·82), age, sex, CT slice thicknesses & vendors (all p >0·05), and generalizable on both the simulated cohort [accuracy 0·95 (0·94-0·95), AUROC 0·97 (0·94-0·99)] and public dataset [accuracy 0·86 (0·82-0·90), AUROC 0·90 (0·86-0·95), sensitivity 0·88, specificity 0·93] including for T1 and isodense tumors (sensitivity 0·76 and 0·88, respectively). Despite being trained on diagnostic CTs, the model could detect PDA at the prediagnostic stage from normal pancreas [accuracy 0·84 (0·79-0·88), AUROC 0·90 (0·87-0·94), sensitivity 0·75 (0·66-0·83), specificity 0·90 (0·85-0·95)] at a median interval of 475 days (range:93-1082 days) between prediagnostic CTs and the clinical diagnosis of PDA. 

CONCLUSION: A 3D-CNN developed on a large dataset shows high accuracy and generalizability for fully-automated detection of PDA (including small and isodense tumors) on diagnostic CTs as well as for early detection of PDA from normal pancreas on prediagnostic CTs at a substantial lead time prior to clinical diagnosis. Prospective validation with blood-based biomarkers could enable AI-augmented early detection of PDA in high-risk subjects.

AI-Powered Fully automated Early Detection of Pancreatic Ductal Adenocarcinoma on Standard-of-care CT Scans.

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