The relevance of pathological verification in suspected pancreatic cancer

• Pancreatic cancer was pathologically verified in 59% of the patients.
• Patients with metastatic pancreatic cancer had higher odds of verification.
• Survival of patients without verification suggests that they suffered from true invasive cancer.
• Treatment decisions in the absence of pathological verification may be justified in selected patients.

ObjectivesThis population-based study assessed which factors were associated with pathological verification of pancreatic cancer.MethodsAll patients diagnosed with a malignancy of the pancreas between 1993 and 2010 in the South of the Netherlands (N = 3321) were included.ResultsPancreatic cancer was pathologically verified in 59% of patients. The proportion of verification increased over time from 56% in 1993–1996 to 69% in 2009–2010 (p < 0.0001). High rates of verification were found among young patients (<50 years vs. 60–69 yrs: adjusted odds ratio (ORadj) 3.2 (95% CI: 1.9–5.4)), patients with a high socioeconomic status (high vs. low: ORadj 1.3 (95% CI: 1.1–1.7)), patients with metastatic disease (metastatic vs locoregional: ORadj 3.2 (95% CI: 2.7–3.8)) and patients treated with chemotherapy (yes vs. no: ORadj 2.4 (95% CI: 1.8–3.2)). The most favorable prognosis was found in patients with verified locoregional disease (median overall survival (mOS) 7.6 months, 95% CI: 7.1–8.6). Patients with unverified metastatic disease carried the worst prognosis (mOS 1.7 months, 95% CI: 1.4–2.0).ConclusionVerification by pathology remains preferable and desirable whenever possible. However, the median survival rate exhibited by patients without verification suggests that the vast majority of patients suffered from true invasive pancreatic cancer. This may justify treatment decisions even in the absence of pathologic verification in selected patients.