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arXiv · 2601.22134

Early and Prediagnostic Detection of Pancreatic Cancer from Computed Tomography

Wenxuan Li·Pedro R. A. S. Bassi·Lizhou Wu·Xinze Zhou·Yuxuan Zhao·Qi Chen·Szymon Plotka·Tianyu Lin·Zheren Zhu·Marisa Martin·Justin Caskey·Shanshan Jiang·Xiaoxi Chen·Jaroslaw B. Ćwikla·Artur Sankowski·Yaping Wu·Sergio Decherchi·Andrea Cavalli·Chandana Lall·Cristian Tomasetti·Yaxing Guo·Xuan Yu·Yuqing Cai·Hualin Qiao·Jie Bao·Chenhan Hu·Ximing Wang·Arkadiusz Sitek·Kai Ding·Heng Li·Meiyun Wang·Dexin Yu·Guang Zhang·Yang Yang·Kang Wang·Alan L. Yuille·Zongwei Zhou
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Abstract

Pancreatic ductal adenocarcinoma (PDAC), one of the deadliest solid malignancies, is often detected at a late and inoperable stage. Retrospective reviews of prediagnostic CT scans, when conducted by expert radiologists aware that the patient later developed PDAC, frequently reveal lesions that were previously overlooked. To help detecting these lesions earlier, we developed an automated system named ePAI (early Pancreatic cancer detection with Artificial Intelligence). It was trained on data from 1,598 patients from a single medical center. In the internal test involving 1,009 patients, ePAI achieved an area under the receiver operating characteristic curve (AUC) of 0.939-0.999, a sensitivity of 95.3%, and a specificity of 98.7% for detecting small PDAC less than 2 cm in diameter, precisely localizing PDAC as small as 2 mm. In an external test involving 7,158 patients across 6 centers, ePAI achieved an AUC of 0.918-0.945, a sensitivity of 91.5%, and a specificity of 88.0%, precisely localizing PDAC as small as 5 mm. Importantly, ePAI detected PDACs on prediagnostic CT scans obtained 3 to 36 months before clinical diagnosis that had originally been overlooked by radiologists. It successfully detected and localized PDACs in 75 of 159 patients, with a median lead time of 347 days before clinical diagnosis. Our multi-reader study showed that ePAI significantly outperformed 30 board-certified radiologists by 50.3% (P < 0.05) in sensitivity while maintaining a comparable specificity of 95.4% in detecting PDACs early and prediagnostic. These findings suggest its potential of ePAI as an assistive tool to improve early detection of pancreatic cancer.

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Wenxuan Li, Pedro R. A. S. Bassi, Lizhou Wu, Xinze Zhou, Yuxuan Zhao, Qi Chen, Szymon Plotka, Tianyu Lin, Zheren Zhu, Marisa Martin, Justin Caskey, Shanshan Jiang, Xiaoxi Chen, Jaroslaw B. Ćwikla, Artur Sankowski, Yaping Wu, Sergio Decherchi, Andrea Cavalli, Chandana Lall, Cristian Tomasetti, Yaxing Guo, Xuan Yu, Yuqing Cai, Hualin Qiao, Jie Bao, Chenhan Hu, Ximing Wang, Arkadiusz Sitek, Kai Ding, Heng Li, Meiyun Wang, Dexin Yu, Guang Zhang, Yang Yang, Kang Wang, Alan L. Yuille, Zongwei Zhou. 2026-01-29. Early and Prediagnostic Detection of Pancreatic Cancer from Computed Tomography. https://arxiv.org/abs/2601.22134

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