AI-powered Early Detection for Pancreatic Cancer Via Non-contrast CT in Opportunistic Screening Cohort

NCT ID: NCT06638866

Last Updated: 2025-03-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

5000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-08-03

Study Completion Date

2030-12-31

Brief Summary

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Pancreatic ductal adenocarcinoma (PDAC) remains a therapeutic challenge with 5-year survival rates of 13%, primarily attributable to advanced-stage diagnosis (AJCC Stage III/IV in \>80% of cases). This prospective, observational, multi-center study will evaluate the performance of an AI-powered opportunistic screening system utilizing non-contrast computed tomography (NCCT) acquired during routine clinical encounters or health check-ups. The proposed AI model will perform automated detection of pancreatic parenchymal abnormalities, including PDAC and precursor lesions (intraductal papillary mucinous neoplasms \[IPMN\], mucinous cystic neoplasms \[MCN\]). Algorithm-positive cases will be independently reviewed by two radiologists. Highly suspected individuals will undergo further diagnostic verification, including serological tests and multimodal imaging confirmation. Patients with confirmed positive diagnosis will receive multidisciplinary consultation and specialized treatment, whereas those with negative results will undergo at least one-year clinical follow-up. This study will quantitatively evaluate the AI system's performance, and aims to advance PDAC early detection, improve patient outcomes, and make it accessible in underserved populations.

Detailed Description

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PDAC is projected to become the second-leading cause of cancer mortality by 2030, with stage-specific survival disparities reaching 83.7% for stage IA versus 2.9% for stage IV disease. This dramatic survival gradient highlights the transformative potential of stage migration through early detection.

Screening-based early detection has demonstrated improved prognosis for PDAC patients; however, implementation faces dual challenges. he low incidence of PDAC renders population-wide screening cost-ineffective, while current screening methods are hampered by high false-positive rates and overdiagnosis risks. In this context, opportunistic screening has garnered attention for its unique implementation advantages. By leveraging existing imaging resources from routine clinical encounters or health check-ups, this approach obviates the need for additional screening infrastructure, potentially reducing healthcare resource consumption while effectively increasing screening coverage among high-risk populations.

Non-contrast computed tomography (NCCT), despite its widespread clinical application and operational convenience, is limited by suboptimal soft tissue resolution, resulting in insufficient sensitivity for early pancreatic lesions (≤2 cm), thus significantly constraining its utility in opportunistic screening. Recent advancements in AI technology have significantly impacted the field of medical image analysis. These techniques have enabled the automation of the detection of subtle pancreatic lesion features in large-scale imaging data, with the potential to enhance the accuracy and efficiency of early pancreatic cancer detection. In preliminary research, a deep learning-based model for pancreatic cancer detection was developed by our team. This model demonstrated the ability to accurately detect and classify pancreatic lesions on NCCT images, with excellent performance in multicenter validation studies. The model also exhibited strong generalizability when applied to chest CT scans. Therefore, AI-powered NCCT shows significant potential for application in hospital-based opportunistic screening programs and may become an effective tool for early pancreatic cancer detection. However, further research is required to fully explore and realize this potential.

This prospective, observational, multi-center study will evaluate the performance of an AI-powered opportunistic screening system utilizing NCCT acquired during routine clinical encounters or health check-ups. The deep learning-based detection system will perform automated identification of pancreatic lesions, including PDAC and precursor entities (intraductal papillary mucinous neoplasms \[IPMN\], mucinous cystic neoplasms \[MCN\]). Algorithm-positive cases will be independently reviewed by two radiologists. Individuals with high suspicion after radiologists review will undergo further validation via serological tests (e.g., CA19-9, CEA) and imaging studies (e.g., contrast-enhanced CT, contrast-enhanced MRI, EUS-FNA). Participants with a confirmed positive diagnosis will undergo multidisciplinary consultation and specialized treatment, while those with a negative diagnosis will be followed clinically for at least one year.

The AI system's performance will be evaluated through three primary metrics: (1) Detection rate of PDAC and high-risk precursor lesions, defined as the proportion of histologically confirmed PDAC and precursor lesions (IPMN/MCN) meeting Sendai criteria among all participants undergoing CT screening. (2) Recall rate, defined as the proportion of individuals recalled for confirmatory testing after AI-positive screening and radiologist review among all participants undergoing CT screening. (3) Positive predictive value (PPV) defined as the proportion of histologically confirmed PDAC and high-risk precursor lesions among all AI-positive screening cases.

Institutional Collaboration: Led by Shanghai Changhai Hospital (PI: Gang Jin, MD) with five regional centers (Yinzhou Hospital, Jiaxing University Hospital, Lishui Central Hospital, Jingning County Hospital) and Alibaba DAMO Academy (technical support).

Conditions

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Pancreatic Cancer Pancreatic Ductal Adenocarcinoma Pancreatic Intraepithelial Neoplasias Intraductal Papillary Mucinous Neoplasm Mucinous Cystic Neoplasm

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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AIgorithm-classified PDAC Group

Participants who underwent non-contrast abdominal and/or chest CT scans and were preliminarily classified by the aIgorithm as PDAC.

PDAC

Intervention Type DIAGNOSTIC_TEST

Participants with algorithm-identified PDAC will be independently reviewed by two radiologists. Those highly suspected will be recalled for further diagnostic evaluation, including serological tests (e.g., CA19-9, CEA) and imaging (e.g., contrast-enhanced CT/MRI, EUS-FNA). Participants with a confirmed positive diagnosis will undergo multidisciplinary consultation and specialized treatment, while those with a negative diagnosis will be followed clinically for at least one year.

AIgorithm-classified Pancreatic Precursor Lesions Group

Participants who underwent non-contrast abdominal and/or chest CT scans and were preliminarily classified by the aIgorithm as pancreatic precursor lesions.

Pancreatic precursor lesions

Intervention Type DIAGNOSTIC_TEST

Participants with algorithm-identified pancreatic precursor lesions will be independently reviewed by two radiologists. Those highly suspected will be recalled for further diagnostic evaluation, including serological tests (e.g., CA19-9, CEA) and imaging (e.g., contrast-enhanced CT/MRI, EUS-FNA). Participants with a confirmed positive diagnosis will undergo multidisciplinary consultation and specialized treatment, while those with a negative diagnosis will be followed clinically for at least one year.

Interventions

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PDAC

Participants with algorithm-identified PDAC will be independently reviewed by two radiologists. Those highly suspected will be recalled for further diagnostic evaluation, including serological tests (e.g., CA19-9, CEA) and imaging (e.g., contrast-enhanced CT/MRI, EUS-FNA). Participants with a confirmed positive diagnosis will undergo multidisciplinary consultation and specialized treatment, while those with a negative diagnosis will be followed clinically for at least one year.

Intervention Type DIAGNOSTIC_TEST

Pancreatic precursor lesions

Participants with algorithm-identified pancreatic precursor lesions will be independently reviewed by two radiologists. Those highly suspected will be recalled for further diagnostic evaluation, including serological tests (e.g., CA19-9, CEA) and imaging (e.g., contrast-enhanced CT/MRI, EUS-FNA). Participants with a confirmed positive diagnosis will undergo multidisciplinary consultation and specialized treatment, while those with a negative diagnosis will be followed clinically for at least one year.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

1\. Individuals undergoing routine non-contrast chest and/or abdominal CT scans for non-pancreatic indications.

Exclusion Criteria

1. History of pancreatic cancer;
2. History of thoracic or abdominal surgery;
3. Acute pancreatitis within 6 months;
4. Patients referred for evaluation of suspected or confirmed pancreatic cancer.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Yinzhou Hospital Affiliated to Medical School of Ningbo University

OTHER

Sponsor Role collaborator

The Second Affiliated Hospital of Jiaxing University

OTHER

Sponsor Role collaborator

Central Hospital of Lishui City

UNKNOWN

Sponsor Role collaborator

Jingning County People's Hospital

UNKNOWN

Sponsor Role collaborator

Alibaba DAMO Academy

UNKNOWN

Sponsor Role collaborator

Changhai Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jin Gang, M.D.

Role: STUDY_CHAIR

Changhai Hospital

Wang Bei Lei, M.D.

Role: STUDY_DIRECTOR

Changhai Hospital

Locations

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Shanghai Changhai Hospital

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Second Affiliated Hospital of Jiaxing University

Jiaxing, Zhejiang, China

Site Status RECRUITING

Yinzhou Hospital Affiliated to Medical School of Ningbo University

Ningbo, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Wang Bei Lei, M.D.

Role: CONTACT

86-13774238083

Guo Shi Wei, M.D.

Role: CONTACT

86-18621500666

Facility Contacts

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Wang Beilei, M.D.

Role: primary

86-13774238083

Shen Yi Jue, M.D.

Role: primary

13605835645

Zhu Ke Lei, M.D.

Role: primary

13566636272

References

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Chu LC, Park S, Kawamoto S, Wang Y, Zhou Y, Shen W, Zhu Z, Xia Y, Xie L, Liu F, Yu Q, Fouladi DF, Shayesteh S, Zinreich E, Graves JS, Horton KM, Yuille AL, Hruban RH, Kinzler KW, Vogelstein B, Fishman EK. Application of Deep Learning to Pancreatic Cancer Detection: Lessons Learned From Our Initial Experience. J Am Coll Radiol. 2019 Sep;16(9 Pt B):1338-1342. doi: 10.1016/j.jacr.2019.05.034. No abstract available.

Reference Type BACKGROUND
PMID: 31492412 (View on PubMed)

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Reference Type BACKGROUND
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Mizrahi JD, Surana R, Valle JW, Shroff RT. Pancreatic cancer. Lancet. 2020 Jun 27;395(10242):2008-2020. doi: 10.1016/S0140-6736(20)30974-0.

Reference Type BACKGROUND
PMID: 32593337 (View on PubMed)

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Reference Type BACKGROUND
PMID: 32135127 (View on PubMed)

Young MR, Abrams N, Ghosh S, Rinaudo JAS, Marquez G, Srivastava S. Prediagnostic Image Data, Artificial Intelligence, and Pancreatic Cancer: A Tell-Tale Sign to Early Detection. Pancreas. 2020 Aug;49(7):882-886. doi: 10.1097/MPA.0000000000001603.

Reference Type BACKGROUND
PMID: 32675784 (View on PubMed)

Stoffel EM, Brand RE, Goggins M. Pancreatic Cancer: Changing Epidemiology and New Approaches to Risk Assessment, Early Detection, and Prevention. Gastroenterology. 2023 Apr;164(5):752-765. doi: 10.1053/j.gastro.2023.02.012. Epub 2023 Feb 18.

Reference Type BACKGROUND
PMID: 36804602 (View on PubMed)

Kenner B, Chari ST, Kelsen D, Klimstra DS, Pandol SJ, Rosenthal M, Rustgi AK, Taylor JA, Yala A, Abul-Husn N, Andersen DK, Bernstein D, Brunak S, Canto MI, Eldar YC, Fishman EK, Fleshman J, Go VLW, Holt JM, Field B, Goldberg A, Hoos W, Iacobuzio-Donahue C, Li D, Lidgard G, Maitra A, Matrisian LM, Poblete S, Rothschild L, Sander C, Schwartz LH, Shalit U, Srivastava S, Wolpin B. Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review. Pancreas. 2021 Mar 1;50(3):251-279. doi: 10.1097/MPA.0000000000001762.

Reference Type BACKGROUND
PMID: 33835956 (View on PubMed)

Klein AP. Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol. 2021 Jul;18(7):493-502. doi: 10.1038/s41575-021-00457-x. Epub 2021 May 17.

Reference Type BACKGROUND
PMID: 34002083 (View on PubMed)

US Preventive Services Task Force; Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Curry SJ, Doubeni CA, Epling JW Jr, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Pancreatic Cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2019 Aug 6;322(5):438-444. doi: 10.1001/jama.2019.10232.

Reference Type BACKGROUND
PMID: 31386141 (View on PubMed)

Cao K, Xia Y, Yao J, Han X, Lambert L, Zhang T, Tang W, Jin G, Jiang H, Fang X, Nogues I, Li X, Guo W, Wang Y, Fang W, Qiu M, Hou Y, Kovarnik T, Vocka M, Lu Y, Chen Y, Chen X, Liu Z, Zhou J, Xie C, Zhang R, Lu H, Hager GD, Yuille AL, Lu L, Shao C, Shi Y, Zhang Q, Liang T, Zhang L, Lu J. Large-scale pancreatic cancer detection via non-contrast CT and deep learning. Nat Med. 2023 Dec;29(12):3033-3043. doi: 10.1038/s41591-023-02640-w. Epub 2023 Nov 20.

Reference Type BACKGROUND
PMID: 37985692 (View on PubMed)

Other Identifiers

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202401063

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

202440208

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

20511101200

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

AI-PANC-1

Identifier Type: -

Identifier Source: org_study_id

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