To analyze the causes and countermeasures of missed diagnosis and misdiagnosis of pancreatic space-occupying lesions by ultrasound.

A retrospective analysis was performed on the preoperative conventional ultrasound reports of patients with pancreatic space-occupying lesions who underwent surgery or puncture biopsy at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to December 2021. Using the pathological results as the gold standard, the patients were divided into three groups: qualified group (including cases whose ultrasound diagnosis was completely consistent with the pathological results, and those whose ultrasound only suggested "space-occupying lesions" or "further examination"), missed diagnosis group (no pancreatic space-occupying lesions were found by ultrasound, and they were diagnosed by other imaging examinations and underwent puncture biopsy or surgery), and misdiagnosis group (pancreatic space-occupying lesions diagnosed by ultrasound, but it was not in accordance with the pathological diagnosis). The general clinical data and imaging data of the three groups were collected. The t test or chi-square test was used to compare the differences in age, gender, maximum diameter of the lesion, lesion location, seniority of ultrasound doctors, and pathological nature (benign or malignant) between the three groups. The accuary of ultrasound diagnosis was improved by theory and operation training for ultrasound doctors and the establishment of a consultation system. The coincidence rate of ultrasound diagnosis to the pathological results from January to December 2021 was analyzed. The chi-square test was used to compare the difference in the coincidence rate of ultrasound diagnosis to the pathological diagnosis between before and after the implementation (the first half vs second half of 2021) of the measures.

A total of 489 patients with pancreatic space-occupying lesions (benign/malignant: 99/390, male/female: 259/230) were enrolled. There were 428 cases in the qualified group, 26 in the missed diagnosis group, and 35 in the misdiagnosis group. Compared to the qualified group, the age of patients in the missed diagnosis group was significantly older [(65.62±7.52) years vs (60.49±12.70) years, t=-2.033, P=0.043], the maximum diameter of the lesions was significantly smaller [(2.69±1.03) cm vs (3.49±1.74) cm, t=2.316, P=0.021], and the proportion of senior doctors was significantly lower (15/26 vs 342/428, χ²=7.199, P=0.007). There was no significant difference in gender, lesion location or pathological nature (benign or malignant) between the missed diagnosis group and the qualified group (P>0.05 for all). In the missed diagnosis group, 18 lesions were located in the head of the pancreas (11 in the uncinate process), and 8 were located in the body and tail of the pancreas (6 in the tail). In 5 cases, the lesions were not clearly displayed due to the interference of abdominal gas. There was no significant difference in age, gender, lesion location, maximum diameter, pathological nature (benign or malignant), or seniority of doctors between the misdiagnosis group and the qualified group (P>0.05 for all). From January to December 2021, the coincidence rates of ultrasound diagnosis of pancreatic space-occupying lesions to the pathological diagnosis were 86.54%, 86.96%, 94.59%, 88.89%, 85.71%, 68.42%, 83.93%, 92.86%, 86.84%, 94.12%, 92.86%, and 93.02%, respectively. The coincidence rate in the second half of 2021 was higher than that in the first half (89.87% vs 85.50%), but the difference was not statistically significant (P>0.05).

Conventional ultrasound has limitations in the diagnosis of pancreatic space-occupying lesions. Age of patients, lesion size and location, and seniority of doctors may lead to missed diagnosis and misdiagnosis. It is necessary to strengthen the training of doctors, establish the consultation system, and apply other combined examinations to improve the diagnostic coincidence rate.