Treatment pathway utilization after endoscopic ultrasound in pancreatic cancer.

Abstract

e16366 Background: Pancreatic malignancies, primarily pancreatic ductal adenocarcinoma (PDAC) with a smaller proportion of pancreatic neuroendocrine tumors (pNETs), have rising incidence and high mortality. In the United States, 5-year survival remains about 12–13% overall and ~44% for localized disease, though most patients present beyond a curable stage. Diagnosis relies on multimodal imaging and EUS-guided tissue acquisition, with growing use of FNB needles to improve yield. Delays between cross-sectional imaging and endoscopic ultrasound (EUS) may influence access to definitive therapy. This study assessed whether the imaging-to-EUS interval is associated with downstream time to treatment and overall treatment uptake. Methods: We performed a retrospective cohort study using the TriNetX United States Collaborative Network. Adults with pancreatic cancer (ICD-10 C25.x) who had an abnormal imaging code (R93.x) and underwent EUS within 90 days were included. Patients were grouped by imaging-to-EUS interval: ≤1 week, 1–2 weeks, 2–4 weeks, and 4–12 weeks. Primary outcomes were time from EUS to initiation of chemotherapy or pancreatectomy within 365 days. The secondary outcome was entry into any treatment pathway. Comparisons between academic and non-academic centers were descriptive. Results: A total of 4,669 patients met criteria. The median imaging-to-EUS interval was 8 days and similar across center types. Median time from EUS to chemotherapy was stable across groups (26–30 days). In contrast, median time from EUS to pancreatectomy increased with later EUS (32 days when performed within 1 week vs 46 days when performed 4–12 weeks after imaging). The proportion without a documented treatment pathway rose with delay (46.7% at 1–2 weeks vs 56.2% at 4–12 weeks). Earlier EUS, particularly within 2 weeks, was associated with higher treatment uptake and shorter time to surgery. Conclusions: Earlier EUS after index imaging was associated with faster initiation of surgical therapy and greater likelihood of entering any treatment pathway, while time to chemotherapy remained largely stable across timing windows. These findings support diagnostic timeliness, particularly rapid-access EUS and high-yield tissue acquisition, as an actionable lever to expedite definitive care in pancreatic cancer. Time to treatment following endoscopic ultrasound (EUS), stratified by the interval from imaging to EUS. EUS timing N No Pathway n (%) Treatment n Median (days) Mean ± SD (days) Min Max ≤1 week 2,012 1,009 (50.1%) Chemotherapy 722 27 38.794 ± 40.373 1 305 Pancreatectomy 178 32 67.758 ± 76.014 2 357 1-2 weeks 895 418 (46.7%) Chemotherapy 345 26 37.771 ± 38.080 1 274 Pancreatectomy 83 49 69.795 ± 68.037 3 348 2-4 weeks 821 408 (49.7%) Chemotherapy 276 30 44.656 ± 48.266 2 352 Pancreatectomy 95 43 67.768 ± 68.008 3 298 4 weeks-3 months 941 529 (56.2%) Chemotherapy 237 29 50.907 ± 58.838 1 348 Pancreatectomy 106 46 77.264 ± 77.004 1 348