Diagnosis of pancreatic cancer

Abstract

The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71-100% and 64-90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities.

Diagnostic utility of clinical and biochemical parameters in pancreatic head malignancy patients with normal carbohydrate antigen 19-9 levels

“…Patients bearing malignant tumors in pancreatic head were more likely to present with abdominal pain (63.77% versus 45.95% in our study). Although abdominal pain was nonspecific 18 , it was the most frequent onset symptom in pancreatic cancer 15,19 , and it was proven to have certain relation with tumor location in pancreatic adenocarcinoma 20 . On the other hand, patients with benign lesions did not often appear with abdominal pain until it reached considerable size and gave rise to the obstruction of the pancreatico-biliary duct 21 .…”

Value of ultrasound examination in differential diagnosis of pancreatic lymphoma and pancreatic cancer

“…Currently, it is one of the top ten malignant tumors, and its prognosis is very poor. The 1-year survival rate is below 20% and the 5-year survival rate is only 3% [1,5,8] . Pancreatic lymphoma is a rare pancreatic tumor that accounts for only 1% of all pancreatic tumors.…”

“…Among the pancreatic tumors, there are much similarities in clinical manifestations and imaging characteristics of pancreatic cancer and pancreatic lymphoma and thus they are easy to be misdiagnosed [1][2][3][4] . However, the treatment and prognosis of pancreatic cancer and pancreatic lymphoma are quite different, and the differential diagnosis of these two diseases is therefore very important [5][6][7] .…”

Screening for Subsequent Pancreatic Cancer in Childhood Cancer Survivors is Needed. A Case Report

“…Abdominal ultrasound is the most accessible, widely used modality and often used first to identify the cause of abdominal pain or other symptoms and signs. But the accuracy of conventional ultrasound for diagnosing pancreatic tumours is only 50-70% [15]. Widely used biomarker CA 19-9 is not suitable for early diagnosis of pancreatic cancer because of its inadequate sensitivity and specificity, but maybe in the future effective biomarkers, like microRNA, in combination with imaging would provide an ideal approach for early detection of pancreatic cancer [16].…”