Imaging modalities for characterising focal pancreatic lesions

Best, Lawrence; Rawji, Vishal; Pereira, Stephen P.; Davidson, Brian R; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd010213.pub2

Cited by 33 publications

(32 citation statements)

References 796 publications

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“…Computed Tomography (CT) is currently the predominant imaging modality for diagnosis and preoperative staging of PDAC. Additional diagnostics include Magnetic Resonance Imaging (MRI), Positron Emission Tomography, endoscopic ultrasound-guided fine-needle aspiration and diagnostic laparoscopy (Best et al 2017). However even with currently available predominant imaging modalities, in 12-18% of surgical explorations, a resection cannot be performed due to unexpected locally advanced disease or occult metastases.…”

Section: Introductionmentioning

confidence: 99%

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

et al. 2020

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Purpose: It is suggested that tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) could be used to predict the stage of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are disputable. This study aimed to assess the value of CEA and CA19-9 serum levels at diagnosis of pancreatic ductal adenocarcinoma (PDAC) as predictors for the advanced stage of PDAC in patients discussed at pancreatic multidisciplinary team (MDT) meetings. Methods: Patients with suspected PDAC discussed at MDT meetings from 2013 to 2017 were reviewed, in order to determine optimal cut-off values of both CEA and CA19-9. Results: In total, 375 patients were included. Optimal cut-off values for predicting advanced PDAC were 7.0 ng/ml for CEA and 305.0 U/ml for CA19-9, resulting in positive predictive values of 83.3%, 73.6%, and 91.4% for CEA, CA19-9 and combined, respectively. Both tumour markers were independent predictors of advanced PDAC, demonstrated by an odds ratio of 4.21 (95% CI:1.85-9.56; p ¼ 0.001) for CEA and 2.58 for CA19-9 (95% CI:1.30-5.14; p ¼ 0.007).Conclusions: CEA appears to be a more robust predictor of advanced PDAC than CA19-9. Implementing CEA and CA19-9 serum levels during MDT meetings as an additional tool for establishing tumour resectability is worthwhile for tailored diagnostics. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

et al. 2020

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“…The goal is to detect stage one PDAC or, preferably, high-grade precursor lesions [2]. However, especially in small lesions, imaging techniques may not be able to distinguish malignancy and high-grade precursors from benign disease [3,4].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported burden of intensified surveillance and surgery in high-risk individuals under pancreatic cancer surveillance

et al. 2020

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In high-risk individuals participating in a pancreatic cancer surveillance program, worrisome features warrant for intensified surveillance or, occasionally, surgery. Our objectives were to determine the patient-reported burden of intensified surveillance and/or surgery, and to assess post-operative quality of life and opinion of surgery. Participants in our pancreatic cancer surveillance program completed questionnaires including the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). For individuals who underwent intensified surveillance, questionnaires before, during, and ≥ 3 weeks after were analyzed. In addition, subjects who underwent intensified surveillance in the past 3 years or underwent surgery at any time, were invited for an interview, that included the Short-Form 12 (SF-12). A total of 31 high-risk individuals were studied. During the intensified surveillance period, median CWS scores were higher (14, IQR 7), as compared to before (12, IQR 9, P = 0.007) and after (11, IQR 7, P = 0.014), but eventually returned back to baseline (P = 0.823). Median HADS scores were low: 5 (IQR 6) for anxiety and 3 (IQR 5) for depression, and they were unaffected by the intensified surveillance period. Of the 10 operated patients, 1 (10%) developed diabetes and 7 (70%) pancreatic exocrine insufficiency. The interviews yielded median quality-of-life scores comparable to the general population. Also, after surgery, patients' attitudes towards surveillance were unchanged (5/10, 50%) or became more positive (4/10, 40%). Although patients were aware of the (sometimes benign) pathological outcome, when asked if surgery had been justified, only 20% (2/10) disagreed, and all would again have chosen to undergo surgery. In conclusion, in individuals at high risk for pancreatic cancer, intensified surveillance temporarily increased cancer worries, without affecting general anxiety or depression. Although pancreatic surgery led to substantial co-morbidity, quality of life was similar to the general population, and surgery did not negatively affect the attitude towards surveillance.

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“…MRI and MRCP are superior in identifying the structural variants and to exclude suspected neoplastic conditions. [7][8][9]. The imaging appearance of common pancreatic adenocarcinoma is determined by its typically dense, fibrous, lowvascularized stroma resulting in low soft-tissue density in CT and low signal on T1-weighted and T2-weighted MRI and no or only minor contrast enhancement ( Fig.…”

Section: Key Pointmentioning

confidence: 99%