Screening for pancreatic cancer: a review for general clinicians

Wiest, Nathaniel E.; Moktan, Varun; Oman, Sven P.; Chirilă, Răzvan M.

doi:10.2478/rjim-2020-0009

Cited by 4 publications

(2 citation statements)

References 88 publications

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“…Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies and has a dismal prognosis with an overall 5-year survival rate of less than 10% [ 3 ]. The only curative therapy for PDAC is early detection followed by surgical resection [ 5 ]. Hence, early detection is important in improving the prognosis and overall survival of patients with PDAC.…”

Section: Introductionmentioning

confidence: 99%

CD63-positive extracellular vesicles are potential diagnostic biomarkers of pancreatic ductal adenocarcinoma

et al. 2022

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Background Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest gastrointestinal cancers with a 5-year survival rate of less than 10%. Biomarkers for early PDAC detection are useful in treating patients with PDAC. Extracellular vesicles (EVs) are lipid-bound vesicles that are potential biomarkers of various diseases such as PDAC. In this study, we quantitatively measured the serum levels of EVs (CD63+-EVs) or platelet-derived EVs (CD41+- and CD61+-EVs) and evaluated their potential use as biomarkers of PDAC. Methods We measured the serum levels of CD63+-, CD41+-, CD61+-EVs using sandwich enzyme-linked immunosorbent assay based on Tim4 with specificity for phosphatidylserine on EVs in age- and sex-matched healthy controls (HCs, n = 39) and patients with PDAC (n = 39). We also examined the effect of tumor burden on the serum EV levels after surgical resection (n = 28). CA19-9, a clinical PDAC biomarker, was also measured for comparison. Results Serum levels of CD63+-EVs, CD41+-EVs, and CD61+-EVs were significantly increased in patients with PDAC compared to HCs. Receiver operating characteristic analysis revealed that CD63+-EVs exhibited the highest diagnostic performance to discriminate patients with PDAC from HCs (area under the curve (AUC): 0.846), which was comparable to CA19-9 (AUC: 0.842). CA19-9 showed lower AUC values in early stages (I–II, AUC: 0.814) than in late stages (III–IV, AUC: 0.883) PDAC. Conversely, CD63+-EVs, CD41+-EVs, and CD61+-EVs showed comparable AUCs between early- and late-stage PDAC. The combined use of CA19-9 and CD63+-EVs showed a higher diagnostic performance for early-stage PDAC (AUC: 0.903) than CA19-9. The serum levels of CD63+-EVs, CD41+-EVs, CD61+-EVs, and CA19-9 decreased significantly after surgical resection, demonstrating that EVs are increased in sera of patients depending on the tumor burden. Conclusions The serum levels of CD63+-EVs and platelet-derived EVs (CD41+-EVs, CD61+-EVs) are increased in patients with PDAC than HCs. Since CD63+-EVs showed a high AUC to discriminate patients with PDAC from HCs; they might be useful as potential biomarkers for PDAC.

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Section: Introductionmentioning

confidence: 99%

CD63-positive extracellular vesicles are potential diagnostic biomarkers of pancreatic ductal adenocarcinoma

et al. 2022

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“…Though EUS is now considered the most sensitive imaging modality for the detection of pancreatic lesions, Wiest et al [164], reported a sensitivity of 88-100%, a specificity of 63.4-94%, a positive predictive value (PPV) of 71.4-96.2%, and a negative (N) PV of 68.5-100% for MRI, that with MRCP has a sensitivity of 97.1-100%, a specificity of 81.8-88%, a PPV of 94.4-97%, and a NPV of 90-100%, similar to EUS, while a lower accuracy was reported for CT. CT sensitivity and specificity are correlated to detector numbers and study protocol [164]. The possibility to add EUS conventional protocol, elastography and/or contrast-enhanced ultrasound (CEUS) could improve the sensitivity of EUS for PC screening [165].…”

Section: Screening Modalitiesmentioning

confidence: 99%

Risk Assessment and Pancreatic Cancer: Diagnostic Management and Artificial Intelligence

Granata

Fusco

Setola

et al. 2023

Cancers

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Pancreatic cancer (PC) is one of the deadliest cancers, and it is responsible for a number of deaths almost equal to its incidence. The high mortality rate is correlated with several explanations; the main one is the late disease stage at which the majority of patients are diagnosed. Since surgical resection has been recognised as the only curative treatment, a PC diagnosis at the initial stage is believed the main tool to improve survival. Therefore, patient stratification according to familial and genetic risk and the creation of screening protocol by using minimally invasive diagnostic tools would be appropriate. Pancreatic cystic neoplasms (PCNs) are subsets of lesions which deserve special management to avoid overtreatment. The current PC screening programs are based on the annual employment of magnetic resonance imaging with cholangiopancreatography sequences (MR/MRCP) and/or endoscopic ultrasonography (EUS). For patients unfit for MRI, computed tomography (CT) could be proposed, although CT results in lower detection rates, compared to MRI, for small lesions. The actual major limit is the incapacity to detect and characterize the pancreatic intraepithelial neoplasia (PanIN) by EUS and MR/MRCP. The possibility of utilizing artificial intelligence models to evaluate higher-risk patients could favour the diagnosis of these entities, although more data are needed to support the real utility of these applications in the field of screening. For these motives, it would be appropriate to realize screening programs in research settings.

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