Towards an updated view on the clinical management of pancreatic adenocarcinoma: Current and future perspectives (Review)

Pekarek, Leonel; Fraile-Martínez, Óscar; García-Montero, Cielo; Álvarez-Mon, Miguel Ángel; Acero, Julio; Ruiz, Lı́dia; García‐Honduvilla, Natalio; Albillos, Agustı́n; Buján, Julia; Álvarez‐Mon, Melchor; Guijarro, Luis; Ortega, Miguel A.

doi:10.3892/ol.2021.13070

Cited by 10 publications

(10 citation statements)

References 145 publications

(143 reference statements)

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“…In this cross-sectional study, the mean age of the studied patients was 62.32±7.82,36 patients (72%) were males and 14 patients (28%) were females. and as regards smoking 32 patients (63%) were smokers as shown in table ( 1) Regarding the site of pancreatic cancer, the most frequent site was the head of the pancreas in 24 patients (48%) followed by head and neck in 13 patients (26%), head and uncinate in 9 patients (18%), and lastly in the body in 4 patients (8%) as shown in table (4).…”

Section: Resultsmentioning

confidence: 87%

“…Precise evaluation of tumor vessel relationship is needed to give an accurate determination of the resectability of pancreatic cancer and to predict the prognosis. Although CT with IV contrast is now the "gold standard" for primary evaluation of pancreatic cancer, not all patients withstand evaluation by CT with IV contrast, because a few patients may have an allergy to the contrast agent, and some patients have impaired kidney function 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The size of the tumor is not deciding factor in surgical resection of pancreatic cancer but the presence of metastasis or the invasion of adjacent major vessels (including the common hepatic artery CHA, superior mesenteric artery SMA, superior mesenteric vein SMV, portal vein PV, Celiac artery CA, splenic artery SPA and splenic vein SPV) signi cantly affect the possibility of resection 4 .…”

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confidence: 99%

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Role of endoscopic ultrasound in staging and vascular assessment of pancreatic cancer

El-Nady

Hassan

Haridy

et al. 2023

Preprint

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Background: computed tomography (CT) of the abdomen with contrast is the gold standard method for the evaluation of pancreatic cancer concerning staging and vascular assessment. however, not all patients can be evaluated by contrast-enhanced CT abdomen as those with an allergy to the contrast agent, pregnancy, and renal impairment, in addition to hazards of radiation and non-availability of tissue sampling in CECT abdomen .so this study was designed to evaluate the diagnostic ability of Endoscopic Ultrasound for staging and vascular assessment of pancreatic cancer in comparison to CT abdomen with contrast. Method: fifty patients with cancer pancreas were evaluated by CECT and EUS as regard staging and vascular invasion. The vascular assessment was done by dividing the EUS findings into three types by the relationship between tumors and major vessels, type 1, clear invasion, encasement of the vessel by a tumor or tumor that contacts a vessel wall more than 180o; type2, Abutment, a tumor that contacts a vessel wall but less than 180o and type 3, clear non-invasion, the existence of distance between a tumor and a vessel. We regarded type 1 and type 2 as signs of vascular invasion and type 3 as a sign of vascular non-invasion, these findings were compared with the findings of the CECT abdomen. The endoscopist was blind to the CT result before the EUS examination. Result: as regards staging of pancreatic cancer EUS showed sensitivity, specificity, and accuracy of 100% for all. and as regard vascular invasion EUS showed sensitivity, specificity, and accuracy of 100%,95.93%, and 96% respectively for venous invasion and 95.65%,100%, and 99.5% for arterial invasion. Conclusion: EUS can evaluate staging and vascular invasion of pancreatic cancer with very high sensitivity, specificity, and accuracy to the extent it can replace CT in evaluation, with the superiority of EUS due to tissue sampling.

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Section: Resultsmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Role of endoscopic ultrasound in staging and vascular assessment of pancreatic cancer

El-Nady

Hassan

Haridy

et al. 2023

Preprint

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show abstract

“…Accurate evaluation of vascular invasion in patients with pancreatic cancer is very important to determine the resectability of pancreatic cancer and to predict the prognosis. Although CT with IV contrast is currently the "gold standard" for preoperative staging of pancreatic cancer, not all patients can be evaluated by CT with IV contrast, because a few patients have allergy to the contrast agent, and some patients have decreased renal function 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The size of the tumor is not deciding factor in surgical resection of pancreatic cancer but the presence of metastasis or the invasion of adjacent major vessels (including the common hepatic artery CHA, superior mesenteric artery SMA, superior mesenteric artery, portal vein SMV, portal vein PV, Celiac artery CA, splenic artery SPA and splenic vein SPV) signi cantly affect the possibility of resection 4 .…”

mentioning

confidence: 99%

Role of endoscopic ultrasound in primary staging and vascular assessment of pancreatic cancer

El-Nady

Haridy

Hassan

et al. 2022

Preprint

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Background: computed tomography (CT) of the abdomen with contrast is the gold standard method for primary evaluation of pancreatic cancer as regard to staging and vascular assessment. however, not all patients can be evaluated by contrast enhanced CT abdomen as those with allergy to the contrast agent, pregnancy, renal impairment, in addition to hazards of radiation and non-availability of tissue sampling in CECT abdomen .so this study was designed to evaluate the diagnostic ability of Endoscopic Ultrasound for staging and vascular assessment of pancreatic cancer in comparison to CT abdomen with contrast. Method: fifty patients with cancer pancreas were evaluated by EUS as regard staging and vascular invasion. Vascular assessment was done by dividing the EUS findings into three types in accordance with the relationship between tumors and major vessels, type 1, clear invasion, encasement of vessel by a tumor or tumor that contact a vessel wall more than 180o; type2, Abutment, a tumor that contacts a vessel wall but less than 180o and type 3, clear non-invasion, existence of distance between a tumor and a vessel. We regarded types 1 and type 2 as signs of vascular invasion and types 3 as sign of vascular non-invasion, these findings were compared with the findings of CT abdomen with contrast. The endoscopist was blind to CT result before EUS examination. Result: as regard to staging of pancreatic cancer EUS showed sensitivity, specificity and accuracy of 100% for all. and as regard vascular invasion EUS showed sensitivity, specificity and accuracy of 100% ,95.93% and 96% respectively for venous invasion and 95.65% ,100% and 99.5% for arterial invasion. Conclusion: EUS can evaluate staging and vascular invasion of pancreatic cancer with very high sensitivity, specificity and accuracy to the extend it can replace CT in primary evaluation, with superiority of EUS due to tissue sampling.

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Pancreatic cancer, radiomics and artificial intelligence

Martí‐Bonmatí

Cerdá-Alberich

Pérez-Enguix

et al. 2022

BJR

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Patients with pancreatic ductal adenocarcinoma (PDAC) are generally classified into four categories based on contrast-enhanced CT at diagnosis: resectable, borderline resectable, unresectable, and metastatic disease. In the initial grading and staging of PDAC, structured radiological templates are useful but limited, as there is a need to define the aggressiveness and microscopic disease stage of these tumours to ensure adequate treatment allocation. Quantitative imaging analysis allows radiomics and dynamic imaging features to provide information of clinical outcomes, and to construct clinical models based on radiomics signatures or imaging phenotypes. These quantitative features may be used as prognostic and predictive biomarkers in clinical decision making, enabling personalized management of advanced PDAC. Deep Learning and Convolutional Neural Networks also provide high level bioinformatics tools that can help define features associated with a given aspect of PDAC biology and aggressiveness, paving the way to define outcomes based on these features. Thus, the prediction of tumour phenotype, treatment response and patient prognosis may be feasible by using such comprehensive and integrated radiomics models. Despite these promising results, quantitative imaging is not ready for clinical implementation in PDAC. Limitations include the instability of metrics and lack of external validation. Large properly annotated datasets, including relevant semantic features (demographics, blood markers, genomics), image harmonization, robust radiomics analysis, clinically significant tasks as outputs, comparisons with gold standards (such as TNM or pretreatment classifications) and fully independent validation cohorts, will be required for the development of trustworthy radiomics and Artificial Intelligence solutions to predict PDAC aggressiveness in a clinical setting.

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Towards an updated view on the clinical management of pancreatic adenocarcinoma: Current and future perspectives (Review)

Cited by 10 publications

References 145 publications

Role of endoscopic ultrasound in staging and vascular assessment of pancreatic cancer

Role of endoscopic ultrasound in staging and vascular assessment of pancreatic cancer

Role of endoscopic ultrasound in primary staging and vascular assessment of pancreatic cancer

Pancreatic cancer, radiomics and artificial intelligence

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