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A 59-year-old man with stage IV pancreatic adenocarcinoma. Axial fused PET/CT image shows FDG-avid left supraclavicular adenopathy ( curved white arrowheads ) consistent with metastatic disease.
Source publication
Because of the evolution of treatment strategies staging criteria for pancreatic cancer now emphasize arterial involvement for determining unresectable disease. Preoperative therapy may improve the likelihood of margin negative resections of borderline resectable tumors. Cross-sectional imaging is crucial for correctly staging patients. Magnetic re...
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Purpose:
This study aimed to investigate the ability of Al18F-NOTA-FAPI PET/CT to diagnose pancreatic carcinoma and tumor-associated inflammation with the comparison of 18F-FDG PET/CT.
Methods:
Prospective analysis of Al18F-NOTA-FAPI PET/CT and 18F-FDG PET/CT scans of 31 patients from 05/2021 to 05/2022 were analyzed. Al18F-NOTA-FAPI imaging was...
Background
Pretherapy serum neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) have been shown to predict prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). However, the published literature is conflicting; hence, we aimed to evaluate their role in predicting survival ou...
In order to provide optimal cancer care and prognostication, it is necessary to stage the disease. The 8th edition of the TNM-staging for exocrine pancreatic ductal adenocarcinoma (PDAC) system has refined size-based T-stages and number-based N-categories. However, several impediments to the value of this may exist. For one, even at small size (e.g...
Purpose
The aim of this study was to validate and improve the 8th edition of the Union for International Cancer Control (UICC) staging system for pancreatic ductal adenocarcinoma (PDAC).
Methods
Prognostic impact of the pathological tumor (pT) and lymph node (pN) stages between the 7th and 8th editions were compared using a single-center cohort of...
Citations
... However, only one in seven PD patients with a pancreatic ductal adenocarcinoma (PDAC) is alive five years after their resection [1]. The standard preoperative workup includes a computed tomography (CT) scan of the chest, abdomen and pelvis to accurately stage the disease [2], but some patients require additional preoperative investigations. If distant metastases cannot be ruled out by CT alone, positron emission tomography (PET-CT) is indicated [3]. ...
Backgrounds/aims:
Pancreatoduodenectomy (PD) is recommended in fit patients with a carcinoma (PDAC) of the pancreatic head, and a delayed resection may affect survival. This study aimed to correlate the time from staging to PD with long-term survival, and study the impact of preoperative investigations (if any) on the timing of surgery.
Methods:
Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD outcomes. Only PDAC patients who underwent an upfront resection were included. Patients who received neoadjuvant chemo-/radiotherapy were excluded. Group A (PD within 28 days of most recent preoperative computed tomography [CT]) was compared to group B (> 28 days).
Results:
A total of 595 patents were included. Compared to group A (median CT-PD time: 12.5 days, interquartile range: 6-21), group B (49 days, 39-64.5) had similar one-year survival (73% vs. 75%, p = 0.6), five-year survival (23% vs. 21%, p = 0.6) and median time-to-death (17 vs. 18 months, p = 0.8). Staging laparoscopy (43 vs. 29.5 days, p = 0.009) and preoperative biliary stenting (39 vs. 20 days, p < 0.001) were associated with a delay to PD, but magnetic resonance imaging (32 vs. 32 days, p = 0.5), positron emission tomography (40 vs. 31 days, p > 0.99) and endoscopic ultrasonography (28 vs. 32 days, p > 0.99) were not.
Conclusions:
Although a treatment delay may give rise to patient anxiety, our findings would suggest this does not correlate with worse survival. A delay may be necessary to obtain further information and minimize the number of PD patients diagnosed with early disease recurrence.
... However, only around 20% of patients present with resectable disease at time of first diagnosis [18]. Five-year survival for R0-resected patients ranges between 15 and 27%; relapse of disease occurs quite often [14,29]. For localized nonresectable disease or for locally recurrent disease, radiotherapy (RT) or chemora-diation (RCHT) is a treatment option. ...
Background
Pancreatic cancer accounts for around 4.6% of cancers deaths worldwide per year. Despite many advances in treatment regimes, the prognosis is still poor. Only 20% of tumors are primarily resectable. Recurrences—both with distant metastasis as well as locoregional—are frequent. For patients with primary nonresectable localized disease or localized recurrences, we offered chemoradiation to achieve local control over a long period of time. We here report our results on combined chemoradiation of pancreatic tumors and local recurrences using proton beam therapy.
Materials and methods
We report on 25 patients with localized nonresectable pancreatic cancer (15 patients) or local recurrent disease (10 patients). All patients were treated with combined proton radiochemotherapy. Overall survival, progression-free survival, local control, and treatment-related toxicity were analyzed using statistically methods.
Results
Median RT dose was 54.0 Gy (RBE) for proton irradiation. The toxicity of treatment was acceptable. Four CTCAE grade III and IV adverse events (bone marrow disfunction, gastrointestinal [GI] disorders, stent dislocation, myocardial infarction) were recorded during or directly after the end of radiotherapy; two of them were related to combined chemoradiation (bone marrow disfunction, GI disorders). Six weeks after radiotherapy, one additional grade IV toxicity was reported (ileus, caused by peritoneal carcinomatosis, not treatment related). The median progression-free survival was 5.9 months and median overall survival was 11.0 months. The pretherapy CA19‑9 level was a statistically significant prognostic factor for enhanced overall survival. Local control at 6 months and 12 months were determined to be 86% and 80%, respectively.
Conclusion
Combined proton chemoradiation leads to high local control rates. Unfortunately, PFS and OS are driven by distant metastasis and were not improved compared to historical data and reports. With this in mind, enhanced chemotherapeutical regimes, in combination with local irradiation, should be evaluated.
... In the context of translational research, different non-invasive imaging techniques have been tested and further developed allowing diagnosis, staging and longitudinal evaluation for preclinical and clinical purposes. Currently, PDAC diagnosis mainly relies on tissue sample analysis and medical imaging, namely computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound guided fine-needle aspiration (22)(23)(24)(25)(26). ...
Background:
Pancreatic ductal adenocarcinoma (PDAC) is highly malignant with a very poor prognosis due to its silent development and metastatic profile with a 5-year survival rate below 10%. PDAC is characterised by an abundant desmoplastic stroma modulation that influences cancer development by extracellular matrix/cell interactions. Elastin is a key element of the extracellular matrix. Elastin degradation products (EDPs) regulate numerous biological processes such as cell proliferation, migration and invasion. The aim of the present study was to characterise for the first time the effect of two EDPs with consensus sequences "GxxPG" and "GxPGxGxG" (VG-6 and AG-9) on PDAC development. The ribosomal protein SA (RPSA) has been discovered recently, acting as a new receptor of EDPs on the surface of tumour cells, contributing to poor prognosis.
Methods:
Six week-old female Swiss nude nu/nu (Nu(Ico)-Foxn1nu) mice were subcutaneously injected with human PDAC MIA PaCa-2/eGFP-FLuc+ cells, transduced with a purpose-made lentiviral vector, encoding green fluorescent protein (GFP) and Photinus pyralis (firefly) luciferase (FLuc). Animals were treated three times per week with AG-9 (n = 4), VG-6 (n = 5) or PBS (n = 5). The influence of EDP on PDAC was examined by multimodal imaging (bioluminescence imaging (BLI), fluorescence imaging (FLI) and magnetic resonance imaging (MRI). Tumour volumes were also measured using a caliper. Finally, immunohistology was performed at the end of the in vivo study.
Results:
After in vitro validation of MIA PaCa-2 cells by optical imaging, we demonstrated that EDPs exacerbate tumour growth in the PDAC mouse model. While VG-6 stimulated tumour growth to some extent, AG-9 had greater impact on tumour growth. We showed that the expression of the RPSA correlates with a possible effect of EDPs in the PDAC model. Multimodal imaging allowed for longitudinal in vivo follow-up of tumour development. In all groups, we showed mature vessels ending in close vicinity of the tumour, except for the AG-9 group where mature vessels are penetrating the tumour reflecting an increase of vascularisation.
Conclusions:
Our results suggest that AG-9 strongly increases PDAC progression through an increase in tumour vascularisation.
... In addition, EUS-FNA is affected by various factors, such as scope position [27], lesion characteristics, the environment surrounding the lesions, and the evaluating pathologist [27][28][29][30]. Positron emission tomographycomputed tomography (PET/CT) is limited in its ability to evaluate small lesions and cannot differentiate between inflammatory lymphadenopathy and metastatic lymphadenopathy [31]. Similarly, MRI has several limiting factors associated with the determination of LN status in clinical settings, namely, spatial resolution problems, motion artifacts, and dose-dependent oversaturation artifacts [6]. ...
Purpose
To develop and validate a radiomics nomogram for the preoperative prediction of lymph node (LN) metastasis in pancreatic ductal adenocarcinoma (PDAC).
Materials and methods
In this retrospective study, 225 patients with surgically resected, pathologically confirmed PDAC underwent multislice computed tomography (MSCT) between January 2014 and January 2017. Radiomics features were extracted from arterial CT scans. The least absolute shrinkage and selection operator method was used to select the features. Multivariable logistic regression analysis was used to develop the predictive model, and a radiomics nomogram was built and internally validated in 45 consecutive patients with PDAC between February 2017 and December 2017. The performance of the nomogram was assessed in the training and validation cohort. Finally, the clinical usefulness of the nomogram was estimated using decision curve analysis (DCA).
Results
The radiomics signature, which consisted of 13 selected features of the arterial phase, was significantly associated with LN status ( p < 0.05) in both the training and validation cohorts. The multivariable logistic regression model included the radiomics signature and CT-reported LN status. The individualized prediction nomogram showed good discrimination in the training cohort [area under the curve (AUC), 0.75; 95% confidence interval (CI), 0.68–0.82] and in the validation cohort (AUC, 0.81; 95% CI, 0.69–0.94) and good calibration. DCA demonstrated that the radiomics nomogram was clinically useful.
Conclusions
The presented radiomics nomogram that incorporates the radiomics signature and CT-reported LN status is a noninvasive, preoperative prediction tool with favorable predictive accuracy for LN metastasis in patients with PDAC.
... While CT is said to have a sensitivity of 89-97% for pancreatic tumors (including adenocarcinoma), although it is DISCUSSION less effective in diagnosing small lesions (< 2 cm) with a sensitivity of 65-75% or still from 70% to 100% according to the authors. [16,17] Currently, it has always been indicated in case of suspicion of a malignant tumor of the pancreas in the clinic or on ultrasound. Computed tomography (CT) is now one of the main methods for staging a suspected pancreatic tumor. ...
Objective . Our objective was to describe the scanographic profile of pancreatic tumors in 3 radiology departments in Kinshasa. Methods . Comparative study conducted in 3 radiology departments in Kinshasa from January 2016 to June 2021, having retained 86 reports of abdominal CT-scans of patients with pancreatic pathology including 62 cases of pancreatic tumors. Results . Male patients were in the majority (sex-ratio M/F=1.6) with a mean age of 55.7±14.7 years (16 to 92 years). The frequency of pancreatic tumors was higher (62 cases/86) compared to that of inflammatory pathologies (20 cases/86). Cholestasis syndrome (50%) and abdominal (epigastric) pain were the most common indications. In tumors the contours were lobulated (56.1%) compared to pancreatitis, where they were blurred in 80% (p<0.05). In 45% of pancreatitis the peripancreatic fat was infiltrated, against 16.7% in tumors (p=0.01). The Wirsung duct was dilated in most tumors compared to pancreatitis where it was irregular with calcifications (p<0.05). The tumors were resectable in 26% of cases. Conclusion . The abdominal CT-scan contributes to the diagnosis of pancreatic pathologies. Tumors are the most common, most of them unresectable . It is often an elderly male subject with a clinical indication.
... In artery evaluation, abutment or encasement classified as tumor involvement. While vein evaluation, encasement, change caliber of vessels in the region of contact, or irregularity of vessel margin were assessed as tumor involvement (24). Furthermore, the anatomy type of BDs were assessed according to the five anatomy types reported by Huang et al. (25) namely, normal, trifurcation, right posterior BD draining to the left hepatic duct, right posterior BD draining to the common BD, and right posterior BD draining to the cystic duct. ...
Purpose: To evaluate CT findings to predict incomplete (R1 or R2) resection and poor survival in patients with perihilar cholangiocarcinoma using pre-operative CT.Materials and Methods: From 2006 to 2012, a total of 139 patients with perihilar cholangiocarcinoma who underwent pre-operative multiphase CT and subsequent curative-intent surgery were included. After two radiologists independently reviewed CT findings including the likelihood of bile duct (BD) involvement from intrapancreatic common bile duct (CBD) to bilateral second-order branches and peritumoral fat stranding using a 5-point scale, vessel involvement (no, abutment, encasement), and LN involvement, imaging findings were finalized by a consensus of two radiologists. When the likelihood scale of 4 or more on preoperative CT was regarded as BD involvement, the diagnostic ability of CT was analyzed by the receiver operating curve using histopathologic results as a reference standard. Residual tumor categorized into no residual tumor (R0) and residual tumor (R+; R1 or R2). Predictive factors of R+ resection on pre-operative CT were analyzed by logistic regression. Cox proportional hazard model was used to determine the prognostic factor for overall survival by using pre-operative CT findings and laboratory results.Results: Seventy-one patients were R0 and sixty-eight patients were R+ resection. For resectability evaluation, mid-CBD involvement (score ≥ 4) in pre-operative CT was significant factor for R+ resection in multivariable analysis ( P < 0.01) with substantial interobserver agreement. In multivariable Cox regression, intrapancreatic CBD involvement (score ≥ 4, hazard ratio [HR] = 1.81, P < 0.01) as well as elevated total bilirubin (HR = 1.53, P = 0.04) and CA 19-9 level (HR = 1.75, P < 0.01) were significant predictors for poor survival. Diagnostic ability to predict mid-CBD and intrapancreatic CBD involvement on pre-operative CT were 0.71 and 0.72 (AUC values).Conclusions: Distal longitudinal extent of perihilar cancer on pre-operative CT is a significant factor for margin positive resection and poor survival on curative-intent surgery.
... Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer that ranks 4th among cancer-related mortalities in the USA, with over 60,000 estimated new cancer cases for 2021 and yearly incidence rising by approximately 1% [1,2]. For initial evaluation of suspected PDAC cases, multidetector computed tomography (CT) with intravenous contrast is preferred for its cost effectiveness, easy availability, and ability to accurately stage the cancer [1,[3][4][5][6][7]. Accurate interpretation of imaging studies as well as the reporting of study findings in a complete and coherent manner by radiologists are critical in guiding optimal multidisciplinary treatment selection, including surgery and neoadjuvant and/ or adjuvant chemotherapy. ...
PurposeWith the rise in popularity of structured reports in radiology, we sought to evaluate whether free-text CT reports on pancreatic ductal adenocarcinoma (PDAC) staging at our institute met published guidelines and assess feedback of pancreatic surgeons comparing free-text and structured report styles with the same information content.Methods
We retrospectively evaluated 298 free-text preoperative CT reports from 2015 to 2017 for the inclusion of key tumor descriptors. Two surgeons independently evaluated 50 free-text reports followed by evaluation of the same reports in a structured format using a 7-question survey to assess the usefulness and ease of information extraction. Fisher’s exact test and Chi-square test for independence were utilized for categorical responses and an independent samples t test for comparing mean ratings of report quality as rated on a 5-point Likert scale.ResultsThe most commonly included descriptors in free-text reports were tumor location (99%), liver lesions (97%), and suspicious lymph nodes (97%). The most commonly excluded descriptors were variant arterial anatomy and peritoneal/omental nodularity, which were present in only 23% and 42% of the reports, respectively. For vascular involvement, a mention of the presence or absence of perivascular disease with the main portal vein was most commonly included (87%). Both surgeons’ rating of overall report quality was significantly higher for structured reports (p < 0.001).Conclusion
Our results indicate that free-text reports may not include key descriptors for staging PDAC. Surgeons rated structured reports that presented the same information as free-text reports but in a template format superior for guiding clinical management, convenience of use, and overall report quality.Graphical abstract
... PDA is hypodense on CT imaging due to the intense desmoplastic nature of the tumor. 16 MDCT also helps to stage the disease by estimating the size of the lesion and also involvement of surrounding structures including the vessels. Thus, MDCT is very important in classifying the resectable, borderline resectable and unresectable cases. ...
... Even though, all the tumors diagnosed in the above study were of pancreatic adenocarcinoma there are other tumors such as pancreatic neuroendocrine tumors (PNETs), lymphomas and rarely metastasis. PNETs show intense enhancement in the arterial phase 16 . Cystic neoplasms of the pancreas can also be diagnosed on MDCT though many require EUS guided cyst fluid analysis for accurate diagnosis. ...
The pancreas is an important exocrine and endocrine gland in the human body located in the upper abdomen. A great deal of information about the pancreas can be obtained on multi-detector computerized tomography (MDCT), including the exact location of the lesion, characterization and relation to the surrounding structures. The present study was done to evaluate the spectrum of pathologies of pancreas visualized on MDCT. A cross-sectional single center study was conducted from November 2018 to January 2020. Patients who were diagnosed with pancreatic pathology of all etiologies and satisfying the inclusion and exclusion criteria were invited to participate in the study. CT examination of the abdomen was typically performed using neutral oral contrast and non-ionic low osmolar iodinated intravenous contrast agent. Abdominal CT images were evaluated as per the standard reporting pattern and the images of pancreas were analyzed. In our study out of 33 patients, 25 patients were male and eight were female patients. Most of the patients belonged to the age group of 40-50 years. Among the various lesions diagnosed on MDCT inflammatory lesions were most common accounting for 60.6% of the cases, followed by tumors (33.3%), and congenital lesions (6.1%). MDCT is a very useful investigation to diagnose various pancreatic pathologies. Predominant pathologies diagnosed were inflammatory lesions (pancreatitis) followed by neoplasms.
... Dedicated pancreatic CT imaging of the abdomen is a preferred imaging modality for determining staging and resectability of PDAC, as per multiple references, including the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2020 Pancreatic Adenocarcinoma [8][9][10][11][12]. Though MRI has been shown to have equivalent sensitivity and specificity for staging of pancreatic cancer and can be used interchangeably [13], CT imaging is more widely used due to its higher cost-effectiveness and availability [9,14]. ...
PurposeTo assess the CT diagnostic performance for evaluating resectability of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy and identify the factor(s) that affect(s) diagnostic performance.Methods
Databases were searched to identify studies published from January 1, 2000, to November 5, 2019 that evaluated the CT diagnostic performance for assessing resectability of post-neoadjuvant PDAC. Two reviewers independently extracted data and assessed the study quality. A meta-analysis was performed to obtain summary sensitivity and specificity values using a bivariate random-effects model, and heterogeneity across studies was assessed. Univariable meta-regression analysis was performed with eight variables, including the different CT criteria for resectability, conventional National Comprehensive Cancer Network (NCCN) criteria for upfront surgery, and modified criteria for post-neoadjuvant surgery.ResultsTen studies were included and analyzed. The summary sensitivity and specificity for resectability were 78% (95% CI 68–86%) and 60% (95% CI 44–74%), respectively. No significant heterogeneity was identified (bivariate correlation coefficient ρ = − 1, p-value for hierarchical summary receiver operating characteristics model β = 0.667). The two different CT criteria showed different diagnostic performance (p < 0.01), with higher sensitivity (81% [95% CI 73–90%] vs. 28% [95% CI 15–42%], p < 0.01) and lower specificity (57% [95% CI 41–73%] vs. 90% [95% CI 80–100%], p < 0.01) for the modified criteria. No other variables affected the diagnostic performance.ConclusionCT criteria were the factors that affected the diagnostic performance. Modification of the conventional criteria improved sensitivity but lowered specificity. Further modifications are required to improve specificity and uniformity.Graphic abstract
... Those patients have a disappointing survival rate, similar to that of non-resected tumors in case of R2 resections. Additionally, a careful multidisciplinary evaluation might help to decrease the morbidity linked to a non-curative major surgery (5,(7)(8)(9). ...
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease even in the early stages, despite progresses in surgical and pharmacological treatment in recent years. High potential for metastases is the main cause of therapeutic failure in localized disease, highlighting the current limited knowledge of underlying pathological processes. However, nowadays research is focusing on the search for personalized approaches also in the adjuvant setting for PDAC, by implementing the use of biomarkers and investigating new therapeutic targets. In this context, the aim of this narrative review is to summarize the current treatment scenario and new potential therapeutic approaches in early stage PDAC, from both a preclinical and clinical point of view. Additionally, the review examines the role of target therapies in localized PDAC and the influence of neoadjuvant treatments on survival outcomes.
