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CC BY 4.0 · Indian J Med Paediatr Oncol 2023; 44(01): 077-083
DOI: 10.1055/s-0042-1759521
Review Article

Imaging Recommendations for Diagnosis, Staging, and Management of Pancreatic Cancer

Nitin Sudhakar Shetty
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Ujjwal Agarwal
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Amit Choudhari
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Anurag Gupta
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Nandakumar PG 
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Manish Bhandare
2   Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Kunal Gala 
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Daksh Chandra 
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Anant Ramaswamy
3   Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Vikas Ostwal
3   Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Shailesh V. Shrikhande
2   Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
,
Suyash S. Kulkarni
1   Department of Radio-Diagnosis, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
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Abstract

Pancreatic cancer is the fourth most prevalent cause of cancer-related death worldwide, with a fatality rate equal to its incidence rate. Pancreatic cancer is a rare malignancy with a global incidence and death ranking of 14th and 7th, respectively. Pancreatic cancer cases are divided into three categories without metastatic disease: resectable, borderline resectable, or locally advanced disease. The category is determined by the tumor's location in the pancreas and whether it is abutting or encasing the adjacent arteries and/or vein/s.

The stage of disease and the location of the primary tumor determine the clinical presentation: the pancreatic head, neck, or uncinate process, the body or tail, or multifocal disease. Imaging plays a crucial role in the diagnosis and follow-up of pancreatic cancers. Various imaging modalities available for pancreatic imaging are ultrasonography (USG), contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and 18-fluoro-deoxy glucose positron emission tomography (FDG PET).

Even though surgical resection is possible in both resectable and borderline resectable non-metastatic cases, neoadjuvant chemotherapy with or without radiotherapy has become the standard practice for borderline resectable cases as it gives a high yield of R0 resection.

Keywords

ablation - biopsy - IRE - magnetic resonance imaging - multi-detector computed tomography - oncology - pancreatic neoplasms - PET-CT

Supplementary Material



Publication History

Article published online:
06 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Hariharan D, Saied A, Kocher HM. Analysis of mortality rates for pancreatic cancer across the world. HPB (Oxford) 2008; 10 (01) 58-62
    CrossrefPubMedGoogle Scholar
  • 2 Hidalgo M. Pancreatic cancer. N Engl J Med 2010; 362 (17) 1605-1617
    CrossrefPubMedGoogle Scholar
  • 3 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68 (01) 7-30
    Google Scholar
  • 4 Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet 2004; 363 (9414): 1049-1057
    CrossrefPubMedGoogle Scholar
  • 5 American Cancer Society. Accessed November 10, 2022, at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures
  • 6 Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol 2014; 20 (24) 7864-7877
    CrossrefPubMedGoogle Scholar
  • 7 Decker GA, Batheja MJ, Collins JM. et al. Risk factors for pancreatic adenocarcinoma and prospects for screening. Gastroenterol Hepatol (N Y) 2010; 6 (04) 246-254
    Google Scholar
  • 8 Sarkar FH, Banerjee S, Li Y. Pancreatic cancer: pathogenesis, prevention and treatment. Toxicol Appl Pharmacol 2007; 224 (03) 326-336
    CrossrefPubMedGoogle Scholar
  • 9 Gaidhani RH, Balasubramaniam G. An epidemiological review of pancreatic cancer with special reference to India. Indian J Med Sci 2021; (May): 1-1
    Google Scholar
  • 10 Tempero MA, Malafa MP, Chiorean EG. et al. NCCN guidelines insights: pancreatic adenocarcinoma, version 1.2019: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2019; 17 (03) 202-210
    CrossrefPubMedGoogle Scholar
  • 11 Daly MB, Pilarski R, Yurgelun MB. et al. NCCN guidelines insights: genetic/familial high-risk assessment: breast, ovarian, and pancreatic, version 1.2020. J Natl Compr Canc Netw 2020; 18 (04) 380-391
    CrossrefPubMedGoogle Scholar
  • 12 Dimitrokallis N, Karachaliou GS, Moris D. New NCCN guidelines for locally advanced pancreatic cancer: new horizons in extending resectability. J BUON 2020; 25 (04) 2125-2126
    PubMedGoogle Scholar
  • 13 van Roessel S, Kasumova GG, Verheij J. et al. International validation of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system in patients with resected pancreatic cancer. JAMA Surg 2018; 153 (12) e183617
    CrossrefPubMedGoogle Scholar
  • 14 Soweid AM. The borderline resectable and locally advanced pancreatic ductal adenocarcinoma: definition. Endosc Ultrasound 2017; 6 (Suppl. 03) S76-S78
    CrossrefPubMedGoogle Scholar
  • 15 He J, Page AJ, Weiss M, Wolfgang CL, Herman JM, Pawlik TM. Management of borderline and locally advanced pancreatic cancer: where do we stand?. World J Gastroenterol 2014; 20 (09) 2255-2266
    CrossrefPubMedGoogle Scholar
  • 16 Lopez NE, Prendergast C, Lowy AM. Borderline resectable pancreatic cancer: definitions and management. World J Gastroenterol 2014; 20 (31) 10740-10751
    CrossrefPubMedGoogle Scholar
  • 17 Kurdia KC, Kapoor VK. Pancreatic cancer: “whether to cross the border”?. Indian J Surg Oncol 2021; 12 (02) 235-237
    CrossrefPubMedGoogle Scholar
  • 18 Hong SB, Lee SS, Kim JH. et al. Pancreatic cancer CT: prediction of resectability according to NCCN criteria. Radiology 2018; 289 (03) 710-718
    CrossrefPubMedGoogle Scholar
  • 19 Cabasag CJ, Arnold M, Piñeros M. et al. Population-based cancer staging for oesophageal, gastric, and pancreatic cancer 2012-2014: International Cancer Benchmarking Partnership SurvMark-2. Int J Cancer 2021; 149 (06) 1239-1246
    CrossrefPubMedGoogle Scholar
  • 20 Yabar CS, Winter JM. Pancreatic cancer: a review. Gastroenterol Clin North Am 2016; 45 (03) 429-445
    CrossrefPubMedGoogle Scholar
  • 21 Mizrahi JD, Surana R, Valle JW, Shroff RT. Pancreatic cancer. Lancet 2020; 395 (10242): 2008-2020
    CrossrefPubMedGoogle Scholar
  • 22 McAllister F, Montiel MF, Uberoi GS, Uberoi AS, Maitra A, Bhutani MS. Current status and future directions for screening patients at high risk for pancreatic cancer. Gastroenterol Hepatol (N Y) 2017; 13 (05) 268-275
    Google Scholar
  • 23 Henrikson NB, Aiello Bowles EJ, Blasi PR. et al. Screening for pancreatic cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2019; 322 (05) 445-454
    CrossrefPubMedGoogle Scholar
  • 24 Burk KS, Lo GC, Gee MS, Sahani DV. Imaging and screening of pancreatic cancer. Radiol Clin North Am 2017; 55 (06) 1223-1234
    CrossrefPubMedGoogle Scholar
  • 25 Canto MI, Hruban RH, Fishman EK. et al; American Cancer of the Pancreas Screening (CAPS) Consortium. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology 2012; 142 (04) 796-804 , quiz e14–e15
    CrossrefPubMedGoogle Scholar
  • 26 Rickes S, Unkrodt K, Neye H, Ocran KW, Wermke W. Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scand J Gastroenterol 2002; 37 (11) 1313-1320
    CrossrefPubMedGoogle Scholar
  • 27 Tummala P, Junaidi O, Agarwal B. Imaging of pancreatic cancer: an overview. J Gastrointest Oncol 2011; 2 (03) 168-174
    PubMedGoogle Scholar
  • 28 Al-Hawary MM, Francis IR, Chari ST. et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 2014; 270 (01) 248-260
    CrossrefPubMedGoogle Scholar
  • 29 Almeida RR, Lo GC, Patino M, Bizzo B, Canellas R, Sahani DV. Advances in pancreatic CT imaging. AJR Am J Roentgenol 2018; 211 (01) 52-66
    CrossrefPubMedGoogle Scholar
  • 30 Pietryga JA, Morgan DE. Imaging preoperatively for pancreatic adenocarcinoma. J Gastrointest Oncol 2015; 6 (04) 343-357
    PubMedGoogle Scholar
  • 31 Kim JK, Altun E, Elias Jr J, Pamuklar E, Rivero H, Semelka RC. Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging 2007; 26 (02) 313-322
    CrossrefPubMedGoogle Scholar
  • 32 Ansari NA, Ramalho M, Semelka RC, Buonocore V, Gigli S, Maccioni F. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: an update. World J Radiol 2015; 7 (11) 361-374
    CrossrefPubMedGoogle Scholar
  • 33 Heinrich S, Goerres GW, Schäfer M. et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 2005; 242 (02) 235-243
    CrossrefPubMedGoogle Scholar
  • 34 Tempero MA, Arnoletti JP, Behrman S. et al; NCCN Pancreatic Adenocarcinoma. Pancreatic adenocarcinoma. J Natl Compr Canc Netw 2010; 8 (09) 972-1017
    CrossrefPubMedGoogle Scholar
  • 35 Yin X, Wang M, Wang H. et al. Evaluation of neurotensin receptor 1 as a potential imaging target in pancreatic ductal adenocarcinoma. Amino Acids 2017; 49 (08) 1325-1335
    CrossrefPubMedGoogle Scholar
  • 36 Conti CB, Cereatti F, Grassia R. Endoscopic ultrasound-guided sampling of solid pancreatic masses: the fine needle aspiration or fine needle biopsy dilemma. Is the best needle yet to come?. World J Gastrointest Endosc 2019; 11 (08) 454-471
    CrossrefPubMedGoogle Scholar
  • 37 Paulsen SD, Nghiem HV, Negussie E, Higgins EJ, Caoili EM, Francis IR. Evaluation of imaging-guided core biopsy of pancreatic masses. AJR Am J Roentgenol 2006; 187 (03) 769-772
    CrossrefPubMedGoogle Scholar
  • 38 Stella SF, Van Borsel M, Markose G, Nair SB. Image-guided percutaneous biopsy for pancreatic lesions: 10-year experience in a tertiary cancer center. Can Assoc Radiol J 2019; 70 (02) 199-203
    CrossrefPubMedGoogle Scholar
  • 39 Zins M, Matos C, Cassinotto C. Pancreatic adenocarcinoma staging in the era of preoperative chemotherapy and radiation therapy. Radiology 2018; 287 (02) 374-390
    CrossrefPubMedGoogle Scholar
  • 40 Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging 2020; 11 (01) 58
    CrossrefPubMedGoogle Scholar
  • 41 Lee W, Oh M, Kim JS. et al. Metabolic activity by FDG-PET/CT after neoadjuvant chemotherapy in borderline resectable and locally advanced pancreatic cancer and association with survival. Br J Surg 2021; 109 (01) 61-70
    CrossrefPubMedGoogle Scholar
  • 42 Shanbhogue KP, Pourvaziri A, Jeyaraj SK, Kambadakone A. Endoscopic and surgical treatment options for chronic pancreatitis: an imaging perspective. Abdom Radiol (NY) 2020; 45 (05) 1397-1409
    CrossrefPubMedGoogle Scholar
  • 43 Xia BT, Fu B, Wang J. et al. Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy?. J Surg Oncol 2017; 115 (04) 376-383
    CrossrefPubMedGoogle Scholar
  • 44 Yang HK, Park MS, Choi M. et al. Systematic review and meta-analysis of diagnostic performance of CT imaging for assessing resectability of pancreatic ductal adenocarcinoma after neoadjuvant therapy: importance of CT criteria. Abdom Radiol (NY) 2021; 46 (11) 5201-5217
    CrossrefPubMedGoogle Scholar
  • 45 Elmi A, Murphy J, Hedgire S. et al. Post-Whipple imaging in patients with pancreatic ductal adenocarcinoma: association with overall survival: a multivariate analysis. Abdom Radiol (NY) 2017; 42 (08) 2101-2107
    CrossrefPubMedGoogle Scholar
  • 46 Zhang Q, Zeng L, Chen Y. et al. Pancreatic cancer epidemiology, detection, and management. Gastroenterol Res Pract 2016; 2016: 8962321
    CrossrefPubMedGoogle Scholar
  • 47 Fang Y, Yao Q, Chen Z. et al. Genetic and molecular alterations in pancreatic cancer: implications for personalized medicine. Med Sci Monit 2013; 19: 916-926
    CrossrefPubMedGoogle Scholar
  • 48 Brunner TB, Scott-Brown M. The role of radiotherapy in multimodal treatment of pancreatic carcinoma. Radiat Oncol 2010; 5 (01) 64
    CrossrefPubMedGoogle Scholar
  • 49 Son SH, Song JH, Choi BO. et al. The technical feasibility of an image-guided intensity-modulated radiotherapy (IG-IMRT) to perform a hypofractionated schedule in terms of toxicity and local control for patients with locally advanced or recurrent pancreatic cancer. Radiat Oncol 2012; 7 (01) 203
    CrossrefPubMedGoogle Scholar
  • 50 Martin II RC. Use of irreversible electroporation in unresectable pancreatic cancer. Hepatobiliary Surg Nutr 2015; 4 (03) 211-215
    PubMedGoogle Scholar
  • 51 Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019; 10 (01) 10-27
    CrossrefPubMedGoogle Scholar
  • 52 Tempero MA. NCCN guidelines updates: pancreatic cancer. J Natl Compr Canc Netw 2019; 17 (5.5): 603-605
    PubMedGoogle Scholar
  • 53 Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. N Engl J Med 2014; 371 (11) 1039-1049
    CrossrefPubMedGoogle Scholar
  • 54 Truty MJ, Thomas RM, Katz MH. et al. Multimodality therapy offers a chance for cure in patients with pancreatic adenocarcinoma deemed unresectable at first operative exploration. J Am Coll Surg 2012; 215 (01) 41-51 , discussion 51–52
    CrossrefPubMedGoogle Scholar
  • 55 Skau Rasmussen L, Vittrup B, Ladekarl M. et al. The effect of postoperative gemcitabine on overall survival in patients with resected pancreatic cancer: a nationwide population-based Danish register study. Acta Oncol 2019; 58 (06) 864-871
    CrossrefPubMedGoogle Scholar
  • 56 Tempero MA, Malafa MP, Al-Hawary M. et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15 (08) 1028-1061
    CrossrefPubMedGoogle Scholar
  • 57 Sperti C, Moletta L, Merigliano S. Multimodality treatment of recurrent pancreatic cancer: Mith or reality?. World J Gastrointest Oncol 2015; 7 (12) 375-382
    CrossrefPubMedGoogle Scholar
  • 58 Paiella S, Butturini G, Frigerio I. et al. Safety and feasibility of Irreversible Electroporation (IRE) in patients with locally advanced pancreatic cancer: results of a prospective study. Dig Surg 2015; 32 (02) 90-97
    CrossrefPubMedGoogle Scholar