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Diagnosis of Pancreatic Cancer

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 37654

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Special Issue Editors

Dr. Keiji Hanada

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Guest Editor

Department of Gastroenterology, Onomichi General Hospital, Onomichi 722-8508, Japan
Interests: endoscopic diagnosis and therapy for pancreatobiliary diseases; early diagnosis of pancreatic cancer

Dr. Atsushi Kanno

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Deapartment of Gastroenterology, Jichi Medicla University, Tochigi, Japan

Dr. Masahiro Serikawa

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Department of Gastroenterology, Hiroshima University School of Medicine, Hiroshima, Japan

Special Issue Information

Pancreatic cancer (PC) is difficult to diagnose at an early stage, with many PCs found to be already metastatic at the time of initial diagnosis. These poor survival rates have not changed significantly in nearly 40 years. Many patients of PC are asymptomatic and no early warning signs of PC have been established. Risk factors for PC include cigarette smoking, obesity, diabetes, chronic pancreatitis, hereditary pancreatitis, various genetic diseases, and familial PC. These higher risk groups may be a good target for screening and early diagnosis programs. The main focus of this review is to describe the current state of play in PC diagnosis. Rapid and accurate diagnosis of a pancreatic mass is crucial for improving prognosis. After evaluating the evidence underpinning all of the modalities for diagnosis, we intend to make a comparison of these modalities and provide an evidence-based algorithm for diagnosis. The main objective of this Special Issue is to evaluate and compare the suitability and accuracy of the current diagnostic modalities that exist for PC. It is extremely valuable to have a thorough understanding of the currently available diagnostic technology, including its benefits and limitations, to provide direction for upcoming research.

Dr. Keiji Hanada
Dr. Atsushi Kanno
Dr. Masahiro Serikawa
Guest Editors

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Keywords

pancreatic cancer
image diagnosis
biological marker
early diagnosis
risk factors

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Published Papers (9 papers)

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Research

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12 pages, 9211 KiB

Open AccessArticle

Clinical Implication of Preoperative C-Reactive Protein/Albumin Ratio in Malignant Transformation of Intraductal Papillary Mucinous Neoplasm: A Propensity Score Analysis

by Hirotsugu Maruyama, Kojiro Tanoue, Yuki Ishikawa-Kakiya, Masafumi Yamamura, Akira Higashimori, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Noriko Kamata, Yasuaki Nagami, Koichi Taira, Go Ohira, Kenjiro Kimura, Ryosuke Amano and Yasuhiro Fujiwara

Diagnostics 2022, 12(2), 554; https://doi.org/10.3390/diagnostics12020554 - 21 Feb 2022

Cited by 2 | Viewed by 2038

Abstract

Background: Inflammation-based scoring has been reported to be useful for predicting the recurrence and prognosis of various carcinomas. This study retrospectively investigated the relationship between inflammation-based score and intraductal papillary mucinous neoplasms (IPMNs). Methods: Between January 2013 and October 2018, we enrolled 417 consecutive patients with pancreatic tumors who received surgical resections at our hospital. The main outcome was the association between the preoperative inflammation-based score and their accuracy in predicting malignant transformation of IPMN. Results: Seventy six patients were eligible. Pathological findings indicated that 35 patients had low-grade dysplasia, 18 had high-grade dysplasia, and 23 had invasive carcinomas. As the C-reactive protein albumin ratio (CAR) was higher, malignant transformation of IPMNs also increased (p = 0.007). In comparing CAR^high and CAR^low using cutoff value, the results using a propensity score analysis showed that the CAR^high group predicted malignant transformation of IPMNs (odds ratio, 4.18; 95% confidence interval, 1.37–12.8; p = 0.01). In the CAR^high group, disease-free survival (DFS) was significantly shorter (p = 0.04). In the worrisome features, the AUC for the accuracy of malignant transformation with CAR^high was 0.84 when combining with the MPD findings. Conclusions: Preoperative CAR could be a predictive marker of malignant transformation of IPMNs. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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12 pages, 614 KiB

Open AccessArticle

Diagnostic Strategy of Early Stage Pancreatic Cancer via Clinical Predictor Assessment: Clinical Indicators, Risk Factors and Imaging Findings

by Ryota Sagami, Takao Sato, Kazuhiro Mizukami, Mitsuteru Motomura, Kazuhisa Okamoto, Satoshi Fukuchi, Yuichiro Otsuka, Takashi Abe, Hideki Ono, Kei Mori, Kurato Wada, Tomoyuki Iwaki, Hidefumi Nishikiori, Koichi Honda, Yuji Amano and Kazunari Murakami

Diagnostics 2022, 12(2), 377; https://doi.org/10.3390/diagnostics12020377 - 1 Feb 2022

Cited by 6 | Viewed by 3322

Abstract

Early detection of pancreatic ductal adenocarcinoma (PDAC) in the general population is difficult due to unknown clinical characteristics. This study was conducted to clarify the factors associated with early stage PDAC. Well-known symptoms and factors associated with PDAC were classified into clinical indicators, risk factors, and imaging findings concomitant with early stage PDAC. To analyze these factors for the detection of patients with early stage PDAC compared to patients without PDAC, we constructed new diagnostic strategies. The factors of 35 patients with early stage PDAC (stage 0 and IA) and 801 patients without PDAC were compared retrospectively. Clinical indicators; presence and number of indicators, elevated pancreatic enzyme level, tumor biomarker level, acute pancreatitis history, risk factors; familial pancreatic cancer, diabetes mellitus, smoking history, imaging findings; presence and number of findings, and main pancreatic duct dilation were significant factors for early stage PDAC detection. A new screening strategy to select patients who should be examined by imaging modalities from evaluating clinical indicators and risk factors and approaching a definitive diagnosis by evaluating imaging findings had a relatively high sensitivity, specificity, and areas under the curve of 80.0%, 80.8%, and 0.80, respectively. Diagnosis based on the new category and strategy may be reasonable for early stage PDAC detection. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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14 pages, 6018 KiB

Open AccessArticle

Analysis of Progression Time in Pancreatic Cancer including Carcinoma In Situ Based on Magnetic Resonance Cholangiopancreatography Findings

by Kentaro Yamao, Masakatsu Tsurusaki, Kota Takashima, Hidekazu Tanaka, Akihiro Yoshida, Ayana Okamoto, Tomohiro Yamazaki, Shunsuke Omoto, Ken Kamata, Kosuke Minaga, Mamoru Takenaka, Takaaki Chikugo, Yasutaka Chiba, Tomohiro Watanabe and Masatoshi Kudo

Diagnostics 2021, 11(10), 1858; https://doi.org/10.3390/diagnostics11101858 - 9 Oct 2021

Cited by 6 | Viewed by 2454

Abstract

Background: Pancreatic cancer (PC) exhibits extremely rapid growth; however, it remains largely unknown whether the early stages of PC also exhibit rapid growth speed equivalent to advanced PC. This study aimed to investigate the natural history of early PCs through retrospectively assessing pre-diagnostic images. Methods: We examined the data of nine patients, including three patients with carcinoma in situ (CIS), who had undergone magnetic resonance cholangiopancreatography (MRCP) to detect solitary main pancreatic duct (MPD) stenosis >1 year before definitive PC diagnosis. We retrospectively analyzed the time to diagnosis and first-time tumor detection from the estimated time point of first-time MPD stenosis detection without tumor lesion. Results: The median tumor size at diagnosis and the first-time tumor detection size were 14 and 7.5 mm, respectively. The median time to diagnosis and first-time tumor detection were 26 and 49 months, respectively. Conclusions: No studies have investigated the PC history, especially that of early PCs, including CIS, based on the initial detection of MPD stenosis using MRCP. Assessment of a small number of patients showed that the time to progression can take several years in the early PC stages. Understanding this natural history is very important in the clinical setting. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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11 pages, 1362 KiB

Open AccessArticle

Improvement of the Diagnosis of Isoattenuating Pancreatic Carcinomas by Defining Their Characteristics on Contrast Enhanced Computed Tomography and Endosonography with Fine-Needle Aspiration (EUS-FNA)

by Robert Psar, Ondrej Urban, Marie Cerna, Tomas Rohan and Martin Hill

Diagnostics 2021, 11(5), 776; https://doi.org/10.3390/diagnostics11050776 - 26 Apr 2021

Cited by 8 | Viewed by 4194

Abstract

(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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15 pages, 2399 KiB

Open AccessArticle

Clinical Analysis of Early-Stage Pancreatic Cancer and Proposal for a New Diagnostic Algorithm: A Multicenter Observational Study

by Juri Ikemoto, Masahiro Serikawa, Keiji Hanada, Noriaki Eguchi, Tamito Sasaki, Yoshifumi Fujimoto, Shinichiro Sugiyama, Atsushi Yamaguchi, Bunjiro Noma, Michihiro Kamigaki, Tomoyuki Minami, Akihito Okazaki, Masanobu Yukutake, Yasutaka Ishii, Teruo Mouri, Akinori Shimizu, Tomofumi Tsuboi, Koji Arihiro and Kazuaki Chayama

Diagnostics 2021, 11(2), 287; https://doi.org/10.3390/diagnostics11020287 - 12 Feb 2021

Cited by 27 | Viewed by 3934

Abstract

Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is challenging but essential for improving its poor prognosis. We established a multicenter study to clarify the clinicopathological features, and to propose new algorithm for early diagnosis of PDAC. Ninety-six patients with stage 0 and IA PDAC were enrolled from 13 high-volume centers. Overall, 70% of the patients were asymptomatic. The serum pancreatic enzyme levels were abnormal in half of the patients. The sensitivity of endoscopic ultrasonography (EUS) for detecting small PDAC was superior to computed tomography and magnetic resonance imaging (MRI) (82%, 58%, and 38%, respectively). Indirect imaging findings were useful to detect early-stage PDAC; especially, main pancreatic duct stenosis on MRI had the highest positive rate of 86% in stage 0 patients. For preoperative pathological diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatic juice cytology was 84%. Among the stage IA patients, EUS-guided fine-needle aspiration revealed adenocarcinoma in 93% patients. For early diagnosis of PDAC, it is essential to identify asymptomatic patients and ensure close examinations of indirect imaging findings and standardization of preoperative pathological diagnosis. Therefore, a new diagnostic algorithm based on tumor size and imaging findings should be developed. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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Review

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22 pages, 1537 KiB

Open AccessReview

Impact of Endoscopic Ultrasound-Guided Tissue Acquisition on Decision-Making in Precision Medicine for Pancreatic Cancer: Beyond Diagnosis

by Hiroshi Imaoka, Mitsuhito Sasaki, Yusuke Hashimoto, Kazuo Watanabe, Shoichi Miyazawa, Taro Shibuki, Shuichi Mitsunaga and Masafumi Ikeda

Diagnostics 2021, 11(7), 1195; https://doi.org/10.3390/diagnostics11071195 - 30 Jun 2021

Cited by 11 | Viewed by 3440

Abstract

Precision medicine in cancer treatment refers to targeted therapy based on the evaluation of biomarkers. Although precision medicine for pancreatic cancer (PC) remains challenging, novel biomarker-based therapies, such as pembrolizumab, olaparib, and entrectinib, have been emerging. Most commonly, endoscopic ultrasound-guided tissue acquisition (EUS-TA) had been used for the diagnosis of PC until now. However, advances in EUS-TA devices and biomarker testing, especially next-generation sequencing, have opened up the possibility of sequencing of various genes even in limited amounts of tissue samples obtained by EUS-TA, and identifying potential genetic alterations as therapeutic targets. Precision medicine benefits only a small population of patients with PC, but biomarker-based therapy has shown promising results in patients who once had no treatment options. Now, the role of EUS-TA has extended beyond diagnosis into decision-making regarding the treatment of PC. In this review, we mainly discuss tissue sampling by EUS-TA for biomarker testing and the current status of precision medicine for PC. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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13 pages, 2924 KiB

Open AccessReview

Pancreatic Ductal Adenocarcinoma: Epidemiology and Risk Factors

by Jun Ushio, Atsushi Kanno, Eriko Ikeda, Kozue Ando, Hiroki Nagai, Tetsurou Miwata, Yuki Kawasaki, Yamato Tada, Kensuke Yokoyama, Norikatsu Numao, Kiichi Tamada, Alan Kawarai Lefor and Hironori Yamamoto

Diagnostics 2021, 11(3), 562; https://doi.org/10.3390/diagnostics11030562 - 20 Mar 2021

Cited by 74 | Viewed by 7999

Abstract

The number of new cases of pancreatic ductal adenocarcinoma is increasing with a cumulative total of 495,773 cases worldwide, making it the fourteenth most common malignancy. However, it accounts for 466,003 deaths per year and is the seventh leading cause of cancer deaths. Regional differences in the number of patients with pancreatic ductal adenocarcinoma appear to reflect differences in medical care, as well as racial differences. Compared to the prevalence of other organ cancers in Japan, pancreatic ductal adenocarcinoma ranks seventh based on the number of patients, eighth based on morbidity, and fourth based on the number of deaths, with a continuing increase in the mortality rate. Risk factors for developing pancreatic ductal adenocarcinoma include family history, genetic disorders, diabetes, chronic pancreatitis, and intraductal papillary mucinous neoplasms. An issue that hinders improvement in the prognosis of patients with pancreatic ductal adenocarcinoma is the development of a strategy to identify patients with these risk factors to facilitate detection of the disease at a stage when intervention will improve survival. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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11 pages, 247 KiB

Open AccessReview

Molecular Approaches Using Body Fluid for the Early Detection of Pancreatic Cancer

by Kennichi Satoh

Diagnostics 2021, 11(2), 375; https://doi.org/10.3390/diagnostics11020375 - 22 Feb 2021

Cited by 8 | Viewed by 2610

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is the most malignant form of gastrointestinal tumor and is the fourth leading cause of deaths due to cancer in Japan. This cancer shows a poor outcome due to the difficulty of its early diagnosis and its rapid growth. Once this disease becomes clinically evident, it is frequently accompanied by distant metastasis at the time of diagnosis. A recent multicenter study in Japan revealed that patients with the early stage of this disease (stage 0 and I) showed favorable prognosis after surgical resection, indicating the importance of early detection for improvement of PDAC prognosis. PDAC develops through a stepwise progression from the precursor lesion, and over the last few decades molecular analyses have shown the detailed genetic alterations that occur in this process. Since advances in molecular technologies have enabled the detection of genetic changes from a very small quantity of samples, a large number of non-invasive molecular approaches have been utilized in an attempt to find precursor or non-invasive carcinoma lesions. In this review, the current efforts in terms of the molecular approaches applied for the early detection of PDAC—especially using body fluids such as pancreatic juice, blood, and saliva—are summarized. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

11 pages, 991 KiB

Open AccessReview

Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer

by Yasutaka Ishii, Masahiro Serikawa, Tomofumi Tsuboi, Ryota Kawamura, Ken Tsushima, Shinya Nakamura, Tetsuro Hirano, Ayami Fukiage, Takeshi Mori, Juri Ikemoto, Yusuke Kiyoshita, Sho Saeki, Yosuke Tamura, Sayaka Miyamoto and Kazuaki Chayama

Diagnostics 2021, 11(2), 238; https://doi.org/10.3390/diagnostics11020238 - 4 Feb 2021

Cited by 6 | Viewed by 3149

Abstract

Pancreatic cancer has the poorest prognosis among all cancers, and early diagnosis is essential for improving the prognosis. Along with radiologic modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), endoscopic modalities play an important role in the diagnosis of pancreatic cancer. This review evaluates the roles of two of those modalities, endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), in the diagnosis of pancreatic cancer. EUS can detect pancreatic cancer with higher sensitivity and has excellent sensitivity for the diagnosis of small pancreatic cancer that cannot be detected by other imaging modalities. EUS may be useful for the surveillance of pancreatic cancer in high-risk individuals. Contrast-enhanced EUS and EUS elastography are also useful for differentiating solid pancreatic tumors. In addition, EUS-guided fine needle aspiration shows excellent sensitivity and specificity, even for small pancreatic cancer, and is an essential examination method for the definitive pathological diagnosis and treatment decision strategy. On the other hand, ERCP is invasive and performed less frequently for the purpose of diagnosing pancreatic cancer. However, ERCP is essential in cases that require evaluation of pancreatic duct stricture that may be early pancreatic cancer or those that require differentiation from focal autoimmune pancreatitis. Full article

(This article belongs to the Special Issue Diagnosis of Pancreatic Cancer)

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