Imaging of Small Pancreatic Ductal Adenocarcinoma

Ariyama, Joe; Suyama, Masafumi; Satoh, Kazuhiro; Sai, Jinkan

doi:10.1097/00006676-199804000-00030

Cited by 105 publications

(70 citation statements)

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“…Conventional treatment approaches such as surgery, radiation, chemotherapy, or a combination thereof have had little impact on the course of this aggressive cancer. Collective studies from Japan indicate that those patients who were incidentally found through other imaging modalities to have early stage carcinoma have an improved five-year survival rate of 30% for those with a 2 cm carcinoma, 57% for those with a 1 cm or less "minute" carcinoma, and 100% for patients with a ductal epithelium tumor measuring less than 1 cm [4][5][6] . Therefore, these studies emphasize that the hope for better control of this disease is through diagnosis at its earlier stages when surgical resection may be curative.…”

Section: Introductionmentioning

confidence: 99%

Novel blood-based microRNA biomarker panel for early diagnosis of pancreatic cancer

Ganepola

Rutledge

Suman

et al. 2014

WJGO

110

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dures and instrumentation of RT-qPCR at an independent venue with a new cohort of cancer patients (n = 11), healthy controls (n = 11), and a group of high risk controls (n = 11). Receiver operating characteristic curve analysis was performed to assess the diagnostic capability of the three-microRNA panel. RESULTS:In the initial high throughput screening, 1220 known human microRNAs were screened for differential expression in pancreatic cancer patients versus controls. A subset of 42 microRNAs was then generated based on this data analysis and current published literature. Eight microRNAs were selected from the list of 42 targets for confirmation study, and three-microRNAs, miR-642b, miR-885-5p, and miR-22, were confirmed to show consistent expression between microarray and RT-qPCR. These three microRNAs were then validated and evaluated as a diagnostic panel with a new cohort of patients and controls and found to yield high sensitivity (91%) and specificity (91%) with an area under the curve of 0.97 (P < 0.001). Compared to the CA19-9 marker at 73%, the three-microRNA panel has higher sensitivity although CA19-9 has higher specificity of 100%. CONCLUSION:The identified panel of three microRNA biomarkers can potentially be used as a diagnostic tool for early stage pancreatic cancer. METHODS:Blood-based circulating microRNAs were profiled by high throughput screening using microarray analysis, comparing differential expression between early stage pancreatic cancer patients (n = 8) and healthy controls (n = 11). A panel of candidate microRNAs was generated based on the microarray signature profiling, including unsupervised clustering and statistical analysis of differential expression levels, and findings from the published literature. The selected candidate microRNAs were then confirmed using TaqMan real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) to further narrow down to a three-microRNA diagnostic panel. The three-microRNA diagnostic panel was validated with independent experimental proce- ORIGINAL ARTICLE 22January 15, 2014|Volume 6|Issue 1|

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Section: Introductionmentioning

confidence: 99%

Novel blood-based microRNA biomarker panel for early diagnosis of pancreatic cancer

Ganepola

Rutledge

Suman

et al. 2014

WJGO

110

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“…5-7), have been identified, and the sensitivity of pancreatic imaging has improved with endoscopic ultrasound (EUS) and high-resolution magnetic resonance imaging (MRI), early detection of small curable pancreatic cancers and premalignant lesions now seems possible. It has been shown that early-stage pancreatic cancer may be resected for cure, as evidenced by a series from Japan where 100% of patients were cured when the pancreatic cancer was <1 cm (8). Unfortunately, no current screening strategy is adequately safe, sensitive, and cost effective to be implemented in the general population, even in those with significant risk factors such as tobacco exposure or advanced age.…”

mentioning

confidence: 99%

Pancreatic Cancer Screening in a Prospective Cohort of High-Risk Patients: A Comprehensive Strategy of Imaging and Genetics

Verna

Hwang

Stevens

et al. 2010

Clinical Cancer Research

191

163

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Purpose: Pancreatic cancer is a virtually uniformly fatal disease. We aimed to determine if screening to identify curable neoplasms is effective when offered to patients at high risk.Experimental Design: Patients at high risk of pancreatic cancer were prospectively enrolled into a screening program. Endoscopic ultrasound (EUS), magnetic resonance imaging (MRI), and genetic testing were offered by a multidisciplinary team according to each patient's risk.Results: Fifty-one patients in 43 families were enrolled, with mean age of 52 years, 35% of whom were male. Of these patients, 31 underwent EUS and 33 MRI. EUS revealed two patients with pancreatic cancer (one resectable, one metastatic), five with intraductal papillary mucinous neoplasms (IPMN), seven with cysts, and six with parenchymal changes. Five had pancreatic surgery (one total pancreatectomy for pancreatic cancer, three distal and one central pancreatectomy for pancreatic intraepithelial neoplasia 2 and IPMN). A total of 24 (47%) had genetic testing (19 for BRCA1/2 mutations, 4 for CDKN2A, 1 for MLH1/ MSH2) and 7 were positive for BRCA1/2 mutations. Four extrapancreatic neoplasms were found: two ovarian cancers on prophylactic total abdominal hysterectomy and bilateral salpingo-oophorectomy, one carcinoid, and one papillary thyroid carcinoma. Overall, 6 (12%) of the 51 patients had neoplastic lesions in the pancreas and 9 (18%) had neoplasms in any location. All were on the initial round of screening. All patients remain alive and without complications of screening.Conclusions: Pancreatic cancer screening for high-risk patients with a comprehensive strategy of imaging and genetics is effective and identifies curable neoplasms that can be resected. Ongoing study will better define who will benefit from screening and what screening strategy will be the most effective. Clin Cancer Res; 16(20); 5028-37. ©2010 AACR.Pancreatic adenocarcinoma is the fourth leading cause of cancer death in most western countries (1). In 2009, there were approximately 42,470 new cases of pancreatic cancer diagnosed in the United States, and 35,240 cancer-related deaths (2). Due to the rapid progression and almost uniform fatality of the disease, early detection through screening will be essential to improve outcomes. As premalignant stages of disease, including pancreatic intraepithelial neoplasia (PanIN; refs. 3, 4) and intraductal papillary mucinous neoplasms (IPMN; refs. 5-7), have been identified, and the sensitivity of pancreatic imaging has improved with endoscopic ultrasound (EUS) and high-resolution magnetic resonance imaging (MRI), early detection of small curable pancreatic cancers and premalignant lesions now seems possible. It has been shown that early-stage pancreatic cancer may be resected for cure, as evidenced by a series from Japan where 100% of patients were cured when the pancreatic cancer was <1 cm (8). Unfortunately, no current screening strategy is adequately safe, sensitive, and cost effective to be implemented in the general population, even in tho...

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“…As previously reported, surrogate end point in pancreatic cancer could be the identification and resection of potentially curable lesions (highgrade precursors and early invasive carcinomas). There is no evidence that diagnosing these lesions will improve survival, but there are data suggesting that resection of very early disease is associated with better prognosis [93,94] . However, no consensus opinion could be reached on the best suitable approach for screening until available imaging modalities and biomarkers will become adequate to detect early stage cancer.…”

Section: Screeningmentioning

confidence: 99%

Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

Lami

Biagini

Galli

2014

WJGE

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Pancreatic cancer is a highly lethal disease with a genetic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prognosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer development. The aim of this strategy is to identify premalignant precursors or asymptomatic pancreatic cancer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA) seems to be the most promising technique for early detection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in highrisk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced endosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-enhanced harmonic EUS, computer-aided diagnostic techniques, confocal laser endomicroscopy miniprobe and the detection of DNA abnormalities or protein markers by FNA, promise improvement of the diagnostic yield of EUS. As the resolution of imaging improves and as our knowledge of precursor lesions grows, we believe that EUS could become the most suitable method to detect curable pancreatic neoplasms in correctly identified asymptomatic at-risk patients.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Endoscopic ultrasonography; Pancreatic cancer; SurveillanceCore tip: In the era of early diagnosis and screening programs, endoscopic ultrasound (EUS) represents the most promising tool able to identify pancreatic precursor neoplasms in high risk individuals. If compared to other imaging techniques, it is highly accurate to diagnose small pancreatic cancer and pre-malignant lesions, with very low rate of complications and limitations. Here are reported the current role of EUS in various international screening programs and its future possible developments.

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Imaging of Small Pancreatic Ductal Adenocarcinoma

Cited by 105 publications

References 0 publications

Novel blood-based microRNA biomarker panel for early diagnosis of pancreatic cancer

Novel blood-based microRNA biomarker panel for early diagnosis of pancreatic cancer

Pancreatic Cancer Screening in a Prospective Cohort of High-Risk Patients: A Comprehensive Strategy of Imaging and Genetics

Endoscopic ultrasonography for surveillance of individuals at high risk for pancreatic cancer

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