Innovative Imaging Techniques Used to Evaluate Borderline-Resectable Pancreatic Adenocarcinoma

Chalfant, Hunter; Bonds, Morgan; Scott, Kristina; Condacse, Anna; Dennahy, Isabel S.; Martin, W. Taylor; Little, Cooper; Edil, Barish H.; McNally, Lacey R.; Jain, Ajay N.

doi:10.1016/j.jss.2022.10.008

Cited by 3 publications

(3 citation statements)

References 76 publications

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“…Yang et al [88] showed that MRI and CT have similar performance in assessing PDAC tumor size before and after NAT. However, dynamic MRI is not commonly performed and should only be attempted by experienced centers due to difficulties in reproducibility and standardization [89]. Provided that resectable or borderline resectable tumors on post-NAT CT were considered eligible for resection, the sensitivity and specificity of the CT-determined resectability were 95.2% (95% CI, 89.1-98.4%) and 8.7% (95% CI, 1.1-28.0%), respectively [90].…”

Section: Resectability After Nat/nacrtmentioning

confidence: 99%

“…The second concerns the possibility that an imaging-clean adipose plane can be restored by NAT, providing an indication of a possible R0 resection that turns out to be incorrect due to the presence of a residual microscopic infiltration of the perivascular region. In the first hypothesis, the forecast of an R0 resectability would be erroneously reduced, and in the second, it would be erroneously increased [89]. The NCCN guidelines have introduced customized criteria for PDAC resection after NAT, where radiographic findings, unless demonstrating clear disease progression, are no longer the only criteria used to propose exploratory surgery in the presence of other patient data showing clinical improvement and at least stable or decreased CA 19-9 [59].…”

Section: Resectability After Nat/nacrtmentioning

confidence: 99%

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Currently Debated Topics on Surgical Treatment of Pancreatic Ductal Adenocarcinoma: A Narrative Review on Surgical Treatment of Borderline Resectable, Locally Advanced, and Synchronous or Metachronous Oligometastatic Tumor

Pedrazzoli

2023

JCM

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Background: Previously considered inoperable patients (borderline resectable, locally advanced, synchronous oligometastatic or metachronous pancreatic adenocarcinoma (PDAC)) are starting to become resectable thanks to advances in chemo/radiotherapy and the reduction in operative mortality. Methods: This narrative review presents a chosen literature selection, giving a picture of the current state of treatment of these patients. Results: Neoadjuvant therapy (NAT) is generally recognized as the treatment of choice before surgery. However, despite the increased efficacy, the best pathological response is still limited to 10.9–27.9% of patients. There are still limited data on the selection of possible NAT responders and how to diagnose non-responders early. Multidetector computed tomography has high sensitivity and low specificity in evaluating resectability after NAT, limiting the resection rate of resectable patients. Ca 19-9 and Positron emission tomography are giving promising results. The prediction of early recurrence after a radical resection of synchronous or metachronous metastatic PDAC, thus identifying patients with poor prognosis and saving them from a resection of little benefit, is still ongoing, although some promising data are available. Conclusion: In conclusion, high-level evidence demonstrating the benefit of the surgical treatment of such patients is still lacking and should not be performed outside of high-volume centers with interdisciplinary teams of surgeons and oncologists.

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Section: Resectability After Nat/nacrtmentioning

confidence: 99%

Section: Resectability After Nat/nacrtmentioning

confidence: 99%

Currently Debated Topics on Surgical Treatment of Pancreatic Ductal Adenocarcinoma: A Narrative Review on Surgical Treatment of Borderline Resectable, Locally Advanced, and Synchronous or Metachronous Oligometastatic Tumor

Pedrazzoli

2023

JCM

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“…In contrast, ICG loses fluorescence intensity after binding to proteins in blood vessels when visualized with NIR [78], therefore limiting use in highly vascular tissues, which is often the case in HPB surgery. Furthermore, the ICG signal may be hindered further by blood pooling within the surgical field secondary to blood loss, which is not uncommon in hepatobiliary surgery [79]. Of importance, hemoglobin is one of the few strong endogenous contrast agents that allow for the identification of microvascular changes and tissue oxygenation using MSOT [58,80], and it has been successfully used to monitor tumor responses to antiangiogenic agents in mouse models [81].…”

Section: Photodynamic Imagingmentioning

confidence: 99%

Intraoperative Imaging in Hepatopancreatobiliary Surgery

Husarova,

MacCuaig,

Dennahy

et al. 2023

Cancers

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Hepatopancreatobiliary surgery belongs to one of the most complex fields of general surgery. An intricate and vital anatomy is accompanied by difficult distinctions of tumors from fibrosis and inflammation; the identification of precise tumor margins; or small, even disappearing, lesions on currently available imaging. The routine implementation of ultrasound use shifted the possibilities in the operating room, yet more precision is necessary to achieve negative resection margins. Modalities utilizing fluorescent-compatible dyes have proven their role in hepatopancreatobiliary surgery, although this is not yet a routine practice, as there are many limitations. Modalities, such as photoacoustic imaging or 3D holograms, are emerging but are mostly limited to preclinical settings. There is a need to identify and develop an ideal contrast agent capable of differentiating between malignant and benign tissue and to report on the prognostic benefits of implemented intraoperative imaging in order to navigate clinical translation. This review focuses on existing and developing imaging modalities for intraoperative use, tailored to the needs of hepatopancreatobiliary cancers. We will also cover the application of these imaging techniques to theranostics to achieve combined diagnostic and therapeutic potential.

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Theranostic nanoparticles for detection and treatment of pancreatic cancer

Agarwal,

Bynum,

Saleh

et al. 2024

WIREs Nanomed Nanobiotechnol

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Pancreatic ductal adenocarcinoma (PDAC) is one of the most recalcitrant cancers due to its late diagnosis, poor therapeutic response, and highly heterogeneous microenvironment. Nanotechnology has the potential to overcome some of the challenges to improve diagnostics and tumor‐specific drug delivery but they have not been plausibly viable in clinical settings. The review focuses on active targeting strategies to enhance pancreatic tumor‐specific uptake for nanoparticles. Additionally, this review highlights using actively targeted liposomes, micelles, gold nanoparticles, silica nanoparticles, and iron oxide nanoparticles to improve pancreatic tumor targeting. Active targeting of nanoparticles toward either differentially expressed receptors or PDAC tumor microenvironment (TME) using peptides, antibodies, small molecules, polysaccharides, and hormones has been presented. We focus on microenvironment‐based hallmarks of PDAC and the potential for actively targeted nanoparticles to overcome the challenges presented in PDAC. It describes the use of nanoparticles as contrast agents for improved diagnosis and the delivery of chemotherapeutic agents that target various aspects within the TME of PDAC. Additionally, we review emerging nano‐contrast agents detected using imaging‐based technologies and the role of nanoparticles in energy‐based treatments of PDAC.This article is categorized under: Implantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Diagnostic Tools > In Vivo Nanodiagnostics and Imaging

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Innovative Imaging Techniques Used to Evaluate Borderline-Resectable Pancreatic Adenocarcinoma

Cited by 3 publications

References 76 publications

Currently Debated Topics on Surgical Treatment of Pancreatic Ductal Adenocarcinoma: A Narrative Review on Surgical Treatment of Borderline Resectable, Locally Advanced, and Synchronous or Metachronous Oligometastatic Tumor

Currently Debated Topics on Surgical Treatment of Pancreatic Ductal Adenocarcinoma: A Narrative Review on Surgical Treatment of Borderline Resectable, Locally Advanced, and Synchronous or Metachronous Oligometastatic Tumor

Intraoperative Imaging in Hepatopancreatobiliary Surgery

Theranostic nanoparticles for detection and treatment of pancreatic cancer

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