Pancreatic and Ampullary Carcinoma. Ultrasound, Computed Tomography, Magnetic Resonance Imaging and Angiography

Abstract

Ultrasound remains the most readily available and least expensive of the imaging techniques used in assessment of the upper abdomen. Ultrasound is very useful in the detection of pancreatic tumors as well as in the evaluation of the extent of the disease. If ultrasound fails technically or is inconclusive, CT is recommended. Determination of CA 19-9 may help to decide whether ultrasound should be followed by CT or other examinations (51). Patients with any equivocal or inconclusive abnormality on ultrasound or CT should undergo ERCP. Even when ultrasound and CT of the pancreas appear normal there may be an indication for performing ERCP if the clinical suspicion of pancreatic cancer is still strong (52). Angiography is a reliable method of assessing major vascular tumor involvement, which to most surgeons would be a sign of unresectability. Although for some investigators CT is superior to angiography in assessing vascular involvement, angiography is performed preoperatively in many cases because it delineates the vascular anatomy, which can be abnormal in up to one third of patients. Percutaneous biopsy is an important technique for confirming the radiologic diagnosis of unresectable pancreatic carcinoma, particularly for differentiating pancreas carcinoma from other focal pancreatic lesions such as islet cell tumor, lymphoma, and chronic pancreatitis.

Prognostic and Therapeutic Significance of Carbohydrate Antigen 19-9 as Tumor Marker in Patients with Pancreatic Cancer

“…A known phenomenon that complicates tumor imaging (especially in CT scan) is the desmoplastic stroma reaction induced by the tumor itself in surrounding soft tissue [4]. Often, this desmoplastic reaction makes it difficult to differentiate normal pancreas, local inflammation and fibrosis from malignant tissue and therefore imaging may sometimes be inaccurate in the assessment of treatment response.…”

Alternative antibody for the detection of CA19-9 antigen: a European multicenter study for the evaluation of the analytical and clinical performance of the Access® GI Monitor assay on the UniCel® DxI 800 Immunoassay System

“…The diagnosis of pancreatic cancer is usually established based on imaging techniques and subsequent histological confirmation. Desmoplastic stroma reaction is a well-known confounder, particularly of computed tomography, which makes it difficult to differentiate normal pancreas, local inflammation and fibrosis from malignant tissue (5). Therefore, other surrogate markers for differential diagnosis and estimation of treatment efficacy are needed.…”

Immunogene Zelltodmarker HMGB1 und sRAGE als neue prädiktive und prognostische Serum Biomarker bei Tumorerkrankungen/Immunogenic cell death markers HMGB1 and sRAGE as new predictive and prognostic serum biomarkers in cancer disease

“…Allerdings unterliegt auch die Beurteilung des Therapieansprechens in den bildgebenden Verfahren relevanten Einschr ä nkungen: Die Sonografie ist stark Untersucher-abh ä ngig und in Schnittbildverfahren k ö nnen Umgebungsreaktionen wie z.B. eine desmoplastische Stromareaktion oder Bestrahlungsnarben die Gr ö ß enbestimmung einer Tumorl ä sion erschweren [6,7] . Die in den RECIST-Kriterien verwendete eindimensionale Ausmessung des Tumors kann f ä lschlicherweise auch zur Untersch ä tzung des Therapieansprechens f ü hren, wenn der Tumor inhomogen einschmilzt, abgestorbenes Tumorgewebe nicht abger ä umt wird oder der Tumor bei stabilem Volumen nur an metabolischer Aktivit ä t verliert [8] .…”