Small carcinoma of the pancreas is curable: New computed tomography finding, pathological study and postoperative results from a single institute

Shimizu, Yasuhiro; Yasui, Kenzo; Matsueda, Kiyoshi; Yanagisawa, Akio; Yamao, Kenji

doi:10.1111/j.1440-1746.2005.03895.x

Cited by 63 publications

(41 citation statements)

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“…Because patients generally present with symptoms relating to late stages of the disease, diagnosis of resectable PDAC is achieved in less than 15% of cases (1). However, investigators have reported that diagnosis and resection of early-stage PDAC (<2 cm in size) can result in a 4-y survival rate of up to 78% (2)(3)(4)(5). These data suggest that early detection of PDAC can improve patient outcome.…”

mentioning

confidence: 96%

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

Eser

Messer²,

Eser³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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Pancreatic ductal adenocarcinoma (PDAC) is a fatal disease with poor patient outcome often resulting from late diagnosis in advanced stages. To date methods to diagnose early-stage PDAC are limited and in vivo detection of pancreatic intraepithelial neoplasia (PanIN), a preinvasive precursor of PDAC, is impossible. Using a cathepsin-activatable near-infrared probe in combination with flexible confocal fluorescence lasermicroscopy (CFL) in a genetically defined mouse model of PDAC we were able to detect and grade murine PanIN lesions in real time in vivo. Our diagnostic approach is highly sensitive and specific and proved superior to clinically established fluorescein-enhanced imaging. Translation of this endoscopic technique into the clinic should tremendously improve detection of pancreatic neoplasia, thus reforming management of patients at risk for PDAC. is one of the deadliest human malignancies, with an extremely poor 5-y survival rate below 5% (1). Because patients generally present with symptoms relating to late stages of the disease, diagnosis of resectable PDAC is achieved in less than 15% of cases (1). However, investigators have reported that diagnosis and resection of early-stage PDAC (<2 cm in size) can result in a 4-y survival rate of up to 78% (2-5). These data suggest that early detection of PDAC can improve patient outcome. In addition, it has been shown that resection of PDAC combined with adjuvant chemotherapy can improve 5-y survival rates to 25%. Thus, increasing the chance of resection will lead to improved survival.Of the more than 33,000 new cases of PDAC diagnosed in the United States every year, ∼10% occur in families with a high prevalence of PDAC and are thus referred to as familial (6, 7). In a cohort study of twins, it was proposed that inherited factors may be responsible for up to 36% of pancreatic cancers, suggesting that the incidence of familial pancreatic cancer may be even higher than presently assumed (8). To date, several conditions associated with familial PDAC have been described and groups of individuals at low, moderate, or high risk for developing the disease have been defined (9, 10). Although clinical trials are currently testing screening protocols for the high-risk group, aimed at detecting curable precursors of PDAC such as intraductal papillary mucinous neoplasia, pancreatic intraepithelial neoplasia (PanIN), and early-stage PDAC (10-12), the results of these trials show that early lesions are often missed. Furthermore, false positive findings can lead to overtreatment of a significant fraction of the screened population (12). These findings show that better diagnostic tools for the detection of preneoplastic lesions and early-stage PDAC are urgently needed. Recent data demonstrate that preinvasive precursors progress slowly over many years to decades to invasive pancreatic cancer (13). The parental pancreatic cancer founder clone then requires more than 5 y to acquire the capacity to metastasize (13). Thus, there is a time frame of several years for the diagnosi...

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mentioning

confidence: 96%

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

Eser

Messer²,

Eser³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

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“…Unlike large pancreatic cancer which is usually symptomatic, small cancers are generally asymptomatic or have non-specific symptoms. In a recent series of small pancreatic cancer 50% of patients were diagnosed incidentally on crosssectional imaging (10). Extra-pancreatic spread is frequently present in small pancreatic cancer.…”

Section: Progression Of Pancreatic Cancer From Pre-invasive Precursormentioning

confidence: 99%

“…To put this in perspective, the median size of resected pancreatic cancers is 30 mm (6). Small cancers constitute only ~ 20% of resected pancreatic cancers (10). In an unpublished series of 300 patients with pancreatic ductal adenocarcinomas who underwent margin-negative (R0) resection between 1987 and 2000 at our center, 54 (18%) were small (i.e., ≤20mm).…”

Section: Definition(s) Of Early Pancreatic Cancermentioning

confidence: 99%

“…In an unpublished series of 300 patients with pancreatic ductal adenocarcinomas who underwent margin-negative (R0) resection between 1987 and 2000 at our center, 54 (18%) were small (i.e., ≤20mm). The 5 year survival after resection of small pancreatic cancers in case series and collective reviews has ranged from 30% to 60% (9)(10)(11), suggesting that detection of small pancreatic cancer will further enhance survival in pancreatic cancer.…”

Section: Definition(s) Of Early Pancreatic Cancermentioning

confidence: 99%

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Detecting Early Pancreatic Cancer: Problems and Prospects

Chari

2007

Seminars in Oncology

153

133

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Pancreatic cancer has a poor prognosis. Improving survival will require diagnosis of early pancreatic cancer which can be defined based on resectability, size or curability. Pancreatic cancer progresses from non-invasive precursor lesions to invasive cancer over a variable time period. Retrospective review of CT scans done prior to diagnosis suggests that pancreatic cancer resectability may be significantly improved if detected as few as 6 months before clinical diagnosis. Since pancreatic cancer is relatively uncommon, to allow cost-effective screening the populations will have to be enriched for the disease using two "sieves", first would be a population of subjects at higher than average risk of pancreatic cancer and the second sieve could be a characteristic phenotype among the members of the high-risk group, an abnormality seen on non-invasive imaging or a serologic marker of early pancreatic cancer. So far two high risk groups have been targets of screening for pancreatic cancer, viz., hereditary pancreatic cancer kindreds and new-onset diabetes. There is no serologic marker of early pancreatic cancer. Confirmation of diagnosis usually requires invasive procedures such endoscopic ultrasonography. Though much work still needs to be done, the developments in the field provide us with hope that screening for early pancreatic cancer could become a reality in the not-so-distant future.

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“…Resection of small tumors (< 2 cm or T1) improves 5-years survival (30% to 60%) [9,10] . However it has been alluded that the better prognosis is for tumors < 1 cm (T1a) with 5-years survival up to 78% [6,11,12] .…”

Section: Introductionmentioning

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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Small carcinoma of the pancreas is curable: New computed tomography finding, pathological study and postoperative results from a single institute

Abstract: The presence of s-PC qualifies as early PC and has a good prognosis. The CT black + white sign will be useful in the diagnosis of s-PC accompanying pancreatitis.

Cited by 63 publications

References 16 publications

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

In vivo diagnosis of murine pancreatic intraepithelial neoplasia and early-stage pancreatic cancer by molecular imaging

Detecting Early Pancreatic Cancer: Problems and Prospects

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

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