Type:
Educational Exhibit
Keywords:
Congenital, Cancer, Diagnostic procedure, Contrast agent-intravenous, MR, CT, Pancreas, Abdomen, Inflammation, MR-Cholangiography
Authors:
A. Xinou, A. Mimila, E. MANAVI, A. Rovithi, D. Panagiotopoulou-Mpoukla; Thessaloniki/GR
DOI:
10.1594/ecr2018/C-2073
Background
Pancreatic adenocarcinoma (PA) is one of the most aggressive malignancies,
ranking fourth among causes of cancer-related deaths in the Western world.
The accurate diagnosis of PA is of critical importance,
because the disease has a high mortality and its treatment has substantial morbidity.
Tumor markers,
mainly CA 19-9,
and biopsy under EUS or CT guidance can assist in making the correct diagnosis but they have several drawbacks.
Whereas CA 19-9 is elevated in 81% of PA cases,
yet it cannot be used for the exclusion of malignancy as its negative predictive value is very low (69%).
EUS-FNA and CT-guided core-needle biopsy have high accuracy,
but low sensitivity in diagnosing PA.
EUS-FNA has a limited role in cases of duodenal stenosis and in lesions situated in the uncinated process or in the tail,
and CT-guided core-needle biopsy has a limited role in small lesions.
Both biopsy techniques cannot be performed in cases of vessel interposition.
These are the reasons why the NCCN guidelines suggest that when there is a high suspicion of malignancy for a solid lesion in the pancreas,
the histological proof of PA is not a prerequisite for pancreatectomy.
This fact led inevitably to a high rate of false-positive pancreatectomies; 5% to 10% of pancreatectomies performed with the clinical diagnosis of PA prove to be pseudotumors.
Correct diagnosis of PA with imaging is therefore crucial in order to prevent unnecessary surgical procedures.
Many benign,
congenital, chronic inflammatory and neoplastic entities can mimic PA and are likely to challenge the radiology resident or the less experienced radiologist in abdominal imaging.
The purpose of this educational exhibit is to provide the key findings that suggest the correct diagnosis,
mainly by CT evaluation,
which is the preferred tool for pancreatic imaging and our subject of interest.