Skip to main content
SpringerLink
Log in

Staging of pancreatic cancer: resectable, borderline resectable, and unresectable disease

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a relatively common malignancy that carries an overall poor prognosis, with five-year survival below 10%. Despite ongoing research, surgical resection remains the only potentially curative treatment. Therefore, accurate identification of those patients who would benefit from surgical resection is of paramount importance. High-quality imaging and image interpretation is central to this process. Radiology helps in the determination of whether patients are resectable, borderline resectable, or unresectable and guides treatment planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. https://www.pancan.org/wp-content/uploads/2016/02/2016-GAA-PC-Facts.pdf. Accessed 26 Nov 2017

  2. https://www.cancer.org/cancer/pancreatic-cancer/about/key-statistics.html. Accessed 26 Nov 2017

  3. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf. Accessed 26 Nov 2017

  4. Pietryga JA, Morgan DE (2015) Imaging preoperatively for pancreatic adenocarcinoma. J Gastrointest Oncol 6(4):343–357. https://doi.org/10.3978/j.issn.2078-6891.2015.024

    PubMed  PubMed Central  Google Scholar 

  5. https://www.nccn.org/professionals. Accessed 26 Nov 2017

  6. Macari M, Spieler B, Kim D, et al. (2010) Dual-source dual-energy MDCT of pancreatic adenocarcinoma: initial observations with data generated at 80 kVp and at simulated weighted-average 120 kVp. Am J Roentgenol 194(1):W27–W32. https://doi.org/10.2214/AJR.09.2737

    Article  Google Scholar 

  7. Gupta S, Wagner-Bartak N, Jensen CT, et al. (2016) Dual-energy CT of pancreatic adenocarcinoma: reproducibility of primary tumor measurements and assessment of tumor conspicuity and margin sharpness. Abdom Radiol 41(7):1317–1324. https://doi.org/10.1007/s00261-016-0689-8

    Article  Google Scholar 

  8. Lee ES, Lee JM (2014) Imaging diagnosis of pancreatic cancer: a state of the art review. World J Gastroenterol 20(24):7864–7877. https://doi.org/10.3748/wjg.v20.i24.7864

    Article  PubMed  PubMed Central  Google Scholar 

  9. Legrand L, Duchatelle V, Molinié V, et al. (2015) Pancreatic adenocarcinoma: MRI conspicuity and pathologic correlations. Abdom Imaging 40(1):85–94. https://doi.org/10.1007/s00261-014-0196-8

    Article  PubMed  Google Scholar 

  10. Chen FM, Ni JM, Zhang ZY, et al. (2016) Presurgical evaluation of pancreatic cancer: a comprehensive imaging comparison of CT versus MRI. AJR Am J Roentgenol 206(3):526–535. https://doi.org/10.2214/AJR.15.15236

    Article  PubMed  Google Scholar 

  11. Koelblinger C, Ba-Ssalamah A, Goetzinger P, et al. (2011) Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology 259(3):757–766. https://doi.org/10.1148/radiol.11101189

    Article  PubMed  Google Scholar 

  12. Kim JH, Park SH, Yu ES, et al. (2010) Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology 257(1):87–96. https://doi.org/10.1148/radiol.10100015

    Article  PubMed  Google Scholar 

  13. Ward J, Robinson PJ, Guthrie JA, et al. (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237(1):170–180

    Article  PubMed  Google Scholar 

  14. Gonzalo-Marin J, Vila JJ, Perez-Miranda M (2014) Role of endoscopic ultrasound in the diagnosis of pancreatic cancer. World J Gastrointest Oncol 6(9):360–368. https://doi.org/10.4251/wjgo.v6.i9.360

    Article  PubMed  PubMed Central  Google Scholar 

  15. DeWitt J, Devereaux B, Chriswell M, et al. (2004) Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 141:753–763

    Article  PubMed  Google Scholar 

  16. Arabul M, Karakus F, Alper E, et al. (2012) Comparison of multidetector CT and endoscopic ultrasonography in malignant pancreatic mass lesions. Hepatogastroenterology 59:1599–1603

    PubMed  Google Scholar 

  17. Adler DG, Jacobson BC, Davila RE, et al. (2005) ASGE guideline: complications of EUS. Gastrointest Endosc 6:8–12. https://doi.org/10.1016/S0016-5107(04)02393-4

    Google Scholar 

  18. Katanuma A, Maguchi H, Hashigo S, Kaneko M, Kin T, Yane K, Kato R, Kato S, Harada R, Osanai M, et al. (2102) Tumor seeding after endoscopic ultrasound-guided fine-needle aspiration of cancer in the body of the pancreas. Endoscopy 44 Suppl 2 UCTN:E160–1. https://doi.org/10.1055/s-0031-1291716

  19. Okano K, Kakinoki K, Akamoto S, et al. (2011) 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of small pancreatic cancer. World J Gastroenterol 17(2):231–235. https://doi.org/10.3748/wjg.v17.i2.231

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jha P, Bijan B (2015) PET/CT for pancreatic malignancy: potential and pitfalls. J Nucl Med Technol 43:92–97. https://doi.org/10.2967/jnmt.114.145458

    Article  PubMed  Google Scholar 

  21. Tamm EP, Balachandran A, Bhosale PR, et al. (2012) Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 50(3):407–428. https://doi.org/10.1016/j.rcl.2012.03.008

    Article  PubMed  Google Scholar 

  22. Farma JM, Santillan AA, Melis M, et al. (2008) PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol 15(9):2465–2471. https://doi.org/10.1245/s10434-008-9992-0

    Article  PubMed  Google Scholar 

  23. Kauhanen SP, Komar G, Seppänen MP, et al. (2009) A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg 250:957–963. https://doi.org/10.1097/SLA.0b013e3181b2fafa

    Article  PubMed  Google Scholar 

  24. Sahani DV, Bonaffini PA, Catalano OA, Guimaraes AR, Blake MA (2012) State-of-the-art PET/CT of the pancreas: current role and emerging indications. Radiographics 32(4):1133–58; discussion 1158–60. https://doi.org/10.1148/rg.324115143

  25. Nakamoto Y, Higashi T, Sakahara H, et al. (1999) Contribution of PET in the detection of liver metastases from pancreatic tumours. Clin Radiol 54(4):248–252

    Article  CAS  PubMed  Google Scholar 

  26. Yoneyama T, Tateishi U, Endo I, Inoue T (2014) Staging accuracy of pancreatic cancer: comparison between non-contrast-enhanced and contrast-enhanced PET/CT. Eur J Radiol 83(10):1734–1739. https://doi.org/10.1016/j.ejrad.2014.04.026

    Article  PubMed  Google Scholar 

  27. AJCC Cancer Staging Manual, Eighth Edition (2016) Springer, Switzerland ISBN 978-3-319-40617-6

  28. Varadhachary GR, Tamm EP, Abbruzzese JL, et al. (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13(8):1035–1046. https://doi.org/10.1245/ASO.2006.08.011

    Article  PubMed  Google Scholar 

  29. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf

  30. Cesmebasi A, Malefant J, Patel SD, et al. (2015) The surgical anatomy of the lymphatic system of the pancreas. Clin Anat 28(4):527–537. https://doi.org/10.1002/ca.22461

    Article  PubMed  Google Scholar 

  31. Al-Hawary MM, Francis IR, Chari ST, et al. (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 270(1):248–260. https://doi.org/10.1148/radiol.13131184

    Article  PubMed  Google Scholar 

  32. Hazirolan T, Metin Y, Karaosmanoglu AD, et al. (2009) Mesenteric arterial variations detected at MDCT angiography of abdominal aorta. Am J Roentgenol 192(4):1097–1102. https://doi.org/10.2214/AJR.08.1532

    Article  Google Scholar 

  33. Sugae T, Fujii T, Kodera Y, et al. (2012) Classification of the celiac axis stenosis owing to median arcuate ligament compression, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenectomy. Surgery 151(4):543–549. https://doi.org/10.1016/j.surg.2011.08.012

    Article  PubMed  Google Scholar 

  34. Okafuji T, Sakai S, Yoshimitsu K, et al. (2004) Pulmonary metastasis from pancreatic cancer: a case showing biphasic radiological and histological patterns. CMIG Extra Cases 28:68–71

    Article  Google Scholar 

  35. Javed AA, Bagante F, Hruban RH, et al. (2015) Postoperative omental infarct after distal pancreatectomy: appearance, etiology management, and review of literature. J Gastrointest Surg 19(11):2028–2037. https://doi.org/10.1007/s11605-015-2920-2

    Article  PubMed  Google Scholar 

  36. Brook OR, Brook A, Vollmer CM, et al. (2015) Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning. Radiology 274(2):464–472. https://doi.org/10.1148/radiol.14140206

    Article  PubMed  Google Scholar 

  37. Ishikawa O, Ohigashi H, Imaoka S, et al. (1992) Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg 215(3):231–236

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Katz MH, Fleming JB, Bhosale P, et al. (2012) Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 118(23):5749–5756. https://doi.org/10.1002/cncr.27636

    Article  PubMed  Google Scholar 

  39. Chang ST, Jeffrey RB, Patel BN, et al. (2016) Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: preliminary experience and implications for patient care. Radiology 281(3):816–825. https://doi.org/10.1148/radiol.2016152790

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA

    Erik V. Soloff

  2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, USA

    Atif Zaheer

  3. Department of Radiology, University of Colorado Denver School of Medicine, Denver, USA

    Jeffrey Meier

  4. Department of Radiology, Groupe Hospitalier Paris saint Joseph, Paris, France

    Marc Zins

  5. Division of Diagnostic Imaging, Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Houston, USA

    Eric P. Tamm

Authors
  1. Erik V. Soloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atif Zaheer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeffrey Meier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Zins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric P. Tamm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik V. Soloff.

Ethics declarations

Conflict of interest

Erik Soloff, Atif Zaheer, Jeffrey Meier, and Marc Zins declares that they have no conflict of interest. Eric Tamm declares in-kind research grant from GE unrelated to this paper.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soloff, E.V., Zaheer, A., Meier, J. et al. Staging of pancreatic cancer: resectable, borderline resectable, and unresectable disease. Abdom Radiol 43, 301–313 (2018). https://doi.org/10.1007/s00261-017-1410-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1410-2

Keywords

Search

Navigation