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White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology’s disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease

  • Naveen M. KulkarniEmail author
  • Erik V. Soloff
  • Parag P. Tolat
  • Guillermo P. Sangster
  • Jason B. Fleming
  • Olga R. Brook
  • Zhen Jane Wang
  • Elizabeth M. Hecht
  • Marc Zins
  • Priya R. Bhosale
  • Hina Arif-Tiwari
  • Lorenzo Mannelli
  • Avinash R. Kambadakone
  • Eric P. Tamm
Review

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy with a poor 5-year survival rate. Accurate staging of PDAC is an important initial step in the development of a stage-specific treatment plan. Different staging systems/consensus statements convened by different societies and academic practices are currently used. The most recent version of the American Joint Committee on Cancer (AJCC) tumor/node/metastases (TNM) staging system for PDAC has shifted its focus from guiding management to assessing prognosis. In order to preoperatively define the resectability of PDAC and to guide management, additional classification systems have been developed. The National Comprehensive Cancer Network (NCCN) guidelines, one of the most commonly used systems, provide recommendations on the management and the determination of resectability for PDAC. The NCCN divides PDAC into three categories of resectability based on tumor-vessel relationship: ‘resectable,’ ‘borderline resectable,’ and ‘unresectable’. Among these, the borderline disease category is of special interest given its evolution over time and the resulting variations in the definition and the associated recommendations for management between different societies. It is important to be familiar with the evolving criteria, and treatment and follow-up recommendations for PDAC. In this article, the most current AJCC staging (8th edition), NCCN guidelines (version 2.2019—April 9, 2019), and challenges and controversies in borderline resectable PDAC are reviewed.

Keywords

Pancreatic ductal adenocarcinoma AJCC staging NCCN Borderline resectable pancreatic adenocarcinoma 

Notes

Acknowledgements

The authors wish to thank the members of Society of Abdominal Radiology’s Disease-Focused Panel for Pancreatic Cancer for their suggestions and input in selecting the topics for the white paper (Ajit Goenka, MD; Alexander Guimares MD, PhD; Arnold Friedman, MD; Atif Zaheer, MD; David Hough, MB ChB; Michael Rosenthal, MD, PhD; Namita Gandhi, MD; Ott Le, MD; Richard Do, MD, PhD; Zarine Shah, MD).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Naveen M. Kulkarni
    • 1
    Email author
  • Erik V. Soloff
    • 2
  • Parag P. Tolat
    • 1
  • Guillermo P. Sangster
    • 3
  • Jason B. Fleming
    • 4
  • Olga R. Brook
    • 5
  • Zhen Jane Wang
    • 6
  • Elizabeth M. Hecht
    • 7
  • Marc Zins
    • 8
  • Priya R. Bhosale
    • 9
  • Hina Arif-Tiwari
    • 10
  • Lorenzo Mannelli
    • 11
  • Avinash R. Kambadakone
    • 12
  • Eric P. Tamm
    • 9
  1. 1.Department of RadiologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of RadiologyUniversity of WashingtonSeattleUSA
  3. 3.Department of RadiologyLSU Health – Shreveport Ochsner-LSU Health – ShreveportShreveportUSA
  4. 4.Gastrointestinal OncologyMoffitt Cancer CenterTampaUSA
  5. 5.Department of RadiologyBeth Israel Deaconess Medical CenterBostonUSA
  6. 6.Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoUSA
  7. 7.Department of RadiologyColumbia University Medical CenterNew YorkUSA
  8. 8.Department of RadiologyGroupe Hospitalier Paris Saint-JosephParisFrance
  9. 9.Abdominal Imaging DepartmentThe University of Texas MD Anderson Cancer CenterHoustonUSA
  10. 10.Department of RadiologyUniversity of Arizona College of MedicineTucsonUSA
  11. 11.IRCCS SDNNaplesItaly
  12. 12.Department of RadiologyMassachusetts General HospitalBostonUSA

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