Pancreatic ductal adenocarcinoma continues to be a highly lethal disease, despite advances in modern medicine. Curative surgical options continue to carry significant morbidity and offer little improvement in overall 5-year survival. Currently, imaging plays an essential role in the pre-operative evaluation of patients who are undergoing evaluation for resection. However, some pancreatic cancers have particularly aggressive biology, despite appearing resectable by conventional imaging criteria. Imaging biomarkers that serve as surrogates for tumors with such aggressive phenotype have been recently described, namely duodenal invasion and extrapancreatic perineural invasion. In this pictorial review, we will summarize key concepts of extrapancreatic perineural invasion, describe its association with a poor prognosis, and highlight the role of imaging in its detection.
Pancreatic cancer adenocarcinoma perineural invasion pathways 3D volume rendering
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BNP—research support and consultant, GE Healthcare. EC—none. RBJ—none. Study Industry Support: none.
Compliance with ethical standards
This study did not involve human and animal subjects, and therefore an Institutional Review Board approval and informed consent were not required. The authors had control of the data and the information submitted for publication. [Blinded to reviewers] is a medical consultant and has received research support from GE Healthcare. All other authors are not employees of or consultants for industry and had control of inclusion of any data and information that might present a conflict of interest. There was no industry support specifically for this study.
Loosen SH, Neumann UP, Trautwein C, Roderburg C, Luedde T (2017) Current and future biomarkers for pancreatic adenocarcinoma. Tumour Biol 39:1010428317692231CrossRefPubMedGoogle Scholar
Jutric Z, Melstrom LG (2017) New treatment options and management considerations in borderline resectable pancreatic cancer. Oncology (Williston Park) 31:443–452Google Scholar
Yoshioka H, Wakabayashi T (1958) Therapeutic neurotomy on head of pancreas for relief of pain due to chronic pancreatitis; a new technical procedure and its results. AMA Arch Surg 76:546–554CrossRefPubMedGoogle Scholar
Patel BN, Giacomini C, Jeffrey RB, Willmann JK, Olcott E (2013) Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion. Cancer Imaging 13:580–590CrossRefPubMedPubMedCentralGoogle Scholar
Marchesi F, Piemonti L, Mantovani A, Allavena P (2010) Molecular mechanisms of perineural invasion, a forgotten pathway of dissemination and metastasis. Cytokine Growth Factor Rev 21:77–82CrossRefPubMedGoogle Scholar
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 281:816–825CrossRefPubMedGoogle Scholar
Patel BN, Gupta RT, Zani S, et al. (2015) How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas. Abdom Imaging 40:2932–2944CrossRefPubMedGoogle Scholar
Mochizuki K, Gabata T, Kozaka K, et al. (2010) MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: correlation with en bloc pathological specimens and diagnostic accuracy. Eur Radiol 20:1757–1767CrossRefPubMedGoogle Scholar
Sai M, Mori H, Kiyonaga M, et al. (2010) Peripancreatic lymphatic invasion by pancreatic carcinoma: evaluation with multi-detector row CT. Abdom Imaging 35:154–162CrossRefPubMedGoogle Scholar
Nakao A, Harada A, Nonami T, Kaneko T, Takagi H (1996) Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 12:357–361CrossRefPubMedGoogle Scholar
Tian H, Mori H, Matsumoto S, et al. (2007) Extrapancreatic neural plexus invasion by carcinomas of the pancreatic head region: evaluation using thin-section helical CT. Radiat Med 25:141–147CrossRefPubMedGoogle Scholar
Mitsunaga S, Hasebe T, Kinoshita T, et al. (2007) Detail histologic analysis of nerve plexus invasion in invasive ductal carcinoma of the pancreas and its prognostic impact. Am J Surg Pathol 31:1636–1644CrossRefPubMedGoogle Scholar
Amin MB, Edge S, Greene F, et al. (2017) AJCC cancer staging handbook : from the AJCC cancer staging manual, 8th edn. New York: SpringerCrossRefGoogle Scholar
Allen PJ, Kuk D, Castillo CF, et al. (2017) Multi-institutional validation study of the american joint commission on cancer (8th edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg 265:185–191CrossRefPubMedPubMedCentralGoogle Scholar
Dal Molin M, Blackford AL, Siddiqui A, et al. (2017) Duodenal involvement is an independent prognostic factor for patients with surgically resected pancreatic ductal adenocarcinoma. Ann Surg Oncol 24(8):2379–2386. doi:10.1245/s10434-017-5864-9CrossRefPubMedGoogle Scholar