Extrapancreatic perineural invasion in pancreatic adenocarcinoma

  • Bhavik N. Patel
  • Eric Olcott
  • R. Brooke Jeffrey
Article

Abstract

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.

Keywords

Pancreatic cancer adenocarcinoma perineural invasion pathways 3D volume rendering 

Notes

Disclosures

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.

References

  1. 1.
    Loosen SH, Neumann UP, Trautwein C, Roderburg C, Luedde T (2017) Current and future biomarkers for pancreatic adenocarcinoma. Tumour Biol 39:1010428317692231CrossRefPubMedGoogle Scholar
  2. 2.
    Jutric Z, Melstrom LG (2017) New treatment options and management considerations in borderline resectable pancreatic cancer. Oncology (Williston Park) 31:443–452Google Scholar
  3. 3.
    Luberice K, Downs D, Sadowitz B, Ross S, Rosemurgy A (2017) Has survival improved following resection for pancreatic adenocarcinoma? Am J Surg 214(2):341–346. doi: 10.1016/j.amjsurg.2017.05.007 CrossRefPubMedGoogle Scholar
  4. 4.
    Bachmann J, Michalski CW, Martignoni ME, Buchler MW, Friess H (2006) Pancreatic resection for pancreatic cancer. HPB (Oxford) 8:346–351CrossRefGoogle Scholar
  5. 5.
    Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB (2007) Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics 27:1653–1666CrossRefPubMedGoogle Scholar
  6. 6.
    Sohal DPS, Willingham FF, Falconi M, Raphael KL, Crippa S (2017) Pancreatic adenocarcinoma: improving prevention and survivorship. Am Soc Clin Oncol Educ Book 37:301–310CrossRefPubMedGoogle Scholar
  7. 7.
    Sohal DP, Walsh RM, Ramanathan RK, Khorana AA (2014) Pancreatic adenocarcinoma: treating a systemic disease with systemic therapy. J Natl Cancer Inst 106:dju011CrossRefPubMedGoogle Scholar
  8. 8.
    Liebig C, Ayala G, Wilks JA, Berger DH, Albo D (2009) Perineural invasion in cancer: a review of the literature. Cancer 115:3379–3391CrossRefPubMedGoogle Scholar
  9. 9.
    Alotaibi AM, Lee JL, Kim J, et al. (2017) Prognostic and oncologic significance of perineural invasion in sporadic colorectal cancer. Ann Surg Oncol 24:1626–1634CrossRefPubMedGoogle Scholar
  10. 10.
    Murakami Y, Uemura K, Sudo T, et al. (2013) Perineural invasion in extrahepatic cholangiocarcinoma: prognostic impact and treatment strategies. J Gastrointest Surg 17:1429–1439CrossRefPubMedGoogle Scholar
  11. 11.
    Deshmukh SD, Willmann JK, Jeffrey RB (2010) Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. AJR Am J Roentgenol 194:668–674CrossRefPubMedGoogle Scholar
  12. 12.
    Bapat AA, Hostetter G, Von Hoff DD, Han H (2011) Perineural invasion and associated pain in pancreatic cancer. Nat Rev Cancer 11:695–707CrossRefPubMedGoogle Scholar
  13. 13.
    Liebig C, Ayala G, Wilks J, et al. (2009) Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 27:5131–5137CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Demir IE, Ceyhan GO, Liebl F, et al. (2010) Neural invasion in pancreatic cancer: the past, present and future. Cancers (Basel) 2:1513–1527CrossRefGoogle Scholar
  15. 15.
    Pour PM, Bell RH, Batra SK (2003) Neural invasion in the staging of pancreatic cancer. Pancreas 26:322–325CrossRefPubMedGoogle Scholar
  16. 16.
    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
  17. 17.
    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
  18. 18.
    Batsakis JG (1985) Nerves and neurotropic carcinomas. Ann Otol Rhinol Laryngol 94:426–427CrossRefPubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    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
  21. 21.
    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
  22. 22.
    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
  23. 23.
    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
  24. 24.
    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
  25. 25.
    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
  26. 26.
    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
  27. 27.
    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
  28. 28.
    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 265:185–191CrossRefPubMedGoogle Scholar
  29. 29.
    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/s10434-017-5864-9 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Bhavik N. Patel
    • 1
  • Eric Olcott
    • 1
    • 2
  • R. Brooke Jeffrey
    • 1
  1. 1.Department of RadiologyStanford University School of MedicineStanfordUSA
  2. 2.Department of RadiologyVeterans Affairs Palo Alto Health Care SystemPalo AltoUSA

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