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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

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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.

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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).

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Authors and Affiliations

  1. Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA

    Naveen M. Kulkarni & Parag P. Tolat

  2. Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Erik V. Soloff

  3. Department of Radiology, LSU Health – Shreveport Ochsner-LSU Health – Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA

    Guillermo P. Sangster

  4. Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA

    Jason B. Fleming

  5. Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 4, Boston, MA, 02215-5400, USA

    Olga R. Brook

  6. Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA

    Zhen Jane Wang

  7. Department of Radiology, Columbia University Medical Center, 622 W 168th St, PH1-317, New York, NY, 10032, USA

    Elizabeth M. Hecht

  8. Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 75014, Paris, France

    Marc Zins

  9. Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030-400, USA

    Priya R. Bhosale & Eric P. Tamm

  10. Department of Radiology, University of Arizona College of Medicine, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ, 85724, USA

    Hina Arif-Tiwari

  11. IRCCS SDN, Naples, Italy

    Lorenzo Mannelli

  12. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA

    Avinash R. Kambadakone

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  1. Naveen M. Kulkarni
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Kulkarni, N.M., Soloff, E.V., Tolat, P.P. et al. 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. Abdom Radiol 45, 716–728 (2020). https://doi.org/10.1007/s00261-019-02289-5

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