Abstract
The preoperative evaluation of resectability for pancreatic cancer fails to identify up to 25% of patients who are unfortunately found to be unresectable at surgical exploration. Inoperative findings in this circumstance is usually due to either small volume metastatic disease or regional tumor invasion. While advances in computed tomography (CT) technology has increased accuracy of local tumor extent, occult metastatic disease remains a common problem. Although 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been demonstrated to be useful in the staging of many malignancies (e.g. esophageal cancer, recurrent colorectal cancer, lung cancer), it has not been found to significantly increase the accuracy of determining resectability preoperatively in pancreatic cancer, especially with regard to detection of small volume metastatic disease. There are a variety of pancreatic cancer-specific antigens which are being developed as a method for targeted molecular imaging; we provide preliminary data targeting the integrin αvβ6 to demonstrate the potential feasibility of this approach. Further developments may allow the accurate determination of patients with resectable pancreatic cancer, and more importantly, those with unresectable disease that may forego unnecessary surgery, the associated morbidity, and the subsequent delay of appropriate therapy.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106–130.
Haller DG. New perspectives in the management of pancreas cancer. Semin Oncol 2003;30(4 Suppl 11):3–10.
Ellsmere J, Mortele K, Sahani D, et al. Does multidetector-row CT eliminate the role of diagnostic laparoscopy in assessing the resectability of pancreatic head adenocarcinoma? Surg Endosc 2005;19:369–373.
Gulliver DJ, Baker ME, Cheng CA, et al. Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability. AJR Am J Roentgenol 1992;159:503–507.
Prokesch RW, Chow LC, Beaulieu CF, et al. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 2002;224:764–768.
Saldinger PF, Reilly M, Reynolds K, et al. Is CT angiography sufficient for prediction of resectability of periampullary neoplasms? J Gastrointest Surg 2000;4:233–237; discussion 238–9.
Spitz FR, Abbruzzese JL, Lee JE, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997;15:928–937.
Steinberg WM, Barkin J, Bradley EL 3rd, et al. Workup of a patient with a mass in the head of the pancreas. Pancreas 1998;17:24–30.
Varadhachary GR, Tamm EP, Crane C, et al. Borderline resectable pancreatic cancer. Curr Treat Options Gastroenterol 2005;8:377–384.
Warshaw AL, Gu ZY, Wittenberg J, Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990;125:230–233.
Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr 2005;29:170–175.
Harris JP, Nelson RC. Abdominal imaging with multidetector computed tomography: state of the art. J Comput Assist Tomogr 2004;28(Suppl 1):S17–S19.
Horton KM, Fishman EK. Adenocarcinoma of the pancreas: CT imaging. Radiol Clin North Am 2002;40:1263–1272.
Kalra MK, Maher MM, Mueller PR, Saini S. State-of-theart imaging of pancreatic neoplasms. Br J Radiol 2003;76:857–865.
Smith SL, Rajan PS. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol 2004;59:26–38.
Ishiguchi T, Maruyama K, Fukatsu H, Ishigaki T. Radiologic diagnosis of pancreatic carcinoma. Semin Surg Oncol 1998;15:23–32.
Iacobuzio-Donahue CA, Ryu B, Hruban RH, Kern SE. Exploring the host desmoplastic response to pancreatic carcinoma: gene expression of stromal and neoplastic cells at the site of primary invasion. Am J Pathol 2002;160:91–99.
Yachida S, Fukushima N, Nakanishi K, et al. Minute pancreatic adenocarcinoma presenting with stenosis of the main pancreatic duct. Pathol Int 2002;52:607–611.
Clarke DL, Thomson SR, Madiba TE, Sanyika C. Preoperative imaging of pancreatic cancer: a management-oriented approach. J Am Coll Surg 2003;196:119–129.
Diehl SJ, Lehmann KJ, Sadick M, et al. Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 1998;206:373–378.
Legmann P, Vignaux O, Dousset B, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998;170:1315–1322.
Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 1997;168:1439–1443.
Conlon KC, Dougherty E, Klimstra DS, et al. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg 1996;223:134–140.
Friess H, Kleeff J, Silva JC, et al. The role of diagnostic laparoscopy in pancreatic and periampullary malignancies. J Am Coll Surg 1998;186:675–682.
Holzman MD, Reintgen KL, Tyler DS, Pappas TN. The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies. J Gastrointest Surg 1997;1:236–243; discussion 243-244.
Pisters PW, Lee JE, Vauthey JN, et al. Laparoscopy in the staging of pancreatic cancer. Br J Surg 2001;88:325–337.
Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis. J Comput Assist Tomogr 2005;29:438–445.
Rumstadt B, Schwab M, Schuster K, et al. The role of laparoscopy in the preoperative staging of pancreatic carcinoma. J Gastrointest Surg 1997;1:245–250.
Vargas R, Nino-Murcia M, Trueblood W, Jeffrey RB Jr. MDCT in pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR Am J Roentgenol 2004;182:419–425.
Reddy KR, Levi J, Livingstone A, et al. Experience with staging laparoscopy in pancreatic malignancy. Gastrointest Endosc 1999; 49(4 Pt 1):498–503.
Jones EC, Chezmar JL, Nelson RC, Bernardino ME. The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. AJR Am J Roentgenol 1992;158:535–539.
Michl P, Pauls S, Gress TM. Evidence-based diagnosis and staging of pancreatic cancer. Best Pract Res Clin Gastroenterol 2006;20:227–251.
Roche CJ, Hughes ML, Garvey CJ, et al. CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. AJR Am J Roentgenol 2003;180:475–480.
Acton PD, Zhuang H, Alavi A. Quantification in PET. Radiol Clin North Am 2004;42:1055–1062, viii.
Nichols MT, Russ PD, Chen YK. Pancreatic imaging: current and emerging technologies. Pancreas 2006;33:211–220.
Brown RS, Wahl RL. Overexpression of Glut-1 glucose transporter in human breast cancer. An immunohistochemical study. Cancer 1993;72:2979–2985.
Ito T, Noguchi Y, Satoh S, et al. Expression of facilitative glucose transporter isoforms in lung carcinomas: its relation to histologic type, differentiation grade, and tumor stage. Mod Pathol 1998;11:437–443.
Reske SN, Grillenberger KG, Glatting G, et al. Overexpression of glucose transporter 1 and increased FDG uptake in pancreatic carcinoma. J Nucl Med 1997;38:1344–1348.
Higashi T, Tamaki N, Torizuka T, et al. FDG uptake, GLUT-1 glucose transporter and cellularity in human pancreatic tumors. J Nucl Med 1998;39:1727–1735.
Keogan MT, Tyler D, Clark L, et al. Diagnosis of pancreatic carcinoma: role of FDG PET. AJR Am J Roentgenol 1998;171:1565–1570.
Friess H, Langhans J, Ebert M, et al. Diagnosis of pancreatic cancer by 2[18F]-fluoro-2-deoxy-D-glucose positron emission tomography. Gut 1995;36:771–777.
Ho CL, Dehdashti F, Griffeth LK, et al. FDG-PET evaluation of indeterminate pancreatic masses. J Comput Assist Tomogr 1996;20:363–369.
Inokuma T, Tamaki N, Torizuka T, et al. Evaluation of pancreatic tumors with positron emission tomography and F-18 fluorodeoxyglucose: comparison with CT and US. Radiology 1995;195:345–352.
Klever P, Bares R, Fass J, et al. PET with fluorine-18 deoxyglucose for pancreatic disease. Lancet 1992;340:1158–1159.
Stollfuss JC, Glatting G, Friess H, et al. 2-(Fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation. Radiology 1995;195:339–344.
Rose DM, Delbeke D, Beauchamp RD, et al. 18 Fluorodeoxyglucose-positron emission tomography in the management of patients with suspected pancreatic cancer. Ann Surg 1999;229:729–737; discussion 737–8.
Sendler A, Avril N, Helmberger H, et al. Preoperative evaluation of pancreatic masses with positron emission tomography using 18F-fluorodeoxyglucose: diagnostic limitations. World J Surg 2000;24:1121–1129.
Delbeke D, Rose DM, Chapman WC, et al. Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med 1999;40:1784–1791.
Nakamoto Y, Higashi T, Sakahara H, et al. Contribution of PET in the detection of liver metastases from pancreatic tumours. Clin Radiol 1999;54:248–252.
Nishiyama Y, Yamamoto Y, Yokoe K, et al. Contribution of whole body FDG-PET to the detection of distant metastasis in pancreatic cancer. Ann Nucl Med 2005;19:491–497.
Imdahl A, Nitzsche E, Krautmann F, et al. Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg 1999;86:194–199.
Yokoyama Y, Nagino M, Hiromatsu T, et al. Intense PET signal in the degenerative necrosis superimposed on chronic pancreatitis. Pancreas 2005;31:192–194.
Goh BK, Tan YM, Chung YF. Utility of fusion CT-PET in the diagnosis of small pancreatic carcinoma. World J Gastroenterol 2005;11:3800–3802.
Heinrich S, Goerres GW, Schafer M, et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 2005;242:235–243.
Herlyn M, Steplewski Z, Herlyn D, Koprowski H. Colorectal carcinoma-specific antigen: detection by means of monoclonal antibodies. Proc Natl Acad Sci USA 1979;76:1438–1442.
Magnani JL, Brockhaus M, Smith DF, et al. A monosialoganglioside is a monoclonal antibody-defined antigen of colon carcinoma. Science 1981;212:55–56.
Lamerz R. Role of tumour markers, cytogenetics. Ann Oncol 1999;10(Suppl 4):145–149.
Benini L, Cavallini G, Zordan D, et al. A clinical evaluation of monoclonal (CA19-9, CA50, CA12-5) and polyclonal (CEA, TPA) antibody-defined antigens for the diagnosis of pancreatic cancer. Pancreas 1988;3:61–66.
Malesci A, Tommasini MA, Bonato C, et al. Determination of CA 19-9 antigen in serum and pancreatic juice for differential diagnosis of pancreatic adenocarcinoma from chronic pancreatitis. Gastroenterology 1987;92:60–67.
Paganuzzi M, Onetto M, Marroni P, et al. CA 19-9 and CA 50 in benign and malignant pancreatic and biliary diseases. Cancer 1988;61:2100–2108.
Pasquali C, Sperti C, D’Andrea AA, et al. Evaluation of carbohydrate antigens 19-9 and 12-5 in patients with pancreatic cancer. Pancreas 1987;2:34–37.
Schlieman MG, Ho HS, Bold RJ. Utility of tumor markers in determining resectability of pancreatic cancer. Arch Surg 2003;138:951–955; discussion 955–6.
Magnani JL, Steplewski Z, Koprowski H, Ginsburg V. Identification of the gastrointestinal and pancreatic cancer-associated antigen detected by monoclonal antibody 19-9 in the sera of patients as a mucin. Cancer Res 1983;43:5489–5492.
Safi F, Schlosser W, Falkenreck S, Beger HG. Prognostic value of CA 19-9 serum course in pancreatic cancer. Hepatogastroenterology 1998;45:253–259.
Egawa S, Takeda K, Fukuyama S, et al. Clinicopathological aspects of small pancreatic cancer. Pancreas 2004;28:235–240.
Riker A, Libutti SK, Bartlett DL. Advances in the early detection, diagnosis, and staging of pancreatic cancer. Surg Oncol 1997;6:157–169.
Mann DV, Edwards R, Ho S, et al. Elevated tumour marker CA19-9: clinical interpretation and influence of obstructive jaundice. Eur J Surg Oncol 2000;26:474–479.
Cerwenka H, Aigner R, Quehenberger F, et al. Preoperative differential diagnosis of benign and malignant pancreatic lesions-the value of pancreatic secretory trypsin inhibitor, procarboxypeptidase B, CA19-9 and CEA. Hepatogastroenterology 1997;44:1117–1121.
Koopmann J, Fedarko NS, Jain A, et al. Evaluation of osteopontin as biomarker for pancreatic adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2004;13:487–491.
Koopmann J, Rosenzweig CN, Zhang Z, et al. Serum markers in patients with resectable pancreatic adenocarcinoma: macrophage inhibitory cytokine 1 versus CA19-9. Clin Cancer Res 2006;12:442–446.
Li Z, Sclabas GM, Peng B, et al. Overexpression of synucleingamma in pancreatic adenocarcinoma. Cancer 2004;101:58–65.
Sipos B, Hahn D, Carceller A, et al. Immunohistochemical screening for beta6-integrin subunit expression in adenocarcinomas using a novel monoclonal antibody reveals strong upregulation in pancreatic ductal adenocarcinomas in vivo and in vitro. Histopathology 2004;45:226–236.
Author information
Authors and Affiliations
About this article
Cite this article
Parsons, C.M., Sutcliffe, J.L. & Bold, R.J. Preoperative evaluation of pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg 15, 429–435 (2008). https://doi.org/10.1007/s00534-007-1240-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-007-1240-7