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Diagnostik beim Pankreaskarzinom

Diagnostic procedures for pancreatic cancer

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Durch das diagnostische Vorgehen soll bei Verdacht auf Pankreaskarzinom bei Patienten mit Pankreasläsionen sicher zwischen Karzinomen und Raumforderungen anderer Ursache unterschieden werden. Da beim überwiegenden Anteil der Patienten mit Pankreaskarzinom zum Zeitpunkt der Diagnose bereits ein inoperables Stadium vorliegt, ist ein zweiter Schwerpunkt neben der eigentlichen Diagnosesicherung potenziell kurativ behandelbare Patienten zu erkennen. Nach einer Oberbauchsonographie als meist erstem Schritt ist die Multidetektor-Computertomographie derzeit als Standard in der Bildgebung anzusehen, u. a. auch aufgrund der im Vergleich zum endoskopischen Ultraschall besseren Verfügbarkeit auch außerhalb von Zentren. Bei -- basierend auf der CT -- potenziell kurativ therapierbaren Patienten sollte eine zweite, alternative Bildgebung durchgeführt werden. Hier empfiehlt sich der endoskopische Ultraschall, der einen substanziellen Zugewinn an Information zur Multidetektor-CT erbringen kann. Bei entsprechender qualitativ hoch stehender Geräteausstattung ist die MRT eine Alternative zur CT, die noch mehr an Bedeutung erlangen wird. Bei Tumoren, die als nichtoperabel eingeschätzt werden, sollte vor Einleitung einer spezifischen Therapie die Diagnose mittels Gewebeentnahme gesichert werden.

Abstract

The objective of staging in persons with pancreatic lesions is to distinguish between cancer and nontumorous lesions of the pancreas. As most patients with pancreatic cancer at the time of diagnosis present in an advanced and unresectable stage, another main target is to identify those patients who can be treated with curative intent. After abdominal ultrasound, which is usually the first diagnostic step, multidetector CT is regarded as the standard imaging procedure in diagnosing pancreatic cancer at present because it is more readily available than endoscopic ultrasonography (EUS) and therefore more frequently used. In potentially resectable patients EUS should be used as a valuable preoperative adjunct to multidetector CT. When high-end devices are more commonly available, MRI will increase in importance as an alternative to MD CT. In pancreatic tumors considered to be unresectable, malignancy should be confirmed histologically before treatment with chemotherapy.

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Authors and Affiliations

  1. Abt. Innere Medizin I, Universitätsklinikum Ulm

    V. Kächele, T. Seufferlein & G. Adler

  2. Abt. Röntgendiagnostik, Universitätsklinikum Ulm

    H. J. Brambs, M. S. Juchems & S. Pauls

  3. Abt. Innere Medizin I, Universitätsklinikum Ulm, Robert-Koch-Straße 8, 89081 , Ulm

    V. Kächele

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  1. V. Kächele
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  2. T. Seufferlein
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  4. H. J. Brambs
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  6. S. Pauls
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Correspondence to V. Kächele.

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Kächele, V., Seufferlein, T., Adler, G. et al. Diagnostik beim Pankreaskarzinom. Onkologe 10, 1276–1284 (2004). https://doi.org/10.1007/s00761-004-0795-z

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