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Moderne Pankreasdiagnostik bei Tumorverdacht

Modern diagnostics for suspected pancreatic tumors

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die vorliegende Übersichtsarbeit Tumorverdacht konzentriert sich im Wesentlichen auf das maligne duktale Adenokarzinom des Pankreaskopfes. Männer sind von der Erkrankung häufiger betroffen als Frauen (Verhältnis ca. 2:1). Die Inzidenz liegt bei ca. 10–15 Erkrankungsfälle pro 100.000 Einwohner in Deutschland. Die Häufigkeit ist insgesamt steigend. Die einzig potenziell kurative Therapie des Adenokarzinoms des Pankreas ist die chirurgische R0-Resektion. Zurzeit sind jedoch nur ca. 20 % aller Patienten zum Zeitpunkt der Diagnosestellung potenziell kurativ resektabel und auch nach erfolgreicher Resektion ist das Langzeitüberleben über 5 Jahre mit ca. 20 % ernüchternd schlecht. Insgesamt überleben nur 5 % aller Patienten mit der Diagnose Pankreaskarzinom 5 Jahre. Deshalb ist es eine besondere Herausforderung, die Diagnose frühzeitig zu stellen. Gleichzeitig stellt die Differenzialdiagnostik bei Patienten mit vorbestehender chronischer Pankreatitis eine besondere Schwierigkeit der Diagnostik dar, insbesondere weil auch bei diesen Patienten regelmäßig ebenfalls eine Vergrößerung des Pankreaskopfes vorliegt. Eine dritte zentrale Fragestellung ist die nach der chirurgischen Resektabilität. In diesem Beitrag werden die technischen Grundlagen der hauptsächlich genutzten diagnostischen Werkzeuge EUS, CT, MRT und PET/CT beschrieben sowie ihre Vorzüge und Limitationen gegeneinander abgewogen.

Abstract

This review on suspected tumors essentially focuses on malignant ductal adenocarcinoma of the head of the pancreas. Men are more often affected than women (ratio 2:1). The incidence in Germany is approximately 10-15 cases per 100,000 inhabitants and is generally increasing. The only potentially curative therapy for adenocarcinoma of the pancreas is surgical R0 resection; however, currently only approximately 20 % of patients are potentially resectable at the time of diagnosis and even after successful resection the long-term 5-year survival of approximately 20 % is soberingly poor. In total only 5 % of patients with the diagnosis of pancreatic cancer survive longer than 5 years. It is therefore a special challenge to make an early diagnosis. Likewise, the differential diagnosis of patients with pre-existing chronic pancreatitis is a special difficulty in the diagnostics because these patients very often also have an enlarged pancreas head. A third core question is the surgical resectability. This article describes the technical principles of the most commonly used diagnostic tools endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT and elucidates their advantages and limitations.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Layer, E.S. Fuchs und J. Hoffend geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universität Mainz, Bremserstr. 79, 67063, Ludwigshafen, Deutschland

    G. Layer & J. Hoffend

  2. Medizinische Klinik C, Gastroenterologie, Hepatologie und Diabetologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universität Mainz, Ludwigshafen, Deutschland

    E.S. Fuchs

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  1. G. Layer
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Layer, G., Fuchs, E. & Hoffend, J. Moderne Pankreasdiagnostik bei Tumorverdacht. Gastroenterologe 9, 21–30 (2014). https://doi.org/10.1007/s11377-013-0820-0

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