What diagnostic tests are used to diagnose pancreatic cancer?

From the Guidelines

To diagnose pancreatic cancer, imaging tests and biopsies are essential.

Diagnostic Tests

The following tests are recommended:

• Imaging tests:
  • Computed Tomography (CT) scan with contrast 1
  • Magnetic Resonance Imaging (MRI) combined with MRCP 1
  • Abdominal ultrasound for initial examination 1
• Endoscopic Ultrasound (EUS): to obtain images of the pancreas and collect tissue samples for biopsy 1
• Endoscopic Retrograde Cholangiopancreatography (ERCP): to visualize the bile and pancreatic ducts, but its role is limited to relieving bile duct obstruction 1
• Blood tests:
  • Cancer Antigen 19-9 (CA 19-9) to detect tumor markers and guide treatment decisions 1
• Biopsy:
  • Fine-needle aspiration (FNA) biopsy with EUS guidance (preferred) or CT guidance 1
  • Core needle biopsy for additional staging information and to determine malignancy 1 It is essential to consult a healthcare professional for a comprehensive evaluation and to determine the most appropriate diagnostic approach.

Important Considerations

• A pathologic diagnosis is not required before surgery, but it is necessary before administration of neoadjuvant therapy and for patients staged with locally advanced, unresectable pancreatic cancer or metastatic disease 1
• EUS-FNA is preferable to CT-guided FNA in patients with resectable disease because of increased diagnostic yield, safety, and a potential lower risk of peritoneal seeding 1

From the Research

Diagnostic Tests for Pancreatic Cancer

The following diagnostic tests are used to diagnose pancreatic cancer:

• Imaging techniques:
  • Computed Tomography (CT) scan: highly sensitive in detecting pancreatic cancer, with a sensitivity of up to 96% 2
  • Magnetic Resonance Cholangiopancreatography (MRCP): a second-line modality for suspected pancreatic cancer, with a sensitivity of up to 93.5% 2
  • Ultrasound: often used as the first modality to identify a cause of abdominal pain or jaundice, with a sensitivity of 74% 3
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): provides a 92% sensitivity in detecting pancreatic carcinoma 3
  • Endoscopic Ultrasound (EUS): superior to spiral CT and MRI in detecting small tumors, with a high sensitivity in localizing lymph node metastases or vascular tumor infiltration 4
• Tumor markers:
  • Carbohydrate Antigen 19-9 (CA 19-9): a serum tumor marker with a sensitivity of 83% in detecting pancreatic carcinoma, but limited specificity 3, 5
  • Other tumor markers: such as carcinoembryonic antigen, with lower sensitivities compared to CA 19-9 3
• Biopsy:
  • Fine-needle biopsy: allows diagnosis of pancreatic carcinoma with a sensitivity of 83% and a specificity of 99% 3
  • Endoscopic Ultrasound-guided Fine-needle Aspiration (EUS-FNA): considered the golden standard for pancreatic cancer diagnosis 5
• Other diagnostic methods:
  • Liquid biopsy: involving circulating tumor cells, circulating tumor DNA, microRNAs, and exosomes in blood, and biomarkers in urine and saliva, with promising prospects for early diagnosis 5
  • Artificial intelligence, computer-aided diagnosis system, metabolomics technology, ion mobility spectrometry (IMS) associated technologies, and novel nanomaterials: innovative technologies being tested for early diagnosis of pancreatic cancer 5