From the Guidelines
The diagnostic workup for pancreatic cancer should begin with a contrast-enhanced CT scan of the abdomen and pelvis, followed by additional tests such as MRI, EUS, and laboratory tests as needed, with tissue diagnosis obtained via EUS-guided biopsy, CT-guided percutaneous biopsy, or during surgical exploration. The workup for pancreatic cancer is crucial for determining the extent of the disease and guiding treatment decisions. According to the study by 1, a pathologic diagnosis of adenocarcinoma of the pancreas is most frequently made using fine-needle aspiration (FNA) biopsy with either EUS guidance or CT.
Key Components of the Diagnostic Workup
- Imaging studies:
- Contrast-enhanced CT scan of the abdomen and pelvis
- MRI as an alternative or complement to CT
- EUS for visualizing small tumors and obtaining tissue samples
- Laboratory tests:
- Liver function tests
- CA 19-9 tumor marker
- Complete blood count
- Tissue diagnosis:
- EUS-guided biopsy
- CT-guided percutaneous biopsy
- Surgical exploration The study by 1 highlights the importance of staging and risk assessment in pancreatic cancer, with CA 19-9 levels correlated to the level of bilirubin and any cause of cholestasis.
Staging and Risk Assessment
- CA 19-9 levels: correlated to the level of bilirubin and any cause of cholestasis
- Imaging work-up: determines the tumor size and precise burden, as well as arterial and venous local involvement
- EUS: valuable for detecting vascular invasion and predicting resectability The study by 1 discusses the role of CT in diagnosing and staging pancreatic cancer, with triphasic CT protocol allowing for selective visualization of important arterial and venous structures.
Role of CT in Diagnosing and Staging
- Triphasic CT protocol: allows for selective visualization of important arterial and venous structures
- CT imaging: primary means of staging pancreatic cancer
- Software for 3-dimensional reconstruction of CT data: provides additional valuable information on the anatomic relationship between the pancreatic tumor and surrounding blood vessels and organs. A multidisciplinary team approach involving gastroenterologists, oncologists, radiologists, and surgeons is crucial for optimal management of pancreatic cancer, as emphasized by the studies 1.
From the Research
Diagnostic Workup for Pancreatic Cancer
The diagnostic workup for pancreatic cancer involves several procedures to detect and stage the disease. The following are some of the key procedures used:
- Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) biopsy: This procedure is considered the gold standard for tissue diagnosis of pancreatic cancer 2, 3, 4.
- Computed tomography (CT) scans: CT scans are used to evaluate the extent of the disease and to assess for metastasis 5, 6.
- Magnetic resonance imaging (MRI): MRI can be used to evaluate the pancreas and surrounding tissues, but it is not as commonly used as CT scans.
- Serum tumor markers: Serum tumor markers such as CA 19-9 can be used to support a diagnosis of pancreatic cancer, but they are not specific and can be elevated in other conditions 6.
- Endoscopic retrograde cholangiopancreatography (ERCP): ERCP can be used to visualize the pancreatic duct and to obtain tissue samples, but it is not as commonly used as EUS with FNA biopsy 3, 5.
Staging of Pancreatic Cancer
The staging of pancreatic cancer involves evaluating the extent of the disease and assessing for metastasis. The following are some of the key factors used to stage pancreatic cancer:
- Tumor size and location: The size and location of the tumor are important factors in determining the stage of the disease 4.
- Lymph node involvement: The presence or absence of lymph node involvement is an important factor in determining the stage of the disease 2, 4.
- Metastasis: The presence or absence of metastasis is an important factor in determining the stage of the disease 5, 6.
- Vascular involvement: The presence or absence of vascular involvement is an important factor in determining the stage of the disease 2.
Accuracy of Diagnostic Procedures
The accuracy of diagnostic procedures for pancreatic cancer varies. The following are some of the key findings:
- EUS with FNA biopsy: EUS with FNA biopsy has a high sensitivity and specificity for diagnosing pancreatic cancer, with a sensitivity of 94% and a negative predictive value of 82% 4.
- CT scans: CT scans have a sensitivity of 77.8% and a specificity of 86.7% for diagnosing pancreatic cancer 5.
- Serum tumor markers: Serum tumor markers such as CA 19-9 have a sensitivity of 90% and a specificity of 69% for diagnosing pancreatic cancer 6.