Detecting circulating tumor material and digital pathology imaging during pancreatic cancer progression

Table 1 Summary of demonstrated clinical uses for digital pathology, circulating tumor cells and extracellular vesicles for pancreatic cancer

	Digital pathology	CTCs	EVs
Screening in population	Relies on invasive biopsies	Detection of KRAS mutations[92]	Early detection possibility (GPC1+ EVs)[117]
			GPC1+ EVs detected in IPMNs[117]
Diagnosis	Differential diagnosis of mucinous cancers[62]	Pancreatic CTC detected by ISET[82] and CellSearch[81]	EVs express mutated KRAS and p53 in PDAC serum[123] EVs detected in pancreaticobiliary cancers[124]
Staging	Early stage detection in mice[60] Distinguish Grade I/II in humans[61]	(C-MET, CK20, CEA) + CTCs elevated in late stages[96]	miR-17-5p in serum exosomes correlates with stage[128]
Prognosis	Potential	CTC positivity has prognostic value in locally advanced pancreatic cancer[81] CK20 expression in CTC indicates shorter overall survival[94]	Potential
Monitor treatment	Potential	CTC levels decrease during 5-FU therapy[91]	Potential
Drug sensitivity/ pharmacokinetics	CT scans can predict drug transport[35]	CTC apoptosis can be detected after 5-FU therapy[91]	Demonstrated for breast cancer[111]
Monitor recurrence	Potential	CTC positivity correlates with postoperative staging[94-97]	potential

EVs: Extracellular vesicles; CTCs: Circulating tumor cells; 5-FU: 5-Fluorouracil; PDAC: Pancreatic ductal adenocarcinoma; CT: Computed tomography; PDAC: Pancreatic ductal adenocarcinoma; CEA: Carcino-embryonic antigen.