Early detection of pancreatic cancer

Abstract

The diagnosis of pancreatic cancer associates an appalling significance. Detection of preinvasive stage of pancreatic cancer will ameliorate the survival of this deadly disease. Premalignant lesions such as Intraductal Papillary Mucinous Neoplasms or Mucinous Cystic Neoplasms of the pancreas are detectable on imaging exams and this permits their management prior their invasive development. Pancreatic intraepithelial neoplasms (PanIN) are the most frequent precursors of pancreatic adenocarcinoma (PDAC), and its particular type PanIN high-grade represents the malignant non-invasive form of PDAC. Unfortunately, PanINs are not detectable on radiologic exams. Nevertheless, they can associate indirect imaging signs which would rise the diagnostic suspicion. When this suspicion is established, the patient will be enrolled in a follow-up strategy that includes performing of blood test and serial imaging test such as computed tomography or magnetic resonance imaging, which will cost in the best-case scenario a burden of healthcare systems, and potential mortality in the worst-case scenario when the patient underwent resection surgery, worthless when there is no moderate or high grade dysplasia in the final histopathology. This issue will be avoid having at its disposal a diagnostic technique capable of detecting high-grade PanIN lesions, such is the cytology of pancreatic juice obtained by nasopancreatic intubation. Herein, we review the possibility of detection of early malignant lesions before they become invasive PADC.

Keywords: Early pancreatic cancer; Pancreatic adenocarcinoma precursor lesions; Pancreatic juice analysis; PanIN; High-grade pancreatic intraepithelial neoplasm; Magnetic resonance cholangiopancreatography

Core Tip: High-grade pancreatic intraepithelial neoplasia can be diagnosed by cytology of pancreatic juice before they become invasive carcinoma. Candidates to this diagnostic procedure are patients with disturbed anatomy in pancreatic imaging without evident tumor such as segmental atrophy of parenchyma, main pancreatic duct (MPD) stenosis/dilatation, focal blurred MPD or local parenchymal fatty changes.