Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association.
ABSTRACT Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed. A consensus statement describing a standardized reporting template authored by a multi-institutional group of experts in pancreatic ductal adenocarcinoma that included radiologists, gastroenterologists, and hepatopancreatobiliary surgeons was developed under the joint sponsorship of the Society of Abdominal Radiologists and the American Pancreatic Association. Adoption of this standardized imaging reporting template should improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, and accurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. Standardization can also help to facilitate research and clinical trial design by using appropriate and consistent staging by means of resectability status, thus allowing for comparison of results among different institutions. © RSNA and the AGA Institute, 2014 Online supplemental material is available for this article.
- SourceAvailable from: Peter Muscarella
Article: Pancreatic adenocarcinoma.[Show abstract] [Hide abstract]
ABSTRACT: Overview An estimated 36,800 people will die of pancreatic cancer in the United States in 2010.1 This disease is the fourth most common cause of cancer-related death among men and women in the United States.(1) Its peak incidence occurs in the seventh and eighth decades of life. Although incidence is roughly equal for the sexes, African Americans seem to have a higher incidence of pancreatic cancer than white Americans.(2) These guidelines only discuss tumors of the exocrine pancreas; neuroendocrine tumors are not included. By definition, these NCCN Guidelines cannot incorporate all possible clinical variations and are not intended to replace good clinical judgment or individualization of treatments. Exceptions to the rule were discussed among the panel members during development of these guidelines. A 5% rule (omitting clinical scenarios that constitute fewer than 5% of all cases) was used to eliminate uncommon clinical occurrences or conditions from these guidelines. The panel unanimously endorses participation in a clinical trial as the preferred option over standard or accepted therapy. Risk Factors and Genetic Predisposition Although the associated increase in risk is small, the development of pancreatic cancer is firmly linked to cigarette smoking.(3-5) Some evidence shows that increased consumption of red meat and dairy products is associated with an elevation in pancreatic cancer risk,(6) although other studies have failed to identify dietary risk factors.(4) An increased body mass index is also associated with increased risk.(7-9) Occupational exposure to chemicals, such as beta-naphthylamine and benzidine, is also associated with an increased risk of pancreatic...Journal of the National Comprehensive Cancer Network: JNCCN 10/2010; 8(9):972-1017. · 4.24 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To retrospectively determine the frequency, clinical and pathologic characteristics, and computed tomographic (CT) findings of visually isoattenuating pancreatic adenocarcinomas and to investigate the utility of magnetic resonance (MR) imaging and positron emission tomography (PET)/CT for detecting them. Institutional review board approval was obtained. Patient informed consent was waived. Of 743 consecutive patients with pathologically proved pancreatic cancer, 644 patients (392 men, 252 women; mean age, 60 years ± 9.5 [standard deviation]) who had undergone both arterial and portal phase contrast material-enhanced CT were included. Visually isoattenuating pancreatic adenocarcinoma was defined as lesion isoattenuation in both scan phases. Serum levels of carbohydrate antigen 19-9, immunoglobulin G (IgG), and IgG fraction 4 (IgG4), survival after curative-intent surgery; and pathologic findings of visually isoattenuating pancreatic adenocarcinomas were analyzed. CT findings of visually isoattenuating pancreatic adenocarcinomas and the sensitivity of MR imaging and PET/CT for detecting them were determined. The frequency of visually isoattenuating pancreatic adenocarcinomas among pancreatic cancers was 5.4% (35 of 644). Serum levels of carbohydrate antigen 19-9, IgG, and IgG4 were elevated in 51.5% (17 of 33), 8.3% (one of 12), and 8.3% (one of 12) of patients, respectively. Visually isoattenuating pancreatic adenocarcinoma, compared with usual pancreatic adenocarcinoma, was independently associated with a better survival after curative-intent surgery: Adjusted hazard ratio was 0.430 (P = .006). Thirty surgically resected visually isoattenuating pancreatic adenocarcinomas were 1.5-4 cm (median, 3 cm). Their pathologic findings differed from those of usual pancreatic adenocarcinomas: lower tumor cellularity, more frequent intratumoral acinar tissue and islet cells, and less prominent tumor necrosis. Visually isoattenuating pancreatic adenocarcinomas showed various abnormalities at CT, which may suggest an isoattenuating mass or nodule. Sensitivities of MR imaging and PET/CT were 79.2% (19 of 24) and 73.7% (14 of 19), respectively. Visually isoattenuating pancreatic adenocarcinoma represents a small but meaningful subset of pancreatic cancer and has characteristic clinical and pathologic features. MR imaging and PET/CT may be useful as subsequent examinations when the patient is suspected of having the lesion at CT.Radiology 10/2010; 257(1):87-96. · 6.21 Impact Factor
Article: Pancreatic cancer.[Show abstract] [Hide abstract]
ABSTRACT: Substantial progress has been made in our understanding of the biology of pancreatic cancer, and advances in patients' management have also taken place. Evidence is beginning to show that screening first-degree relatives of individuals with several family members affected by pancreatic cancer can identify non-invasive precursors of this malignant disease. The incidence of and number of deaths caused by pancreatic tumours have been gradually rising, even as incidence and mortality of other common cancers have been declining. Despite developments in detection and management of pancreatic cancer, only about 4% of patients will live 5 years after diagnosis. Survival is better for those with malignant disease localised to the pancreas, because surgical resection at present offers the only chance of cure. Unfortunately, 80-85% of patients present with advanced unresectable disease. Furthermore, pancreatic cancer responds poorly to most chemotherapeutic agents. Hence, we need to understand the biological mechanisms that contribute to development and progression of pancreatic tumours. In this Seminar we will discuss the most common and deadly form of pancreatic cancer, pancreatic ductal adenocarcinoma.The Lancet 05/2011; 378(9791):607-20. · 39.21 Impact Factor