Pancreatic cancer: current concepts in imaging for diagnosis and staging

Because of its late clinical presentation, pancreatic cancer remains the fourth most common cause of cancer death. Surgery is the only option for cure, and advancements in surgical technique and neoadjuvant therapy have the potential to increase the number of patients who could undergo surgery for potential cure. Accurate diagnosis and staging of pancreatic ductal carcinoma are therefore of great importance. This paper reviews the state of the art for such diagnostic modalities as computed tomography, magnetic resonance imaging, endoscopic ultrasound, positron emission tomography, and laparoscopic surgery and laparoscopic ultrasound for diagnosis and staging of pancreatic cancer. Currently, accurate diagnosis and staging probably require the use of a combination of techniques, including multiphase helical or multidetector computed tomography and/or dynamically enhanced magnetic resonance imaging with endoscopic ultrasound with fine-needle aspiration. The role of positron emission tomography still needs to be determined. The role of laparoscopic surgery and laparoscopic ultrasound may be limited in those institutions with state-of-the-art imaging techniques.