Updates on Imaging Assessment of Pancreatic Cancer for Determining Anatomic and Biologic Resectability

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy.
• Imaging is crucial for PDAC diagnosis, staging, and treatment planning.
• Current treatment strategies are guided by tumor stage and resectability, primarily assessed through imaging.

Purpose of the Study:

• To provide an updated overview of imaging techniques for PDAC.
• To discuss anatomical resectability assessments and their limitations.
• To explore biological and conditional factors for refined PDAC risk stratification.

Main Methods:

• Review of current imaging modalities including CT, MRI, and PET/CT.
• Analysis of anatomical factors determining resectability (tumor-vessel contact).
• Evaluation of biological markers (CA19-9, imaging phenotype, lymph node status, metabolic activity) and their role.

Main Results:

• Anatomical resectability alone has limitations; an expanded concept including biological and host factors is emerging.
• Radiological restaging after neoadjuvant therapy (NAT) is challenging due to difficulties differentiating viable tumor from fibrosis.
• Biological factors may offer incremental value in assessing treatment response post-NAT.

Conclusions:

• Refined risk stratification in PDAC requires integrating anatomical, biological, and conditional factors.
• Addressing challenges in post-NAT restaging is critical for optimizing patient management.
• Further research into biomarkers for treatment response assessment is warranted.