Diagnostic Method Advancement to Improve the Prognosis of Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and early diagnosis is essential for improving patient outcomes. Conventional imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) have limitations in detecting small PDAC. Endoscopic ultrasonography (EUS) is useful for identifying small lesions; however, even small PDAC can be invasive and may metastasize, resulting in Stage IV disease. The most effective way to improve the prognosis of PDAC is to diagnose lesions confined to the ductal epithelium, such as high-grade pancreatic intraepithelial neoplasia (HG-PanIN) or carcinoma in situ (CIS). Identifying focal pancreatic parenchymal atrophy (FPPA) on CT or MRI may suggest the presence of HG-PanIN/CIS and prompt further evaluation using serial pancreatic juice aspiration cytologic examination (SPACE). Recognizing FPPA and performing SPACE enables the diagnosis of PDAC at Stage 0 (HG-PanIN/CIS), which can lead to improved prognosis.