Pancreatic cancer diagnostic study of choice

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## Overview

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The diagnostic study of choice for pancreatic cancer is the dynamic spiral CT scan with contrast media (oral and IV) enhancement. Findings on CT scan that may be suggestive of pancreatic cancer include morphological changes of the gland, destruction of the peripancreatic fat and loss of the sharp margins with surrounding structures, involvement of the regional lymph nodes and adjacent vasculature, pancreatic ductal dilatation, pancreatic atrophy and obstruction of the common bile duct . CT scan is also used for the staging of pancreatic cancer.

## Diagnostic Study of Choice

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### Gold standard/Study of choice:

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* The dynamic spiral CT scan with contrast media(oral and IV) enhancement is the gold standard test for the diagnosis and staging of pancreatic cancer.

* The following result of CT scan is confirmatory of pancreatic cancer: [1][2][3][4][5]

*     * Morphological changes of the gland
* Destruction of the peripancreatic fat and loss of the sharp margins with surrounding structures
* Involvement of the regional lymph nodes and adjacent vasculature
* Pancreatic ductal dilatation
* Pancreatic atrophy
* Obstruction of the common bile duct (CBD)
* MDCT (Multi-detector row computed tomography) the imaging modality widely used in suspected pancreatic cancer patients as the pre-operative examination. [6]
* MDCT is used as the primary imaging modality, and is used in conjunction with PET/CT. MDCT helps in local and distant disease assessment in a single scan. [7]
* MDCT is useful in the evaluation of vascular involvement, which helps in predicting the tumor resectability.[6]

By Hellerhoff (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

## References

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1. ↑ Horwhat JD, Gerke H, Acosta RD, Pavey DA, Jowell PS (2009). "Focal or diffuse "fullness" of the pancreas on CT. Usually benign, but EUS plus/minus FNA is warranted to identify malignancy". JOP. 10 (1): 37–42. PMID 19129613.CS1 maint: Multiple names: authors list (link)
2. ↑ Freeny PC, Marks WM, Ryan JA, Traverso LW (1988). "Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT". Radiology. 166 (1 Pt 1): 125–33. doi:10.1148/radiology.166.1.2827228. PMID 2827228.CS1 maint: Multiple names: authors list (link)
3. ↑ Karasawa E, Goldberg HI, Moss AA, Federle MP, London SS (1983). "CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis". Radiology. 148 (2): 489–93. doi:10.1148/radiology.148.2.6867347. PMID 6867347.CS1 maint: Multiple names: authors list (link)
4. ↑ Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS (1997). "The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery". AJR Am J Roentgenol. 168 (4): 971–7. doi:10.2214/ajr.168.4.9124153. PMID 9124153.CS1 maint: Multiple names: authors list (link)
5. ↑ Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R; et al. (2013). "Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence". Pancreas. 42 (1): 11–9. doi:10.1097/MPA.0b013e3182550d77. PMID 22699206.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ 6.0 6.1 Lee ES, Lee JM (2014). "Imaging diagnosis of pancreatic cancer: a state-of-the-art review". World J Gastroenterol. 20 (24): 7864–77. doi:10.3748/wjg.v20.i24.7864. PMC 4069314. PMID 24976723.
7. ↑ Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB (2007). "Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT". Radiographics. 27 (6): 1653–66. doi:10.1148/rg.276075034. PMID 18025509.CS1 maint: Multiple names: authors list (link)

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