Atsushi Kanno1, Atsushi Masamune2, Keiji Hanada3, Hiroyuki Maguchi4, Yasuhiro Shimizu5, Toshiharu Ueki6, Osamu Hasebe7, Takao Ohtsuka8, Masafumi Nakamura8, Mamoru Takenaka9, Masayuki Kitano10, Masataka Kikuyama11, Toshifumi Gabata12, Koji Yoshida13, Tamito Sasaki14, Masahiro Serikawa15, Toru Furukawa16, Akio Yanagisawa17, Tooru Shimosegawa2. 1. Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan. Electronic address: atsushih@med.tohoku.ac.jp. 2. Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan. 3. Department of Gastroenterology, JA Onomichi General Hospital, Japan. 4. Center for Gastroenterology, Teine-Keijinkai Hospital, Japan. 5. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Japan. 6. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Japan. 7. Department of Gastroenterology, Nagano Municipal Hospital, Japan. 8. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan. 9. Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Japan. 10. Second Department of Internal Medicine, Wakayama Medical University, School of Medicine, Japan. 11. Division of Gastroenterology, Shizuoka General Hospital, Japan. 12. Department of Radiology, Kanazawa University Hospital, Japan. 13. Department of Interventional Bilio-Pancreatology, Kawasaki Medical School, Japan. 14. Department of Gastroenterology, Hiroshima Prefectural Hospital, Japan. 15. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Japan. 16. Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Japan; Department of Histopathology, Tohoku University, Graduate School of Medicine, Japan. 17. Department of Pathology, Kyoto Prefectural University of Medicine, Japan.
Abstract
BACKGROUND/ OBJECTIVES: The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. METHODS: We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. RESULTS: Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. CONCLUSIONS: This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
BACKGROUND/ OBJECTIVES: The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. METHODS: We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. RESULTS: Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. CONCLUSIONS: This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
Authors: Mohamed M Gad; Mihnea-Alexandru Găman; Anas M Saad; Muneer J Al-Husseini; Omar A Shehata; Mohannad Abou Saleh; Alfred D Nelson; Carlos Roberto Simons-Linares Journal: Ann Gastroenterol Date: 2020-02-12
Authors: Esther Llop; Pedro E Guerrero; Adrià Duran; Sílvia Barrabés; Anna Massaguer; María José Ferri; Maite Albiol-Quer; Rafael de Llorens; Rosa Peracaula Journal: World J Gastroenterol Date: 2018-06-28 Impact factor: 5.742