State of the Art Diagnosis of Pancreatic Ductal Adenocarcinoma

Abstract

Purpose of Review

In this article, we review the ductal pancreatic adenocarcinoma, which is by far the most common solid tumor within the pancreas. We emphasize on the diagnosis and differential diagnoses of this tumor and discuss different imaging modalities.

Recent Findings

Recently major progress has been made in distinguishing different subtypes of tumors using immunolabeling and more recently genetic sequencing, which though is not the main purpose of this article. Because of the wide availability of modern medical imaging techniques, detection of precursor lesions and tumors in pancreatitis are increasingly discovered.

Summary

A large number of different lesions can mimic pancreatic adenocarcinomas. The most important differential diagnoses are anatomical variants, peripancreatic structures or tumors, rarer primary solid pancreatic tumors, cystic tumors, metastases or different variants of pancreatitis. Several precursor lesions can also be differentiated. The correct diagnosis of these precursor lesions and their differential diagnosis are vital, because the therapy of a PDCA is often invasive and requires careful planning. All major imaging techniques are suitable for pancreas imaging. Generally sonography of the abdomen will be the baseline diagnostic tool. In nearly all cases further examinations are required, especially CT, MRI plus MRCP, endosonography, possibly with additional ERCP and the ability for direct biopsy and PET-CT as a molecular imaging tool. In many cases different imaging techniques have to be combined depending on the specific question.

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