Imaging Modalities for Early Detection of Pancreatic Cancer: Current State and Future Research Opportunities

Abstract

Pancreatic cancer, one of the most lethal malignancies, is increasing in incidence. While survival rates for many cancers have improved dramatically over the last 20 years, people with pancreatic cancer have persistently poor outcomes. Potential cure for pancreatic cancer involves surgical resection and adjuvant therapy. However, approximately 85% of patients diagnosed with pancreatic cancer are not suitable for potentially curative therapy due to locally advanced or metastatic disease stage. Because of this stark survival contrast, any improvement in early detection would likely significantly improve survival of patients with pancreatic cancer through earlier intervention. This comprehensive scoping review describes the current evidence on groups at high risk for developing pancreatic cancer, including individuals with inherited predisposition, pancreatic cystic lesions, diabetes, and pancreatitis. We review the current roles of imaging modalities focusing on early detection of pancreatic cancer. Additionally, we propose the use of advanced imaging modalities to identify early, potentially curable pancreatic cancer in high-risk cohorts. We discuss innovative imaging techniques for early detection of pancreatic cancer, but its widespread application requires further investigation and potentially a combination with other non-invasive biomarkers.

Keywords: MRI; early detection; pancreatic cancer; pancreatic cystic lesions; pancreatic ductal adenocarcinoma; radiomics; screening.

Figure 1

Transformation in IPNM on MRI and CT. From left to right- Diffusion weighted imaging, T2, post contrast T1 and CT images in the same patient. Top row shows a simple cystic lesion consistent with a side branch IPMN, showing no malignant features. Bottom row shows a cystic lesion displaying solid enhancing components with restricted diffusion, consistent with malignant degeneration within an IMPN. Arrows indicate cystic component with no cancer (top), and with cancer (bottom).

Figure 2

Characteristics of pancreatic cystic lesion types and their key differences. IPMN= intraductal papillary mucinous neoplasms; MCN= mucinous cystic neoplasms.