Current Status and Perspective of Diagnosis for Pancreatic Diseases – Significance of Pancreatic Disease Screening

Abstract

 The majority of patients with pancreatic ductal adenocarcinoma (PDAC) which accounts for 90% of pancreatic cancer presents a poor prognosis due to advance stage with low resection rate. Since early-stage PDAC has prolonged survival rates, the goal remains early detection and accurate diagnosis. Pancreatic examination is recommended for individuals with risk factors for PDAC such as family history, smoking, heavy drinking, diabetes, obesity, chronic pancreatitis, intraductal papillary mucinous neoplasm (IPMN) and pancreatic cyst. Endoscopic ultrasonography (EUS) is useful for high detection rate of small pancreatic lesion due to its high resolution without artifact by gastrointestinal tract gas. MRI plus MRCP can estimate both pancreatic parenchyma and the pancreatic duct. Recently, focal pancreatic parenchymal atrophy or fatty change suggests specific findings of early PDAC. In cases of suspected malignancy, a histological evaluation such as EUS-guided tissue aquation (EUS-TA) or ERCP-guided pancreatic juice cytology plays an important role. Cystic neoplasm of the pancreas includes IPMN, mucinous cystic neoplasm (MCN), serous neoplasm (SN), and so on. IPMN has the potential for malignant transformation to PDAC. Combination of MRCP and EUS is assumed to be useful for pancreatic disease screening. Further large population study is necessary for establishment of its significance.