Abstract
Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor prognosis, with a high mortality rate often attributed to its late-stage diagnosis. Early detection remains paramount in improving survival outcomes for affected individuals. Summary: The prognosis of PDAC can be significantly improved if the cancer is diagnosed at an early stage, specifically when it remains localized to the ductal epithelium. This early stage is commonly referred to as high-grade pancreatic intraepithelial neoplasia (HG-PanIN) or carcinoma in situ (CIS, stage 0). At this stage, metastasis has not yet occurred, offering the potential for more effective therapeutic interventions. Focal pancreatic parenchymal atrophy (FPPA) has emerged as a crucial radiological and pathological feature suggestive of HG-PanIN/CIS. Key Message: Accurate identification of FPPA is critical for diagnosing HG-PanIN and CIS, both of which represent preinvasive stages of PDAC. Given the implications of early detection, serial pancreatic juice cytologic examination is recommended for patients exhibiting FPPA to facilitate timely diagnosis and intervention.
Plain Language Summary
Pancreatic cancer, specifically pancreatic ductal adenocarcinoma (PDAC), is difficult to diagnose early and has a markedly low survival rate. Most people diagnosed with PDAC have a survival rate of just 5–8% over 5 years. A significant challenge in treating PDAC is that it is hard to detect in its early stages. The cancer often begins as precancerous lesions that are not easy to see using current diagnostic tools. The goal is to find ways to detect these early stages before the cancer spreads. Current methods for diagnosing PDAC, such as ultrasound, computed tomography scans, and magnetic resonance imaging, have limitations, especially when the tumors are small. Endoscopic ultrasound is better for detecting small tumors but is not always enough on its own to make a diagnosis. Researchers are exploring new ways to identify early-stage PDAC using changes in the pancreas, such as a condition called focal pancreatic parenchymal atrophy (FPPA). FPPA is a condition where part of the pancreas shrinks and may signal the presence of precancerous lesions or early cancer. In this review, FPPA is shown to be an important indicator for early-stage PDAC. By closely monitoring FPPA, physicians may be able to detect PDAC earlier, potentially improving survival rates. When FPPA is present, especially if it grows larger, further tests, such as pancreatic juice cytology, are recommended to check for early cancer changes. Overall, FPPA could serve as a valuable tool for detecting PDAC early, especially in high-risk patients.
