Löhr J-Matthias, Vujasinovic Miroslav, Kartalis Nikolaos, Osten Philipp
Karolinska Institute, Stockholm, Sweden.
Department of Medicine, Karolinska Institute, Stockholm, Sweden.
eGastroenterology. 2024 Sep 9;2(3):e100082. doi: 10.1136/egastro-2024-100082. eCollection 2024 Sep.
This report provides an overview of the most common diagnostic methods that bring to light incidental findings of pancreatic cancer. It reviews the impact of medical imaging and genetic assessment on the definitions of incidental findings and incidentaloma of the pancreas. For different diagnostic approaches (eg, MRI and CT) and for different affections (cysts/intraductal papillary mucinous neoplasia, solid lesions), specific guidelines have been proposed and some are established. Based on this, we summarise the differences between the traditional methods with those applied in the PANCAID project. Biomarkers, genetic predispositions, mutations and circulating tumour cells give rise to different levels of concern. The final part of the report discusses the risks and the opportunities associated with further diagnostic procedures and surgical interventions. From the ethical perspective, the most urging question is, can a screening based on liquid biopsy and blood samples open a gateway for the prevention of pancreatic cancer-even if morbidity and lethality of today's surgical interventions is still very high?
本报告概述了揭示胰腺癌偶然发现的最常见诊断方法。它回顾了医学成像和基因评估对胰腺偶然发现和偶然瘤定义的影响。针对不同的诊断方法（如MRI和CT）以及不同的病变（囊肿/导管内乳头状黏液性肿瘤、实性病变），已经提出了一些具体指南，其中一些已经确立。基于此，我们总结了传统方法与在PANCAID项目中应用的方法之间的差异。生物标志物、遗传易感性、突变和循环肿瘤细胞引发了不同程度的关注。报告的最后一部分讨论了进一步诊断程序和手术干预相关的风险和机遇。从伦理角度来看，最紧迫的问题是，基于液体活检和血样的筛查能否为预防胰腺癌打开一扇大门——即使当今手术干预的发病率和致死率仍然很高？
