Letter to the Editor Open Access
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Mar 28, 2025; 17(3): 104818
Published online Mar 28, 2025. doi: 10.4329/wjr.v17.i3.104818
Enhancing diagnostic frameworks in pancreatic cancer imaging: A critical appraisal
Galip Dogukan Dogru, Ahmet Oguz Tugcu, Department of Radiation Oncology, Gulhane Training and Research Hospital, Ankara 06010, Türkiye
Cemal Ugur Dursun, Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul 34865, Türkiye
ORCID number: Galip Dogukan Dogru (0000-0002-4906-8087); Ahmet Oguz Tugcu (0000-0001-6229-9405); Cemal Ugur Dursun (0000-0001-6095-3506).
Author contributions: All authors contributed to this letter to the editor; Dogru GD conceptualized the letter, drafted the manuscript, and approved the final version for publication; Tugcu AO contributed to the writing process, critically revised the content, and approved the final version; Dursun CU reviewed the relevant literature, supported manuscript preparation, and approved the submitted version; all authors have read and approved the final version of this letter.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Galip Dogukan Dogru, MD, Department of Radiation Oncology, Gulhane Training and Research Hospital, General Dr. Tevfik Sağlam Street No. 1 Etlik, Ankara 06010, Türkiye. dogukandogru.95@gmail.com
Received: January 7, 2025
Revised: March 4, 2025
Accepted: March 20, 2025
Published online: March 28, 2025
Processing time: 79 Days and 14.9 Hours

Abstract

This letter to the editor critically appraises the study by Luo et al. While the study provides valuable insights into imaging-pathology correlations in pancreatic cancer, we identify several opportunities for enhancing its clinical relevance. Notably, the exclusion of magnetic resonance cholangiopancreatography and positron emission tomography/computed tomography imaging limits the study’s diagnostic scope, as these modalities offer superior capabilities in differentiating benign from malignant lesions and assessing metabolic tumor activity. Additionally, the retrospective, cross-sectional design restricts the potential for dynamic insights into disease progression. We also highlight the untapped potential of radiomics-based analyses, which could significantly improve diagnostic accuracy and prognostic assessments. We recommend integrating these advanced imaging modalities, adopting longitudinal study designs, and leveraging radiomics approaches in future research to enhance the diagnostic frameworks in pancreatic cancer imaging.

Key Words: Pancreatic cancer; Cancer imaging; Magnetic resonance cholangiopancreatography

Core Tip: Luo et al's study highlights the potential of imaging-pathology correlations in pancreatic cancer diagnosis. However, integrating advanced imaging techniques like magnetic resonance cholangiopancreatography and positron emission tomography/computed tomography could significantly enhance diagnostic precision and provide valuable metabolic and anatomical insights. The inclusion of radiomics-based analyses offers an opportunity to extract quantitative imaging features, improving risk stratification and prognostication. Adopting longitudinal study designs could further elucidate the evolution of imaging features over time, aiding early detection and therapy planning. These enhancements align with trends in precision medicine, paving the way for more comprehensive and clinically impactful research in pancreatic cancer imaging.



TO THE EDITOR

We read with great interest the article "Retrospective analysis of pathological types and imaging features in pancreatic cancer: A comprehensive study" by Luo et al[1]. This study provides a critical exploration of imaging-pathology correlations in pancreatic cancer, a topic of immense significance given the poor prognosis associated with late diagnosis[1]. The authors have successfully highlighted the potential of imaging modalities in enhancing diagnostic accuracy. However, we believe certain aspects warrant deeper discussion to fully contextualize their findings within the existing body of research. One notable omission in this study is the exclusion of magnetic resonance cholangiopancreatography (MRCP) as a part of the imaging protocol. MRCP offers unparalleled visualization of pancreatic and biliary ducts in a non-invasive manner, which is crucial for diagnosing conditions like intraductal papillary mucinous neoplasms (IPMNs) and pancreatic ductal adenocarcinoma (PDAC)[2]. For instance, MRCP could have allowed the identification of subtle ductal irregularities, such as main pancreatic duct dilation or small cystic lesions, which are often missed by conventional magnetic resonance imaging (MRI) protocols[3]. Studies have demonstrated that MRCP’s sensitivity in detecting IPMN-related features, such as branch duct dilation or cystic structures, surpasses that of traditional MRI techniques[4]. Additionally, by integrating MRCP into routine protocols, the reliance on invasive diagnostic tools like endoscopic retrograde cholangiopancreatography could be significantly reduced, leading to lower patient morbidity and healthcare costs[5,6]. Including MRCP in the imaging workflow would likely have enriched the findings of this study, particularly in differentiating benign from malignant cystic lesions and evaluating ductal involvement. Additionally, the omission of endoscopic ultrasound (EUS) represents another limitation, given its established role in pancreatic cancer diagnosis. EUS is particularly valuable for detecting small pancreatic lesions, assessing local tumor invasion, and providing tissue diagnosis through fine-needle aspiration. Furthermore, EUS enables a detailed evaluation of peripancreatic lymph nodes, vascular involvement, and subtle parenchymal changes, which are often missed by computed tomography (CT) or MRI. Incorporating EUS into the imaging protocol could have provided histopathological confirmation and refined the study’s diagnostic approach.

While CT and MRI are standard imaging modalities for pancreatic cancer, the exclusion of positron emission tomography (PET)/CT imaging represents another notable limitation[7]. Beyond its established role in detecting distant metastases, PET/CT has been increasingly recognized for its ability to provide metabolic insights into tumor biology, which is essential for evaluating treatment responses[8]. For example, in patients undergoing neoadjuvant therapy, PET/CT can reveal metabolic changes that might precede anatomical changes, offering a more dynamic and nuanced understanding of therapy efficacy[9]. Incorporating PET/CT into the imaging protocol would have complemented the findings from MRI and CT, providing a comprehensive diagnostic and staging framework for pancreatic cancer[10]. This approach would also have enabled a more robust assessment of tumor activity, particularly in distinguishing metabolically active malignant lesions from benign or necrotic tissue.

Another limitation of this study lies in its retrospective, cross-sectional design. Although the authors provide a robust snapshot of imaging-pathology correlations, a longitudinal study design would offer a dynamic perspective on the evolution of imaging features over time[11]. Such insights could have critical implications for clinical practice, particularly in identifying early markers of malignancy in premalignant lesions like IPMNs[12]. Furthermore, understanding how imaging characteristics correlate with disease progression or treatment resistance could pave the way for more personalized therapeutic interventions. For example, monitoring features like the "double duct sign" in early PDAC or changes in mural nodule enhancement in IPMNs over time could refine risk stratification and treatment planning[13,14]. The absence of temporal data limits the ability to assess how imaging features evolve with disease progression or therapy[15]. Despite employing advanced imaging techniques, the lack of radiomics-based analyses represents a missed opportunity to further enhance the study’s impact. Radiomics is an approach that extracts high-dimensional data from medical images, providing insights into tumor morphology, tissue heterogeneity, and biological characteristics, supported by artificial intelligence and statistical modeling methods. Radiomics enables the extraction of quantitative imaging features that reflect tumor heterogeneity, vascularity, and microenvironmental characteristics, many of which are imperceptible to the human eye[16,17]. When combined with diffusion-weighted imaging, radiomics could significantly enhance the diagnostic accuracy for differentiating benign and malignant lesions[18]. Furthermore, radiomics-based models could have provided prognostic insights, such as predicting overall survival or recurrence risk, thereby extending the clinical utility of the findings[19]. The integration of radiomics with existing imaging modalities would align the study with emerging trends in precision medicine[20]. In conclusion, Luo et al's study[1] lays a robust foundation for understanding imaging-pathology correlations in pancreatic cancer and highlights the potential of advanced imaging techniques. However, addressing the outlined limitations in future research, including the integration of MRCP and PET/CT imaging, adopting longitudinal designs, and leveraging radiomics-based analyses, could significantly enhance its clinical relevance and impact. We appreciate the authors’ significant contributions to this critical area of research and look forward to their future studies that incorporate these considerations.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Radiology, nuclear medicine and medical imaging

Country of origin: Türkiye

Peer-review report’s classification

Scientific Quality: Grade A, Grade B

Novelty: Grade B, Grade B

Creativity or Innovation: Grade B, Grade B

Scientific Significance: Grade B, Grade B

P-Reviewer: Wei R S-Editor: Lin C L-Editor: A P-Editor: Wang WB

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