Published online Mar 28, 2025. doi: 10.4329/wjr.v17.i3.104818
Revised: March 4, 2025
Accepted: March 20, 2025
Published online: March 28, 2025
Processing time: 79 Days and 14.9 Hours
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 can
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.
- Citation: Dogru GD, Tugcu AO, Dursun CU. Enhancing diagnostic frameworks in pancreatic cancer imaging: A critical appraisal. World J Radiol 2025; 17(3): 104818
- URL: https://www.wjgnet.com/1949-8470/full/v17/i3/104818.htm
- DOI: https://dx.doi.org/10.4329/wjr.v17.i3.104818
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, suppor
1. | Luo YG, Wu M, Chen HG. Retrospective analysis of pathological types and imaging features in pancreatic cancer: A comprehensive study. World J Gastrointest Oncol. 2025;17:99153. [PubMed] [DOI] [Cited in This Article: ] [Reference Citation Analysis (2)] |
2. | Lopez Hänninen E, Amthauer H, Hosten N, Ricke J, Böhmig M, Langrehr J, Hintze R, Neuhaus P, Wiedenmann B, Rosewicz S, Felix R. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology. 2002;224:34-41. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 108] [Cited by in RCA: 116] [Article Influence: 5.0] [Reference Citation Analysis (0)] |
3. | Sahani DV, Kadavigere R, Blake M, Fernandez-Del Castillo C, Lauwers GY, Hahn PF. Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations--correlation with MRCP. Radiology. 2006;238:560-569. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 167] [Cited by in RCA: 176] [Article Influence: 9.3] [Reference Citation Analysis (0)] |
4. | Kim SH, Lee JM, Lee ES, Baek JH, Kim JH, Han JK, Choi BI. Intraductal papillary mucinous neoplasms of the pancreas: evaluation of malignant potential and surgical resectability by using MR imaging with MR cholangiography. Radiology. 2015;274:723-733. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 33] [Cited by in RCA: 35] [Article Influence: 3.2] [Reference Citation Analysis (0)] |
5. | Park SH, Kim MH, Kim SY, Kim HJ, Moon SH, Lee SS, Byun JH, Lee SK, Seo DW, Lee MG. Magnetic resonance cholangiopancreatography for the diagnostic evaluation of autoimmune pancreatitis. Pancreas. 2010;39:1191-1198. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 33] [Cited by in RCA: 30] [Article Influence: 2.0] [Reference Citation Analysis (0)] |
6. | Turowska A, Łebkowska U, Kubas B, Janica JR, Ładny RJ, Kordecki K. The role of magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) in the diagnosis and assessment of resectability of pancreatic tumors. Med Sci Monit. 2007;13 Suppl 1:90-97. [PubMed] [Cited in This Article: ] |
7. | Weber WA. Assessing tumor response to therapy. J Nucl Med. 2009;50 Suppl 1:1S-10S. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 173] [Cited by in RCA: 182] [Article Influence: 11.4] [Reference Citation Analysis (0)] |
8. | Benz MR, Armstrong WR, Ceci F, Polverari G, Donahue TR, Wainberg ZA, Quon A, Auerbach M, Girgis MD, Herrmann K, Czernin J, Calais J. 18F-FDG PET/CT Imaging Biomarkers for Early and Late Evaluation of Response to First-Line Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma. J Nucl Med. 2022;63:199-204. [PubMed] [DOI] [Cited in This Article: ] [Reference Citation Analysis (0)] |
9. | Zimmermann C, Distler M, Jentsch C, Blum S, Folprecht G, Zöphel K, Polster H, Troost EGC, Abolmaali N, Weitz J, Baumann M, Saeger HD, Grützmann R. Evaluation of response using FDG-PET/CT and diffusion weighted MRI after radiochemotherapy of pancreatic cancer: a non-randomized, monocentric phase II clinical trial-PaCa-DD-041 (Eudra-CT 2009-011968-11). Strahlenther Onkol. 2021;197:19-26. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 14] [Cited by in RCA: 14] [Article Influence: 2.8] [Reference Citation Analysis (0)] |
10. | Evangelista L, Zucchetta P, Moletta L, Serafini S, Cassarino G, Pegoraro N, Bergamo F, Sperti C, Cecchin D. The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review. Ann Nucl Med. 2021;35:767-776. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 28] [Cited by in RCA: 29] [Article Influence: 7.3] [Reference Citation Analysis (0)] |
11. | Edland KH, Tjensvoll K, Oltedal S, Dalen I, Lapin M, Garresori H, Glenjen N, Gilje B, Nordgård O. Monitoring of circulating tumour DNA in advanced pancreatic ductal adenocarcinoma predicts clinical outcome and reveals disease progression earlier than radiological imaging. Mol Oncol. 2023;17:1857-1870. [PubMed] [DOI] [Cited in This Article: ] [Cited by in RCA: 3] [Reference Citation Analysis (0)] |
12. | Lapin M, Edland KH, Tjensvoll K, Oltedal S, Austdal M, Garresori H, Rozenholc Y, Gilje B, Nordgård O. Comprehensive ctDNA Measurements Improve Prediction of Clinical Outcomes and Enable Dynamic Tracking of Disease Progression in Advanced Pancreatic Cancer. Clin Cancer Res. 2023;29:1267-1278. [PubMed] [DOI] [Cited in This Article: ] [Cited by in RCA: 7] [Reference Citation Analysis (0)] |
13. | Menges M, Lerch MM, Zeitz M. The double duct sign in patients with malignant and benign pancreatic lesions. Gastrointest Endosc. 2000;52:74-77. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 61] [Cited by in RCA: 40] [Article Influence: 1.6] [Reference Citation Analysis (0)] |
14. | Kalady MF, Peterson B, Baillie J, Onaitis MW, Abdul-Wahab OI, Howden JK, Jowell PS, Branch MS, Clary BM, Pappas TN, Tyler DS. Pancreatic duct strictures: identifying risk of malignancy. Ann Surg Oncol. 2004;11:581-588. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 44] [Cited by in RCA: 48] [Article Influence: 2.3] [Reference Citation Analysis (0)] |
15. | Challapalli A, Barwick T, Pearson RA, Merchant S, Mauri F, Howell EC, Sumpter K, Maxwell RJ, Aboagye EO, Sharma R. 3'-Deoxy-3'-¹⁸F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer. Eur J Nucl Med Mol Imaging. 2015;42:831-840. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 22] [Cited by in RCA: 22] [Article Influence: 2.2] [Reference Citation Analysis (0)] |
16. | Mukherjee S, Patra A, Khasawneh H, Korfiatis P, Rajamohan N, Suman G, Majumder S, Panda A, Johnson MP, Larson NB, Wright DE, Kline TL, Fletcher JG, Chari ST, Goenka AH. Radiomics-based Machine-learning Models Can Detect Pancreatic Cancer on Prediagnostic Computed Tomography Scans at a Substantial Lead Time Before Clinical Diagnosis. Gastroenterology. 2022;163:1435-1446.e3. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 37] [Cited by in RCA: 59] [Article Influence: 19.7] [Reference Citation Analysis (0)] |
17. | Eloyan A, Yue MS, Khachatryan D. Tumor heterogeneity estimation for radiomics in cancer. Stat Med. 2020;39:4704-4723. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 3] [Cited by in RCA: 18] [Article Influence: 3.6] [Reference Citation Analysis (0)] |
18. | He M, Xue H, Jin Z. Radiomics in pancreatic ductal adenocarcinoma: a state of art review. J Pancreatol. 2020;3:195-200. [DOI] [Cited in This Article: ] [Cited by in Crossref: 3] [Cited by in RCA: 3] [Article Influence: 0.6] [Reference Citation Analysis (0)] |
19. | Chakraborty J, Langdon-Embry L, Cunanan KM, Escalon JG, Allen PJ, Lowery MA, O'Reilly EM, Gönen M, Do RG, Simpson AL. Preliminary study of tumor heterogeneity in imaging predicts two year survival in pancreatic cancer patients. PLoS One. 2017;12:e0188022. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 51] [Cited by in RCA: 58] [Article Influence: 7.3] [Reference Citation Analysis (0)] |
20. | Kaissis GA, Ziegelmayer S, Lohöfer FK, Harder FN, Jungmann F, Sasse D, Muckenhuber A, Yen HY, Steiger K, Siveke J, Friess H, Schmid R, Weichert W, Makowski MR, Braren RF. Image-Based Molecular Phenotyping of Pancreatic Ductal Adenocarcinoma. J Clin Med. 2020;9:724. [PubMed] [DOI] [Cited in This Article: ] [Cited by in Crossref: 28] [Cited by in RCA: 28] [Article Influence: 5.6] [Reference Citation Analysis (0)] |