Radiology: Volume 254: Number 3—March 2010

Are We Really Closer to Predicting the Development of Pancreatic Cancer?

Alec J. Megibow, MD, MPH

The early, curable malignant lesion of the pancreas is silent. The initial symptoms are mild, indefinite, and not disturbing. Even when a presumptive diagnosis of such a lesion is made on a basis of the history in the absence of any demonstrable finding, the lesion proves to be inoperable. Magnificent advances have been made in the surgical management of pancreatic disease. Until similar advances can be made in diagnosis, the fruits to be enjoyed by pancreatoduodenectomy cannot be touched (1).

These words, written in 1950, artic­ulated the frustration shared by all individuals who treated patients with pancreatic diseases and served as a challenge to those attempting to diagnose them. In the introduction to their classic textbook, "Radiology of the Pancreas and Duodenum," published in 1973, the editors S. Boyd Eaton and Joseph T. Ferrucci Jr wrote, "During the past few years...major advances in pancreatic radiology have produced significant change; nearly all pancreatic disease can now be demonstrated ra­diologically... [although] true early diagnosis remains a rarity" (2). That text reviewed the most common radiologic techniques available at the time: hypotonic duodenography and angiography. A single chapter was devoted to pancre­atic ultrasonography (US)-the editors recognizing that even the crudest (by today's standards) direct visualization of the gland would herald a major advance. In 1976, Sheedy and colleagues from the Mayo Clinic published the first report about the value of abdominal computed tomography (CT) scanning in the evaluation of pancreatic diseases (3). Similar reports from the Cleveland Clinic Foundation (4) and the Mallinck-rodt Institute of Radiology (5) followed in rapid succession; the "modern era" of pancreatic imaging has begun. All of these reports raised the hope that by fi­nally being able to directly visualize the entire pancreas, it may finally become possible to cure pancreatic cancer; the "magnificent advance" in diagnosis had finally been achieved.