Early diagnosis of pancreatic cancer, particularly in intraductal papillary mucinous neoplasm (IPMN), remains challenging despite advances in imaging and biomarkers. Pancreatic adenocarcinoma (PDAC) has a high mortality rate; therefore, its early detection and adequate interventions are necessary to improve the disease outcome. Most IPMNs are asymptomatic and discovered incidentally. Magnetic resonance imaging (MRI) is a preferred tool for diagnosing malignant IPMNs, with a sensitivity of 90.7–94.1% and a specificity of 84.7–87.2% in detecting mural nodules > 5 mm, a strong predictor of high-risk lesions. Radiomics further enhances diagnostic accuracy (sensitivity 91–96%, specificity 78–81%), especially when combined with CA 19-9, which has lower sensitivity (73–90%) but higher specificity (79–95%). Computed tomography (CT), though less effective for small mural nodules, remains widely used; its accuracy improves with radiomics and clinical variables (sensitivity 90.4%, specificity 74%). Conventional endoscopic ultrasonography (EUS) shows lower performance (sensitivity 60%, specificity 80%), but its advanced variations have improved outcomes. Contrast-enhanced EUS (CE-EUS) visualizes mural nodules with more than 90% sensitivity and involvement of the main pancreatic duct, with a sensitivity of 83.5% and a specificity of 87%. EUS–fine-needle aspiration (EUS-FNA) allows cyst fluid analysis; however, CEA, glucose, and KRAS/GNAS mutations show poor value for malignancy risk. Cytology has low sensitivity (28.7–64.8%) but high specificity (84–94%) in diagnostic malignant changes and strongly affects further management. EUS–through-the-needle biopsy (EUS-TTNB) yields high diagnostic accuracy (sensitivity 90%, specificity 95%) but carries a range of 2–23% adverse events, which limits its wide use. EUS–confocal laser endomicroscopy (EUS-nCLE) provides real-time microscopic evaluation, detecting malignant IPMN with a sensitivity of 90% and a specificity of 73%, though its availability is limited. New emerging biomarkers available in cyst fluid or blood include mucins, miRNA panels (sensitivity 66.7–89%, specificity 89.7–100%), lipidomics, and cancer metabolite profiling, with diagnostic accuracy approaching 89–91%. Pancreatoscopy (POP) enables direct main pancreatic duct (MPD) visualization and biopsy with a sensitivity of 64–100% and a specificity of 75–100%, though adverse events occur in around 12% cases. Combining advanced imaging, EUS-based tissue acquisition, and novel biomarkers holds promise for earlier and more accurate detection of malignant IPMN, potentially improving PDAC outcomes.
胰腺癌的早期诊断，特别是导管内乳头状黏液性肿瘤（IPMN）的恶变识别，尽管影像学和生物标志物技术不断进步，仍面临挑战。胰腺导管腺癌（PDAC）死亡率极高，因此早期发现并及时干预对改善预后至关重要。多数IPMN患者无症状，多为偶然发现。磁共振成像（MRI）是诊断恶性IPMN的首选工具，其对>5mm壁结节（高风险病变的强预测因子）的检测灵敏度为90.7–94.1%，特异度为84.7–87.2%。影像组学进一步提升了诊断准确性（灵敏度91–96%，特异度78–81%），尤其与CA 19-9联合应用时效果更佳（CA 19-9灵敏度较低为73–90%，但特异度较高为79–95%）。计算机断层扫描（CT）虽对小壁结节检测效能有限，但应用广泛；结合影像组学与临床变量可提升其准确性（灵敏度90.4%，特异度74%）。传统超声内镜（EUS）诊断性能较低（灵敏度60%，特异度80%），但其进阶技术显著改善了诊断效果。对比增强EUS（CE-EUS）显示壁结节的灵敏度超过90%，对主胰管受累的检测灵敏度为83.5%、特异度为87%。EUS引导下细针穿刺（EUS-FNA）可实现囊液分析，但CEA、葡萄糖及KRAS/GNAS突变对恶性风险评估价值有限。细胞学检测对恶性病变诊断灵敏度较低（28.7–64.8%），但特异度高（84–94%），对后续治疗决策影响显著。EUS引导下经针道活检（EUS-TTNB）诊断准确性高（灵敏度90%，特异度95%），但不良事件发生率在2–23%之间，限制了其广泛应用。EUS引导下共聚焦激光显微内镜（EUS-nCLE）可实现实时显微评估，诊断恶性IPMN的灵敏度为90%、特异度为73%，但设备普及度有限。囊液或血液中的新兴生物标志物包括黏蛋白、miRNA组合（灵敏度66.7–89%，特异度89.7–100%）、脂质组学和癌症代谢谱分析，其诊断准确率可达89–91%。胰管镜（POP）能直接观察主胰管并进行活检，灵敏度为64–100%、特异度为75–100%，但约12%的病例会发生不良事件。整合先进影像技术、基于EUS的组织取样方法及新型生物标志物，有望实现恶性IPMN的更早期、更精准检测，从而改善PDAC的临床结局。
Pancreatic Cancer Detection in Intraductal Papillary Mucinous Neoplasm (IPMN)—New Insights
肿瘤(癌症)患者之家