777
HLAVNÍ42522701005185134178232252
TÉMA69222701003981147194
Current42533701003976100125160198225
trends6663370100255085123161190
in87233701001552
the94033701002664100
diagnosis10563370100375287125163202231246275
of134733701003858
pancreatic142133701003772110141165200234261277307
cancer174433701003065103133168192
36619122701003477119
|326227010043
VNITŘNÍ4268043010746106127172220280301
LÉKAŘSTVÍ748804301074185130188236280325378400
/11688043010757
Vnitř12458043010771118137165191
Lék.1456804301074083122140
2022;68(6):363-3701615804301074487129173188233278301343366380425468511538579619661
/22968043010756
www.casopisvnitrnilekarstvi.cz442680430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
ring42532830107274795146
disease591328301075676109154195229274
response885328301073478112162212262296341
to1246328301073582
systemic1349328301074082117147190265284325
treatment1694328301073563106147175250295344372
in2086328301072675
the2181328301073584129
neoadjuvant23303283010756101151193244263311353396445472
or2822328301075683
metastatic4253423010775120148190224253296323342383
setting829342301074085114145164213263
(50–53).1112342301073174118167210252274288
Elevated1420342301074968113154196224267318
preoperative1758342301075785128178229275302344371391433476
CA22553423010758113
19-92388342301075290120165
may25733423010781123162
also2755342301074968101150
help425356301074892112161
identify606356301072069113162188207231275
patients900356301075294121140183231258293
whose12133563010767115164197241
surgeries1474356301073583109157201228247291324
are1818356301074369112
less195035630107216598132
likely210135630107214077120140180
to2300356301073077
result2396356301072972105152171199
in2615356301072168
an2703356301074391
R02814356301074792
(margin-negative)425370301072495136162210229277305354398448489516535576619641
resection1086370301073275108153194224243291340
and1445370301074795144
can1609370301074687135
predict1764370301075582125175194234264
long-term2048370301072573121171199227269296370
survival2438370301073986112156176217258277
after2735370301074670101144170
resection425384301072770103147189219238286334
(19,779384301072464102114
39,91338430107448598
54).1031384301074388109123
Carcinoembryonic565398301075193119158177225273318392441468511559607626666
antigen1251398301073987114133182226274
(CEA)1545398301072272113167191
and1756398301073987136
CA19123983010750104
1252035398301074380124
are2179398301073966109
nonspecific2307398301074795144177226271312331355375415
mar‑27423983010772113139163
kers425412301073881108142
that587412301073079119146
might753412301077795145193219
be992412301075398
elevated1109412301074766110151193220262312
in1441412301072270
patients1530412301075395122141184233259294
with1844412301076887115164
PDAC20274123010748105156205
as2252412301074477
well.23494123010768111130149165
According2534412301075595134180207255274322371
to425426301072874
reports519426301072568118167194225260
in798426301071765
the883426301072675119
literature,102142630107183664107133175202250276319334
the1375426301072674118
combination1513426301073885159209228276317344362410459
of1992426301074670
serum2082426301073276102151224
CA23264263010750104
19-92450426301074280109153
with2623426301076382111159
CA28014263010750104
125425440301074482126
increased571440301072674115142185226259304354
sensitivity,945440301074185134167186214233274294322365377
and1342440301074896146
the1508440301073583128
combination1656440301074794168218238286327355374422471
of2147440301075579
CA22464403010758113
19-92379440301075189119163
with2562440301077292120169
CEA27514403010758100154
increased425454301071967107134177217250294344
specificity789454301073483128169188212231272290318361
compared1170454301074086160210252278321371
to1561454301072874
CA16554543010751105
19-91780454301074482111155
alone1955454301074160108157201
(55,2176454301072466107120
56).2316454301074487110123
In565468301071968
recent652468301073477119162210237
years,909468301074790131157192208
novel11374683010755104145188208
blood-based1365468301075676125174225253304346380424475
biomarkers1860468301075676124199240266305349375410
for2290468301073078105
early2415468301075191118138178
diagno‑2613468301075675115165214263292
sis42548230107345387
and532482301074998149
prognostic702482301075785133185234284318348368409
stratification113248230107417199141169189214234276318346366415465
have1618482301075698139183
made18214823010783124175221
progress.2062482301075885134185212257291326343
Studies2426482301074976126176196241275
have2722482301075698139183
confirmed425496301074087135159179205279324374
that818496301073280120148
abnormally985496301074594143191218292333352371411
expressed1416496301074786136163206240273317368
serum1803496301073781108156230
non-coding20534963010751100148177219266316335382432
microRNAs2504496301077896136163210256314366401
(miRNAs)425510301072494112156213265299320
have764510301074484123166
certain949510301073678104134175193240
significance120851030107304896143161185204244284332371413
in1640510301071563
the1722510301072471115
diagnosis1856510301074563103151199246279297329
of2204510301074468
early-stage2291510301074079105124163190223252292341384
PDAC,2694510301074298147196211
or425524301074976
even522524301075192137186
in728524301072675
precancerous823524301075785129171214263304348375423472506
pancreatic13495243010758100149191218262303331350392
lesions1761524301072671106124173223257
(44,2038524301073174122137
57).2195524301075294120133
The23495243010749100145
diagnostic2514524301075776117168217266301330350391
value425538301074183102150194
of639538301075579
microRNAs7385383010781100141167215261320372408
was11665383010772114147
shown1333538301074189138203252
to1605538301073582
be17075383010756102
higher1829538301075574123172216243
than2092538301073483124173
that2285538301073483124151
of2456538301075579
conventi‑2555538301074794143183227276303322350
onal425552301074897137156
serum601552301073782108156230
markers8515523010777118145183226253287
(58),1158552301072770113135149
and1326552301074593143
there1488552301073280125151194
is1702552301072355
evidence1777552301074888108157201249290332
that2129552301073280120148
the2296552301073280124
combination2440552301074491165215234282322349368416465
of425566301074873
miRNAs5185663010781100146205258294
and832566301074896147
CA9995663010758113
19-91132566301075190120165
is1317566301072659
more13965663010781130158201
accurate1617566301074890129178204247274318
(59,1955566301073073115127
60).2102566301075297120134
Moreover,22565663010777127154198247288332359371
miRNA26475663010782101147205258
expression425580301074484134161204238272290339387
profiles832580301075784131156175194239272
may11245803010781122161
distinguish1305580301075674107136155204253301320353401
between17265803010756101129197241286334
malignant20805803010781122141160209257298347374
and2473580301074896146
benign26395803010756102150169218266
lesions42559430107196397115163212245
of689594301075175
the784594301073179123
pancreas927594301075294142183209252292326
(61),1272594301072769107124138
and1430594301074492141
they1591594301073079123163
may17735943010777118157
be1949594301075398
used2067594301075083128178
for2264594301072774101
the2385594301073179123
prediction2528594301075380123173191232262281329377
of425608301074871
chemoresistance516608301073784128201249276318352370402431472519559601
and1137608301073785134
facilitate1290608301072162103121139157185226253295
personalized1605608301074690117150198247287306324360402452
treatment207760830107245093133160233277325351
planning2447608301074766106154202220267316
(44,2783608301072061108122
62).425622301074486108121
Another566622301075199147175223267294
emerging8796223010742115160186234253301350
strategy124962230107316087129156199249289
are1558622301073965108
so-called1686622301073179109151193212230274324
“liquid203062230107244362111158177226
biopsies”2276622301074767115165198217260294320
that2616622301072674115142
can2778622301073879127
capture425636301074080129156203229272
tumor-associated716636301072471144192218242282315347395436454493520562611
components,1346636301073782156204253301344391418452467
such1833636301073076116163
as2015636301073770
circulating210463630107375581119166185224251269316365
tumor2488636301072572144192218
DNA,27266363010754111162179
extracellular425650301074483114141182223265285303351369410436
vesicles,881650301074083117135176195238272288
and1189650301074088138
circulating134665030107405985124172191231258277325374
tumor1740650301072775149197224
cells.1984650301074082101120152169
It2173650301071846
has2239650301074788121
been2380650301074994139187
reported2587650301072669118168195226268318
that425664301072876117144
circulating58966430107375682121169188228255274322371
tumor980664301072573147195222
cells122266430107378099118150
can1392664301073779127
be1539664301074691
detected1650664301074690118161202232275325
in1995664301071664
the2078664301072574118
peripheral2216664301074791118137187235280306348367
blood2602664301074767115164214
of2836664301074569
40%–100%425678301074489157205244283329396
of841678301075175
pancreatic936678301075394142183209252292320338379
cancer1334678301074485133174216243
patients,1596678301075395122141185233260294310
which19266783010768117135176224
may21696783010777118157
be2346678301075297
used2463678301075184128178
for2661678301072774101
the2782678301073179123
diagnosis425692301074866105153200247279297328
of772692301074467
early858692301073978103122161
PDAC1038692301074196145193
(63).1250692301072061102122135
These1404692301073786129161204
novel1627692301074491130172190
methods18366923010769112139186233282314
seem2168692301073073116188
very2375692301073779104146
promising,2540692301074571117189207239256302350365
although42570630107416088136184233282330
further775706301072776102133181226252
studies1047706301073766114164182226260
are1326706301074571114
needed1460706301075296141191235285
to1765706301073178
verify1863706301074487114133157200
the2083706301073280124
results2227706301073073107154173200235
and2482706301074593142
validity2644706301074486105123172191219261
of425720301074872
these517720301072776120154198
strategies73472030107346390131158201251270314347
in1101720301071967
clinical118772030107405978126144184226245
practice.1452720301074976118158189207248290305
Imaging4257464012525104153205229281334
methods7877464012579128165217269322363
Abdominal5657623010753105156205281300349391410
ultrasound996762301075574103131173207257306355406
(US)1422762301073188129154
is1596762301072659
a16767623010748
non-invasive,17457623010755105155183204253293336370389431475490
broadly2255762301075886134176227246287
available,2563762301074889131150170211262282327342
and425776301074189138
easily583776301074687120138157197
feasible799776301072770110144162211231275
technique1094776301073073114162210229277325369
that1483776301073079119146
is1649776301072254
usually1723776301075083130171190209249
the1991776301073179123
first213477630107264672107136
imaging2289776301072295136185204252301
method26107763010776121149197245295
used3047328301074882127177
in3244328301072675
suspected3339328301074088122171217259290333384
pathology3743328301075799126175224244293344385
of4148328301075580
the4248328301073583128
pancreatobiliary43963283010757100148189216260301328376426446465484525551595
tract5011328301073562105146176
(64).5208328301073073120142155
The53833283010749100144
disadvantage304734230107486698139188228268315342382430473
of3540342301074367
abdominal3626342301073785134182255273319359377
US4023342301075291
is4133342301071547
its419934230107154377
low4295342301071562126
specificity,4440342301073078122162180204223262280307349360
expert4819342301074079128172198228
dependence,5066342301074588136180228276319366406447461
and3047356301074088137
also320335630107375688135
the3358356301072471115
dependence3492356301074689138182230278322369409451
on3962356301074492
the4074356301072471115
patient‘s4208356301074687114132175223249267298
body4525356301074695144184
habitus4728356301074585134153180227260
(64).5007356301072062107128141
According5167356301074988126172199246265312360
to3047370301072874
various3141370301073879105125173221254
authors,3414370301073886114162210237271287
the3721370301072573117
sensitivity3858370301073075123156174202221262281309352
of4229370301074569
US4318370301075393
in4431370301071563
PDAC4514370301074299149199
detection4732370301074690118160202232251299347
ranges5099370301072365113162206240
from535937030107204895169
48%–98%3047384301074489156204248292359
(64,3425384301072769115130
65).3574384301074790113126
In3719384301072270
a38093843010744
Japanese3872384301073475124166214258292336
multicenter42283843010776124143171189230272320347390416
study4664384301073665113163203
involving4887384301072169108156176216236284333
early-st‑5240384301074686113132172200234263287
age3047398301074190134
pancreatic3201398301075092140180207250290317336376
cancers,3597398301074182130171213240274290
dilatation390739830107496886127154195223241289338
of4265398301074872
the4357398301072876121
MPD44973983010771116173
was46903983010765107140
the4850398301072876121
most49903983010775123157186
common5195398301074188162235284332
abnormality3047412301074190139188214289330349367395438
on3504412301074897
US3621412301075696
in3737412301071866
up3823412301074897
to3940412301072874
75%4034412301074485150
patients4203412301075092119138181229256291
(66).4514412301072466111133146
Computed3187426301075197170219266294336385
tomography3592426301072470143191240266307356404442
(CT)4053426301072169114141
has4213426301074585118
a43504263010737
crucial4406426301073763111151169208227
role465242630107237089132
in4804426301071562
diagnosis,4885426301074664104152200247280298330346
staging,525042630107305999148166213262277
and3047440301074292143
planning3211440301075879121171221241290342
or3574440301075684
monitoring36794403010783133184203233281309330380431
the4131440301073585131
treatment4283440301073664109150179255301351380
of4683440301075782
patients47864403010758101130149195245273310
with5116440301077495124174
PDAC53114403010753113165216
(64,3047454301072466112127
67).3194454301075092116129
Currently,33434543010758104131158201249276296336347
a37104543010748
biphasic3777454301075776125174215248267307
pancreatic4104454301075698146187213256297324343383
protocol4507454301075683130158205246293312
with4839454301077291119168
submillimeter5026454301074088137212230249268286360404432475501
section3047468301073478119149168216265
thickness333146830107277594134172221266299333
and3683468301074088137
standard3840468301073261102150200240267315
use4175468301074679123
of4318468301074670
multiplanar44084683010772120138166185235254295343384410
reconstructions4838468301072568109155204237266293341382412431479528561
are5418468301074066109
recommended3047482301072770112159234308352401451495546
(64,3613482301073173119134
67).3767482301075193118131
It3918482301072654
involves3992482301072574114162181223266300
both43124823010757107134183
intravenous4515482301072674101128170210254303351400433
contrast4968482301074794144171198240273303
with5291482301077291120168
a54794823010748
high3047496301074867116164
iodine3231496301072068118136184228
content3479496301074288137164206254281
(at378049630107256391
a38904963010742
rate395249630107286997139
of4111496301074973
3–54204496301074591134
ml/s)4357496301077594127157178
and4555496301074290139
ingestion4714496301072068117161195224243291340
of5073496301074973
water51664963010766108135177204
as5390496301074275
a54854963010742
neutral3047510301074892140168195237256
oral3322510301075077118137
contrast3479510301074188137163190232265294
(64).3793510301072567113135148
The3960510301074493138
pancreatic4117510301075193141182208251291318337377
phase45145103010751100141174218
should4752510301073582131179198247
be5019510301075196
performed5135510301075195122149196223298342392
after304752430107406393135160
40–503226524301074084131172214
seconds3459524301072972112158205253285
and3763524301073783131
the3913524301072471114
portal4046524301074593119149189207
phase4272524301074693132165208
after449852430107376090132157
65–704674524301074081126164205
seconds4898524301072972112157205253285
following520152430107206685103150213232278326
intravenous304753830107196794120162202245293341390423
contrast3489538301074693141168195237270299
application.3808538301074696146165184224265293311359408424
Three-dimensional4252538301074797123166211240291310383428476509527575624664683
(3D)4955538301073072129151
images5126538301072498139188232266
are5411538301074773116
convenient3047552301074087135175218266285328377403
for347055230107257299
assessing3589552301074275109153187220238286335
tumor-vessel3944552301072977151199226251292335369402446466
relationships,442955230107287190131158177225273306354373422456472
especially4920552301074579128173214233273292311351
before5290552301075196120167194237
planned3047566301075069110158206250300
surgery3367566301073380107155199226269
(64).3655566301072466112134147
Based3187580301074587120165215
on34215803010754103
the3543580301073482126
extent3689580301074989120162211237
of3946580301075478
disease,4043580301075574106151191224268283
PDAC43465803010750107158207
is4573580301072457
divided4650580301075573114134183227277
into494758030107247299146
one51125803010754103147
of5278580301075478
four5376580301072977125151
categories:3047594301074082109151201250277296340373389
resectable3455594301072871105149190220262311331375
(Fig.385059430107256684133149
3),401959430107456680
borderline41195943010751100127175219246265284331376
resectable,4514594301072871105149190221262311331375390
locally4923594301072169110152171189229
advanced5172594301074291133174222263305355
(Fig.304760830107246583132148
4),321560830107436579
and3313608301074189138
metastatic34716083010773117145186220249290317336376
(Fig.386760830107236483132148
5).403460830107446780
Due41346083010757106150
to4304608301072773
the4397608301072776120
gradual4537608301074874116165213254273
improvement4829608301071992141168215256299373417465492
of5340608301074872
CT5432608301075096
imaging3047622301071992133182201249298
technology,3365622301072567108156204253272321371411423
the3807622301072573118
sensitivity3944622301073175123156174203221262282310352
of4316622301074569
CT4405622301074893
for451862230107216895
detection4633622301074690118160201232250298347
and5000622301073886135
evaluation5155622301074081123142189230257276324372
of3047636301074872
PDAC31396363010744101151200
resectability3359636301072568102146187218259309328346365393436
has3814636301074788121
increased3955636301071765106132175215249293343
from431863630107225097171
76%4509636301074282148
to4677636301072673
95%4770636301074285150
and4939636301074088138
73%5096636301074386151
to5267636301072673
83%,5360636301074285150167
respectively3047650301072770103152197239269288329372391431
(67).3498650301072768110134147
CT3665650301075499
is3784650301072254
accurate3858650301074484123171197239266309
for4186650301072774101
determination4307650301075296123166192267285333374401420468517
of4843650301075175
unresectable4938650301075098125168201245287317358408428472
di‑542965030107527198
sease3047664301073478118151195
with3262664301076584112161
sensitivity3442664301073478126159177206224265285313356
of3817664301074872
up3909664301074897
to4026664301072874
91%4120664301074484145
and4285664301074189138
specificity4443664301073383128169187211231271290318361
of4823664301074872
100%4915664301074483129197
(64).5131664301072466112134147
To3187678301074285
assess3292678301074881115159193227
resectability3539678301073376110155197227269319338357376404447
of4006678301075479
the4105678301073483127
lesion,4252678301072670104123171220236
it4508678301072553
is4581678301072659
necessary4660678301075599141184218251293320363
to5043678301073582
assess5145678301074781115159193227
po‑53926783010756106135
tential3047692301072870119145164204223
infiltration329069230107176588108127155181223250269317366
of3675692301074670
the3765692301072674118
superior3903692301073279128173199219267294
mesenteric42166923010772116150194242269312338358398
artery,463469230107386596138165208219
coeliac4873692301073885130149167208248
axis514169230107397998131
and5291692301073987137
its544769230107174580
branches,3047706301075077118166207255299333349
portal34157063010750100127158199218
vein,3653706301074184102150166
and3838706301074290139
superior3997706301073481130175202221269296
mesenteric43137063010774118152196244271313340359399
vein.4732706301074184103151167
Three4919706301074292118161206
degrees5144706301075094144170213258291
of5455706301074872
vascular3047720301074080112151198216255280
contact3346720301073681128154194233262
with3627720301076078105152
the3798720301072370113
tumor3930720301072370141188214
are4163720301073762103
evaluated,4285720301073979119137183222248289338352
i.e.,46567203010715307387101
no4776720301074491
contact,4885720301073681129154194233263278
abutment5182720301073684131158230273320345
(≤180°),3047734301072475115153198226251264
or3331734301075279
encasement3429734301074896137178211256329373422448
(>180°),3897734301072879114153198226250264
on41817343010751100
the4301734301073180124
basis4445734301075395128146179
of4644734301075175
which47397343010769117136176224
it4983734301072351
is5053734301072356
possible51287343010754103137170188238257301
to5449734301073278
predict3047748301075077120170188229259
resectability3326748301073275109153194225266316335354372400443
(64,3788748301073072118133
68).3941748301075095117130
The4091748301074898142
disadvantage4253748301075573106148197238280328355396446490
of4762748301075478
CT48607483010758103
in4982748301072573
determining5075748301075599127169196270289337355403453
local3047762301071967109150169
resectability3236762301072871105149190221262312331350368396439
of3694762301075074
PDAC37887623010748105155204
is4012762301072154
the4085762301073079123
existence4227762301074686105138167209258298341
of4587762301075074
interobserver468176230107216996138165212262295340366410453480
variability5180762301074385111130171220239258277305347
among30477763010740113161209257
evaluators,3323776301074080121140186226253299325359374
even3717776301073979122169
among39067763010737109157205254
experienced4179776301074079128172198217260307347389438
radiologists4637776301072364112130178197244293312344372406
(69).5063776301072061103125138
In5220776301071663
additi‑5302776301073786135153180199225
Pancreatic27078930954076119156180218254279296332
lesion3056893095175787104147190
Resectable55419090954080110150187214251296314353
lesion9251909095165686103146189
of113219090954264
typical121419090952463108125161199216
PDAC144719090954192137181
appearence57420090953681126166202226264307344382
without97320090955876101144188231256
metastases1247200909565105130167197223260290330360
Locally307119590953678115152170186222
advanced331119590953680117155198234272317
lesion36461959095175686103146190
Borderline201319590954084108151191215233249292332
resectable23621959095246293132169197234278296335
Metastatic4132195909562102127164194220257282299335
disease44851959095436089129165195235
Urgent55324680955074117156199224
surgery7942468095307296139179203241
(EUS105324680952158107143
confirmation121424680953577121142160184250287311328371415
of58325680954364
resecrability6652568095236292132169193230275292309326351389
in107225680951659
some114925680953073139179
centers)134525680953674117142180204234254
EUS319525180953786122
with333525180955875100144
biopsy349625180954462105150180217
EUS209625180953786122
with223625180955875100144
biopsy239725180954462105150180217
EUS448124180953786122
with462124180955875100144
biopsy478224180954462105150180217
or501624180954367
metastasis4497251809566105130167197224261291307337
biopsy485125180954462105150180217
CT257213010954686
in267613010951659
pancreatic275313010954481124161185223259284301337
protocol310713010954569111136178215256274
(MRI/MRCP213414010952182123141170232273319359
in251014010951760
specific258814010952973114151168189207243
situations28491401095304672115151176193236279309
–3176140109540
e.323314010953952
g.330314010954358
cystic337814010953674105131148184
lesions)35801401095165686103146189219238
(PET18731501095216298138
in202815010951760
specific210615010952973114151168189207243
situations23671501095304672115151176193236279309
–2694150109540
e.275115010953952
g.282115010954358
suspicion289715010952972101145163199216259302
of321715010954264
small329915010952995132149166
distant34821501095446190116153196221
metastases3720150109566105130168197224261291330361
Fig.42561901134873125152
2.60461901135481
Diagnostic71362801075675120166212257287313331368
work-up1098628010762106132169194240286
of140062801074568
a1484628010746
suspected154662801073175105149188225253289335
pancreatic189762801074591137175200237282308326363
tumor227662801072772143189215
(according250762801072466104140183209252270316361
to288562801072670
Ducreux2971628010756102140165202248284
et327262801073864
al.33526280107466480
and344862801074592137
Lang360162801073782128173
et379062801073965
al.38716280107466480
(37,396762801072464101108
38)).409162801074283105126139
CT42528740954381
–520287409540
computed57528740953372136176217241273314
tomography;90428740952362126167208231269310352383398
MRI1316287409561100116
–1447287409540
magnetic1501287409564104145186221244261294
resonance18102874095235684123165206247281313
imaging;213828740951680120161177218259272
MRCP242528740956099142180
–2619287409540
magnetic2674287409563104144186220244260294
resonance29822874095235684124166206247281314
cholangiopancreatography;331028740953375115132172214254271311352393435468491524565588627668691730771812844859
PET418328740953873110
–4307287409540
positron436228740954081108124147170209251
emission462728740953498114141168184224266
tomography;490728740952463127167208232270311352384399
PDAC42529740953887129171
–610297409540
pancreatic66529740954081122156179212252276292326
ductal100529740954081114139178195
adenocarcinoma;121429740954081115157197232271294326343384424488529542
EUS177129740953582115
–1900297409540
endoscopic195529740953475116156183216255296313347
ultrasound.23162974095415780103142169209250291332347