599
HLAVNÍ506722701005185134178232252
TÉMA533422701003981147194
Current401733701003976100125160198225
trends42583370100255085123161190
in446433701001552
the453233701002664100
diagnosis46483370100375287125163202231246275
of493933701003858
pancreatic501333701003772110141165200234261277307
cancer533633701003065103133168192
|5584227010018
3675617227010059102134
/35568043010757
Vnitř36328043010771118137165192
Lék.3843804301074184122140
2022;68(6):363-3704003804301074487128172187232277301343365379424467510537578619660
/46838043010757
VNITŘNÍ47598043010792153173218267326347
LÉKAŘSTVÍ5127804301074185131189236280326378400
www.casopisvnitrnilekarstvi.cz42580430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
on425538301074795
to540538301072470
the629538301072572116
tumor-vessel764538301072572145193219243284326360392436455
contact,1238538301073783131157198238268283
the1541538301072472115
size167653830107304884126
of1821538301074568
the1908538301072572116
tumor2043538301072572145192219
itself228153830107164378121140163
also246453830107375688135
predicts2619538301074672115164182222252286
resectability.425552301072668100143183212252301319337354381423434
Significantly878552301073754102149166189208247288334360378417
more13145523010769116142183
positive1516552301074593126143170188228270
resection180455230107236597140180209227274321
margins21445523010769108134180198245277
are2439552301073762104
described2562552301074487120159185203251295343
in425566301071865
tumors509566301072470142189215249
measuring7765663010769113151184229255273320368
>41163566301074992
cm12745663010736108
than1401566301072471110157
in1577566301071562
tumors1657566301072471143190216249
measuring19255663010769112151183229254273319367
<22311566301074991
cm24215663010736108
on2548566301074491
CT2658566301074791
(70).2768566301072062103125137
Thrombosis,425580301074292118165239289338371390422438
vascular883580301074283117157205224264291
deformation,1194580301075094117165192266307334353401450465
and1679580301074290139
collateral1838580301074188108126167194236263305323
vessel2181580301074285119152196216
development2416580301075195135179198246296370414463489
are425594301074167110
other554594301074572120164190
features764594301072064104131178205247281
increasing1064594301071664104130173213246264312361
the1445594301072472116
likelihood158159430107163472115134152200248297346
of1947594301074569
vascular2035594301073879112153200219259285
invasion2340594301071663103144177195243291
(68,2651594301072162107123
71).279359430107418299112
The565608301074292136
anatomical720608301074391132159205280298338380399
(radiological)113960830107254991140159207227275325343384425444468
definition1627608301075195118138186205233251299348
of1995608301074973
borderline20886083010751100127176220246266284332376
PDAC24846083010747104154203
is2707608301072053
not2780608301075098125
fully42562230107247493113153
uniform.5996223010755104123148197224300317
It936622301072655
is1011622301072659
generally10916223010756101151196223265285304345
described14566223010757102136178205225276322373
as1849622301074882
a19526223010748
locally2020622301072676118160180199240
advanced2280622301074899141183233274317369
tumor2669622301073584159208236
without425636301076584112160208256284
distant72863630107466597126167215242
metastases9896363010771115142183217245287320364397
that1406636301072472113140
affects156563630107386189132173203238
the1822636301072573117
mesentericoportal19586363010771115148192240267309335355395441491540566597638657
veins263563630107378099146179
or2834636301074471
potentially425650301075098126168216242261301320338378
resectable82365030107236699143184214255305324368
arteries121165030107376394136163182225259
(68,1489650301072163107123
72,163265030107408399
73).1750650301074184105118
In1887650301071664
addition1970650301073887136155183201249298
to2287650301072571
the2378650301072472116
anatomical2514650301073885126153199273291331373391
definition,425664301074993117137184203231250298346362
it807664301071846
is873664301071851
necessary943664301074892134176210243285311354
to1317664301072774
evaluate1411664301074383125144191232259302
the1732664301072876120
risk187266430107264578115
of2007664301074771
distant2098664301074967100129170218245
metastases,23636643010773117145186220249290323368401417
CA28006643010751105
19-9425678301074482111155
levels,600678301071862103146165198214
and833678301074088137
the990678301072775119
patient‘s1129678301074890117136180228255273304
performance1453678301074994120147194221296337385425468
status1940678301073362103130178211
or2171678301074673
comorbidities2264678301073985160208235285304354372400419463497
(68,2780678301072365110125
73).425692301074487108121
PDAC5657063010745102152201
typically786706301072467117136176218236255295
becomes1100706301074791133179253297330
hypodense1450706301074583134183232276324357401
on1871706301074493
postcontrast1983706301074796129158196243291318345386419448
CT.2451706301074893104
However,25747063010754102166210250293320331
in425720301071966
5–14%511720301074187125164228
it759720301071644
can822720301073779126
be968720301074791
directly107972030107466490133174204223263
indistinguishable,1362720301071663112131164192211259308355374406454495544564607622
i.e,20037203010716327690
isodense211372030107154896146190238271315
compared2447720301073784158207248275317367
to2834720301072471
the425734301072876120
surrounding565734301073178104131178227275324343390440
parenchyma1025734301074688114157206246294333407448
(74).1493734301072164103124137
EUS1650734301073994134
with1804734301076281109157
fine-needle198173430107214188133162211255300350369413
tissue241473430107254376109156200
acquisi‑2634734301073879126174193225244271
tion42574830107284694142
can587748301073778126
confirm732748301073783132155175201274
these1026748301072573117150194
isodense123974830107164897146190238271315
tumors1573748301072572145194220254
with1847748301076281108156
a20237483010738
sensitivity2080748301073074122155173201219260279307350
of2449748301074568
90.5%2537748301074186101145209
(75).2766748301072064104127140
As425762301075388
an532762301074694
early645762301074888115134174
predictor839762301075481124174192233263310337
of1195762301075276
a12917623010745
malignant13567623010778119138156205253294342369
tumor1744762301073280154203229
before1993762301075499123170197240
development2253762301075397138181200249299373417465492
of2765762301075276
a28617623010745
focal425776301072471112154173
pancreatic618776301074890138178205248288315334374
lesion101277630107186295114162210
on1242776301074795
CT,1357776301075095106
a14827763010740
novel1542776301074795136179198
feature1760776301072266106133181207250
may20307763010773113152
be2202776301074893
suggestive2315776301073279129178222256285304345388
–27237763010743
the2786776301072775119
”K3047286301072672
sign”.313828630107314998146171181
It3339286301071644
is3402286301071649
a34702863010738
localized3527286301071665106147166184221263313
narrowing3860286301074586112139186250270317366
of4246286301074569
the4334286301072573117
pancreatic4471286301074688136176202245285312331371
parenchyma4862286301074688114157205245293331406447
on5328286301074593
an5441286301073886
axial3047300301074181100140159
CT3225300301074994
scan3338300301073172113161
resembling3519300301072366100144217267286305352402
the3940300301072573118
shape4077300301073178119168213
of4310300301074569
the4398300301072573118
letter453530030107166088118161187
K47423003010742
(76).4803300301072165105127140
Advances4963300301075098139181229269311345
in5328300301071663
the5411300301072573117
use3047314301074779122
of3188314301074467
artificial327431430107376393111134153193211250268
intelligence356131430107156288130148166184232275322361403
also398331430107375587134
represent4136314301072365113139181214257304330
a44853143010737
great4541314301074571113152178
potential,4738314301074694120162209235253292310325
offering508231430107446793136162180227275
new5376314301074488151
opportunities3047328301074898148197224255303351370398417460494
not3561328301074897124
only3705328301074897115155
for388032830107247299
the3998328301072877121
detection4138328301075094122164205236254302351
but4509328301075098126
also465532830107416093141
for481632830107247198
the4934328301072876120
classification5074328301074059100133167185209229269310337356404453
of3047342301074872
pancreatic3139342301074991139180206249289316335375
lesions353434230107196397115163212245
(67).3798342301072466107132145
Magnetic31873563010770111160208253280299340
resonance3546356301072669103151200241289329372
(MR)3937356301072492138161
imaging4118356301071891132181200248297
of4435356301074771
the4526356301072776120
pancreas4665356301075091139180206249289323
along5007356301074160108157206
with5233356301076483111160
MR54123563010770115
cholangiopancreatography30473703010741901401602022523023223714224655155565846286696977457978248679189681007
(MRCP)40753703010731101148201247270
allow436537030107496888137204
for4589370301073180108
accurate4717370301074991131180207250278322
detection50593703010757102131175217248268317367
of5447370301075580
early3047384301074484110130170
PDAC32363843010746103154203
by3459384301075089
facilitating3568384301072466107126144163191232259278326375
morphological39633843010774123150200249297317365415434474516535
analysis4517384301074290130149189223242274
of4811384301074973
pancreatic4903384301075192140181207250290317336377
ductal5299384301075097138168210228
changes3047398301074088128176225269303
(64).3369398301072163109130143
A35323983010749
recent3601398301072366107149197224
study3844398301073159107156196
found4060398301072068116164213
that4292398301072573114140
incipient4452398301071663104122171190234282309
MPD47803983010767112169
stenosis4968398301073160102150198231250282
on5270398301074493
pre‑5382398301074774116145
-diagnostic304741230107277897137186234283316345364404
MRCP34714123010772117169213
can3704412301074183131
be3855412301075196
detected3970412301075195123165206237279329
26–494319412301074588135182224
months45634123010775123172199247280
prior486341230107517897145172
to5055412301072975
pancreatic5150412301075193141181208251291318337377
tumor3047426301072876149198225
detection3292426301074791119161203233252300348
on3660426301074795
any3775426301073987126
of3921426301074670
the4011426301072674119
imaging4149426301071891132181200248297
methods44664263010772116144192241291324
(CT,4810426301072272117127
MR,49574263010768114131
or5108426301074673
EUS)5201426301074195135159
(77).5380426301072266109134147
The3047440301074292136
advantages3202440301074392133175223250291340384418
of3640440301074973
MR37334403010771117
include3869440301072068109128175224268
the4157440301072977122
ability4298440301074292111130148176219
to4537440301072975
identify4632440301072069113162188207231275
isodense4926440301072153102152196244277321
tumors5267440301072977150199226260
or3047454301074774
tumors3140454301072471144191218251
within3410454301076180107155173220
a36494543010737
hypertrophic3705454301074582132176202232259305354402420459
pancreatic4184454301074586133173199241281307325365
head,4568454301074488127176191
distinguish477845430107456395124142189237284302334381
neoplasm5178454301074588136185205244277349
frommass-forming304746830107235095167255294326358383407453478551568615663
pancreatitis,3728468301074586132171197238277303321348366397412
and4159468301073683131
also430846830107375586133
to4460468301072369
detect4547468301074587114155195224
small47904683010729100140158175
liver498446830107153372114139
metastases51424683010769112138178210238278310353385
unrecognized3047482301074896122165206253303351370406449499
on3566482301074897
CT3683482301075297
(64,3800482301072466112127
73).3947482301074487108122
Its408848230107204883
sensitivity4190482301073479127160178206225266285313356
and4566482301074189139
specificity4724482301073584129170189212232273291319362
in5106482301071967
assessing5193482301074174108152185219237285334
vascular3047496301074182116156204223263290
invasion3356496301072371111152186204252300
is3676496301072356
comparable3751496301074591165215257283325374394438
to4209496301073178
CT43074963010755100
(73).4427496301072872115136149
Nonetheless,45964963010762110159203231279323342386420453469
MR50854963010774120
imaging5225496301072396137186205253302
might3047510301077391138185211
not3277510301074592118
be3414510301074690
routinely3523510301072268115143161208251269308
done3850510301074592140183
in4052510301071562
some4133510301072977149192
centers4344510301073778125151193218252
due4614510301074592135
to4768510301072469
its485651030107154376
lower4951510301071663126169194
availability5164510301073776117134152192240259277295322363
and3047524301074189138
higher3205524301074968117165209235
costs3460524301074187121150185
compared3665524301074087161211252279322372
to4056524301072975
CT.4151524301075297108
Therefore,4279524301074392137163206230277304347362
MR46605243010771117
is4796524301072053
not4868524301074998125
currently5013524301074188115142185233260279319
used5352524301074881125175
as3047538301074174
the3141538301072876120
primary328153830107507696169210236279
imaging3580538301071992133182201249298
method38985383010774118146194242292
in4210538301071967
PDAC42975383010745102152201
(64).4518538301072466112134147
Positron3187552301074592125143171198245294
emission35015523010743117136168202220268317
tomography3837552301072875149197248274316365414452
(PET)/CT4309552301072469110154182212262307
is4636552301071951
not4707552301074897124
routinely4851552301072774122150169217261280320
indicated5191552301071967116135175217244286336
in3047566301071967
the3133566301073382126
diagnostic3278566301075573114163211259293322341381
evaluation3679566301074889131150197238265284332380
of4079566301075377
PDAC,41765663010750107157207223
but44185663010755103132
it4569566301072452
should4641566301073987135183202251
be49125663010755100
considered5031566301074692141174192241285312355405
in5456566301072371
patients3047580301074989116134176223249283
with3349580301076179106154
a35215803010737
high3577580301074462110157
risk375358030107234173109
for388158030107206793
occult3993580301074384121168186213
metastatic42255803010769112139179212240280306325364
disease,460858030107446294137176209252265
such4892580301073076115162
as5073580301073769
those5161580301072471119151194
with5374580301076179106153
CA30475943010751105
19-93171594301074178108151
concentrations3342594301073783131171213261288314355382401448497529
out3891594301074492120
of4030594301074569
proportion4118594301074673120169218245276294342390
to4527594301072571
their4618594301072472116134160
suspected4798594301073077109158203244273316365
stage5183594301073059100149192
(19).539559430107206097119132
Endoscopy30476204012552104156209250292343396446
The3187636301074394140
role3348636301073483103149
of3518636301075681
endoscopic36196363010752102153203238280328380400442
retrograde4082636301073478107135184236263306357403
cholangiopancreatography45066363010748981481682102603113313814324755255675956396817097588098378809319821022
(ERCP)3047650301072467113166212235
in3302650301072675
patients33986503010757100128148193242270306
with3724650301077393122172
suspected3916650301074190124174220263294338389
PDAC43266503010753111163213
has4560650301075698132
evolved4713650301075193142162204249300
into5033650301072676103151
a52056503010748
mainly52746503010782124143192212253
therapeutic3047664301072877122149191242287336365384425
modality34926643010781131181223242261290333
for3845664301073179107
patients3972664301075799127146190239267302
with4294664301077393121170
biliary448466430107577796115156183227
obstruction47316643010755106140169197246287318337386435
requiring5187664301073377128176195222242290340
placement3047678301075070111152194268313361389
of3455678301075579
a35546783010748
biliary362267830107567695113154180224
stent.3866678301074069112161188204
However,40906783010764113178222262306333345
routine4455678301073380129157176224269
preoperative4744678301075683127176227272298340368387428472
decom‑52366783010755100141188263291
pression3047692301075077120153187205253302
for336869230107227097
obstructive3484692301074797130159186234275305324365408
malignant39126923010772113132150199247288336363
jaundice4295692301071758105153203221262304
should4619692301073279128176195244
not4883692301074695122
be5025692301074893
performed5138692301074893119146194220295339389
in3047706301071967
patients3134706301075698126145189237264299
who34537063010772121170
are3643706301074774117
eligible378070630107507088138157206226270
for4070706301073178106
resection;4196706301073376110154196226245294343357
it4573706301072654
has4647706301075596129
not47967063010755104131
been49477063010757102147196
proven5162706301075784131172216264
to5446706301073481
be3047720301075095
beneficial3161720301075499147191215234275293334353
in3533720301072371
regard3623720301073174124164191239
to3882720301073178
patient3979720301075495122141185233260
outcome,4259720301075199128166213287331346
and4625720301074492141
there4786720301073280124151194
is4999720301072355
evidence5074720301074788108157201249290332
for5426720301072775101
increased3047734301071968109136179220254299350
postoperative34177343010757107141170218268314341383411430472516
complications3953734301074795170220240259300342369389437487520
(78).4493734301073176118141155
Strict4668734301074976103122163194
indication4882734301072675125144185227254274322372
criteria527473430107477494123166193212253
should3047748301073481130178197246
thus3313748301072876123156
apply,3489748301074190140160200212
e.g.,3720748301074459108124139
concurrent3879748301074087135176224250277320368395
acute4294748301074181129157200
cholangitis.4514748301074088136156196244294312340359392409
EUS3187762301074297137
is3344762301072457
considered3420762301074693141174193242286312355405
the3845762301073382126
most39907623010780128162191
sensitive4200762301074084132165183211230271314
method45347623010779124151200248298
for4852762301072977104
detecting4975762301075599127169211241260307357
early5352762301074989115135175
pancreatic3047776301074991138179205248287314333373
neoplasms3439776301074589138188207247280353386
(79).3845776301072064105127140
The4005776301073888132
median41567763010771114164183223270
sensitivity4446776301073074122155173200219260279307349
of4815776301074468
EUS4903776301073893133
for505577630107216894
the5169776301072573116
detec‑5305776301074689117159200222
Fig.42561101134873125152
3.60461101135682
CT71362001074891
scan82062001073370114160
of99662001074770
resectable10826200107286496133171198241287305344
pancreatic144262001074793139176202238283309327365
ductal182362001074792130157201219
adenocarcinoma205862001074793131177222261305330366384430475547592
(PDAC)266662001072668123169216240
within42573001076280106152170216
the65873001072672110
pancreatic78473001074591138175200237282308326363
head116473001074684129175
Fig.304761101134873125152
4.322661101135886
CT333962001074891
scan344662001073572116162
of362562001074972
locally371362001072368106150169187224
advanced395362001075095133177223261297343
pancreatic431262001074995141179204241286312330367
ductal469562001075095133160204222
adenocarcinoma493362001075095133180225263307333369387433478549594
(PDAC)304773001072466121167214238
of330173001074568
the338573001072773111
pancreatic351273001074591137175200237282308326363
body389173001074691138175
with408273001076280106152
infiltration42507300107196587106124150175218244262307354
of462073001074568
the470473001072672110
celiac48317300107377492110155193
trunk50407300107265297144180
Fig.425284901134873124152
5.603284901135277
CT707285801074890
scan813285801072965109155
of984285801074265
generalized1065285801074381127165191233251269304341386
pancreatic1467285801074388134171196233278304321359
ductal1842285801074287125152195213
adenocarcinoma2071285801074388126172217255299324360377423468539584
(PDAC)2671285801072163118164211234
of425296801074568
the509296801072672111
pancreatic636296801074591137174200237282308326363
body1015296801074591137174
with1206296801076280106152
liver137429680107193775112138
metastases15282968010771110136179209235279309346377
(arrowheads)192229680107236692118161224270308353399428449