Liquid biopsy as diagnostic tool for pancreatic lesions

On the unenhanced CT of the abdomen and pelvis (A, D), no kidney or ureteral stones are identified. As an incidental finding, discrete peripancreatic fat stranding is present around the pancreatic head which leads to an effacing of the normal parenchymal contour (short open arrow in (A)). The finding was suspicious of a pancreatic head tumour. The presence of a tumour (long open arrow) is confirmed on diffusion-weighted (DWI) (B) and T2-weighted (C) MR imaging performed a few days later. On maximum intensity projection magnetic resonance cholangiopancreatography (MIP MRCP), there is no dilation of the main pancreatic duct [short arrows in (E) and (F)] or the extrahepatic bile ducts (long arrow in (F)). The tumour (long open arrow in (E)) causes slight dilation of some surrounding side branches (thin lines in (E) and (F)). Amylase and CA 19–9 were normal. After pancreaticoduodenectomy (pT2N0L0V1Pn1R1), the histopathological analysis showed pancreatic ductal adenocarcinoma, positive for MUC1, MUC5A, p53mut and loss of SMAD4.

Image source: Löhr JM et al., eGastroenterology 2024 (CC BY-NC 4.0)

These pancreatic lesions, which vary in severity, can occasionally signal pancreatic cancer in its earliest stages. However, traditional methods, including MRI and CT scans, are limited by invasiveness, cost, and variable sensitivity to early pancreatic changes. 

The research, published in eGastroenterology, highlights the potential of liquid biopsy, a minimally invasive test that analyzes blood for circulating tumor DNA, genetic predispositions, and cancer-specific biomarkers. “Liquid biopsy is promising for screening, especially in asymptomatic individuals, as it opens the possibility of detecting genetic markers and circulating cancer cells,” notes Dr. Löhr. “Unlike traditional imaging, which requires specific equipment and expertise, liquid biopsy could become a widely accessible tool for early detection.”  

With pancreatic cancer being one of the deadliest cancers, the ability to catch lesions early could save lives, especially given the disease's high mortality rates. “Our work suggests that integrating liquid biopsy with current diagnostic tools could allow us to intervene sooner, ultimately improving patient outcomes,” Dr. Löhr adds.

In addition to technical insights, the study also examines the ethical dimensions of such incidental findings, which can cause patient anxiety and require sensitive clinical management. The team underscores the importance of clear guidelines to address incidental findings in a way that balances diagnostic utility with patient well-being. 

Source: First Hospital of Jilin University

13.11.2024

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