Pancreatic adenocarcinoma consists the most common form of pancreatic cancer, one of the most prevalent malignant diseases on a worldwide level. Its poor prognosis, even when in cases that it is diagnosed in the relatively early stages of the disease, and its dismal 5-year survival rate of less than 5 %, render this form of pancreatic cancer as a highly lethal malignancy. Therefore, it is of the utmost importance to investigate and compare the accuracy and the relative advantages or shortcoming of the existing imaging modalities for evaluating patients with suspected pancreatic adenocarcinoma. This essay intends to provide the basis for a systematic literature review that will compare two imaging modalities related to this field and, subsequently answer which one of them is more accurate and effective: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). We propose a distinct methodological design that will efficiently provide us with solid findings and answers this question with well-defined inclusion and elusion criteria, but also with a distinct research strategy. Furthermore, and with the critical assistance of tools and frameworks such as PICO, the SIGN checklist, and the PRISMA guidelines we intend to evaluate the pieces of evidence collected, and hence ensure that our finding not only will they be meaningful and accurate, but they will also identify existing gaps in literature and trigger novel directions on future research.
The pancreas is an organ located behind the stomach which plays a fundamental role in digestion and in the regulation of sugar within the human body (Goodenough, Wallace and McGuire, 1998). The majority of the cells in the pancreas form the exocrine cells and glands that are, in turn, responsible for initiating the release of digesting enzymes in the stomach. However, and at the same time, the majority of pancreatic cancers begin in those cells. More specifically, approximately 95 % of exocrine pancreatic cancers are pancreatic adenocarcinomas, thus rendering this form the most common type of pancreatic cancer (Badashah, 2015; Sharma et al., 2011). Essentially, all types of pancreatic cancer affect approximately 1 to 10 individuals per 100,000, and their respective prevalence is much higher in developed countries and amongst men (Ryan, Hong and Bardeesy, 2014). In fact, this is now the third most common form of cancer in the United States, surpassing the respective incident rates of breast cancer (pancan.org, 2016). Yet, the most critical fact regarding this disease is that it typically has a dismal 5-year survival rate of less than 5 % (Klapman and Malafa, 2008). Therefore, it is of utmost importance to investigate and compare the accuracy and the relative advantages or shortcoming of the existing imaging modalities for evaluating patients with suspected pancreatic adenocarcinoma.
First of all, and based on the devastating survival rates of patients suffering from pancreatic cancer, it comes as no surprise that there is a greater need to improve these rates by focusing on early and accurate detection imaging modalities that would, in turn, allow the provision of optimal treatment to patients (Lee and Lee, 2014). It should be mentioned that pancreatic cancer has an, overall, poor prognosis, even when it is diagnosed in relatively early stages of the disease, owing to the fact that most patients are asymptomatic till late or exhibit nonspecific symptoms (Tummala, Junaidi and Agarwal, 2011). Therefore, and according to Ryan, Hong and Bardeesy (2014) it is expected that 90 % of all patients diagnosed at some point with pancreatic cancer, they will eventually die. In other words, and as stated in the previous paragraph, pancreatic cancer is a highly lethal malignancy and a global health threat that needs to be anticipated in a much more effective manner. Currently, the initial diagnosis of pancreatic masses is performed with cross-sectional imaging techniques such as endoscopic ultrasound (EUS), multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI), or even with a combination of Positron Emission Tomography and CT (PET/CT) (Pietuga and Morgan, 2015; Shrikhande et al., 2012). In fact, there have been several research studies that have already examined the role and the effectiveness of each of these imaging modalities in the early diagnosis of pancreatic cancers – and more specifically of pancreatic adenocarcinomas. However, the majority of them are not recent; hence they do not include novel research studies, and they also suffer from distinct limitations. For instance, Tummala, Junaidi and Agarwal (2011), performed a literature review by summarising current literature – peer revi
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