Print and Media Review

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This hard cover book is primarily aimed at radiologists, although there are multiple excellent chapters that are of interest to gastroenterologists and surgeons. This 196-page book has 11 chapters written by 18 authors who are well respected in their fields. The paper quality is excellent and the index is thorough. It starts out with a discouraging overview of this common and deadly malignancy. The text focuses on the common ductal adenocarcinoma, 85% of all pancreatic neoplasms, but also discusses the pathology, clinical presentation, and imaging characteristics of multiple uncommon pancreatic neoplasms. Indeed, one of the highlights of the book is a description of several rare pancreatic tumors and mimics of neoplasms such as autoimmune and focal pancreatitis, fatty infiltration of the pancreas, and accessory spleens.

A few of the chapters, especially those on computed tomography (CT) and magnetic resonance imaging(MRI), are very technical, using terminology understandable only by radiologists. Sentences include phrases such as “fat-suppressed, dynamic, T1-weighted, 3-dimensional, low flip angle spoiled gradient echo acquisition” without any explanation of what these terms mean. There are also very few clinical data assessing the accuracy of MRI, although Chapter 5 on imaging evaluation did a better job of comparing methods of pancreatic imaging. Despite the technical read, a nonradiologist can learn from these radiology chapters, which comprise about 50% of the book. For instance, there are details of the patient preparation for pancreatic protocol CT scans (which our patients expect us to know), such as 900-mL oral contrast 30–40 minutes before the scan followed by 300 mL of water. The utility of rapid IV contrast injection for both CT and MR, 3–5 mL/s, requiring a power injector, is also explained.

There was an excellent, brief chapter on the utility of endoscopic ultrasound (EUS) for pancreatic neoplasms and cysts written by gastroenterologists. In the rest of the book, the value of EUS was understated, often primarily relegated to tissue acquisition by the radiologist authors. Indeed, the conclusion to the cystic pancreatic neoplasm chapter states that MDCT and MRI are the “most reliable” imaging techniques; EUS is barely mentioned. In contrast, many gastroenterologists and surgeons believe that EUS plays a pivotal role in assessing these cysts.

As someone who performs EUS, it remains unclear to me how common are “simple pancreatic cysts.” Simple cysts are handled differently by the various chapter authors, making it impossible to conclude on their definition or epidemiology. The radiology chapter on pancreatic cysts did not mention simple cysts; the one on EUS mentions simple cysts of the pancreas, but does not elaborate. The last chapter on rare pancreatic neoplasms and mimics of pancreatic cancer defined “simple cysts” as rare true epithelial lined cysts most commonly seen in syndromic diseases such as von Hippel-Lindau and polycystic kidney diseases.

The illustrations are an outstanding feature of this book. There are multiple black and white CT and MR figures illustrating both common and rare pancreatic lesions. The color plates are all located in the center of the book, even though most of them are associated with the second chapter on pathology of pancreatic neoplasms. This central location is only mildly irritating while reading and presumably leads to publication cost savings.

For the gastroenterologist reader, the chapter on surgical staging is particularly enlightening since this has changed considerably over the past 10 years. It is separated into 2 general sections, one on pancreatic head carcinomas and one on pancreatic body/tail cancers because the operative approach is quite different for these 2 locations. The text and the diagrams in the surgical staging chapter were truly outstanding. There are careful descriptions of the goal for clear margins (R0 = clear; R1 = microscopic cancer; R2 = macroscopic cancer) and how this is achieved for various locations of pancreatic cancers. There is also an explanation of the difference between N1, or local lymph nodes, and N2 nodes, which are the nodes that the N1 nodes drain into. I strongly recommend this chapter for all endosonographers who are frequently asked to comment on resectability.

An additional valuable chapter for gastroenterologists and surgeons discusses current chemotherapy and radiation therapy options for pancreatic cancer both as neoadjuvant treatment in borderline resectable patients and as a primary treatment in the large number of inoperable patients.

Bottom Line: This relatively short and very readable text is aimed primarily at radiologists with a focus on pancreatic imaging, although it is an excellent read for gastroenterologists, particularly those who focus on endoscopic ultrasound and pancreatic disorders. There is a thorough discussion of both common ductal adenocarcinoma and numerous rare neoplasms. Also included are the pathology of pancreatic neoplasms and the surgical and oncologic treatment of pancreatic cancer.