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Peer-reviewedCC BY 4.0Surgery Today

Radiologic–pathologic discrepancy in the tumor size assessment of pancreatic ductal adenocarcinoma in the era of preoperative therapy

  • Kazuki Kobayashi1
  • Kaya Ijiri2
  • Takazumi Tsunenari1
  • Naoto Yonamine1
  • Mikiya Takao1
  • Takahiro Einama1
  • Hironori Tsujimoto1
  • Hideki Ueno1
  • Sho Ogata2,3
  • Yoji Kishi1
  1. 1Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Saitama Japan
  2. 2Department of Laboratory Medicine, National Defense Medical College Hospital, Tokorozawa, Saitama Japan
  3. 3Department of Pathology and Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama Japan
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Abstract

Tumor size plays a central role in the staging, resectability assessment, and response evaluation of pancreatic ductal adenocarcinoma (PDAC). However, radiologic tumor size does not necessarily correspond to pathologic tumor size, and this discrepancy has become more clinically relevant in the preoperative therapy era. PDAC is characterized by infiltrative growth, abundant desmoplastic stroma, and ill-defined tumor borders, all of which complicate accurate size assessment on imaging. After preoperative therapy, fibrosis, necrosis, and scattered residual tumor cells further obscure the relationship between radiologic abnormalities and viable tumor burden. This review summarizes the mechanisms underlying radiologic–pathologic discrepancies in tumor size assessment of PDAC, with a focus on computed tomography, magnetic resonance imaging, ultrasound, and pathologic evaluation after preoperative therapy. We also discuss the prognostic implications of imaging-based and pathological tumor sizes and highlight the limitations of size-based response assessment. Finally, we review emerging approaches beyond conventional size metrics, including functional imaging, radiomics, and pathological standardization. Recognizing the biological and treatment-related basis of tumor size discrepancy is essential for improving tumor assessment and refining staging strategies in contemporary PDAC management.

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Cite

BibTeXRIS
BibTeX
@article{kobayashi2026radiologicpathologic,
  title = {{Radiologic–pathologic discrepancy in the tumor size assessment of pancreatic ductal adenocarcinoma in the era of preoperative therapy}},
  author = {Kazuki Kobayashi and Kaya Ijiri and Takazumi Tsunenari and Naoto Yonamine and Mikiya Takao and Takahiro Einama and Hironori Tsujimoto and Hideki Ueno and Sho Ogata and Yoji Kishi},
  journal = {Surgery Today},
  year = {2026},
  month = jul,
  doi = {10.1007/s00595-026-03419-5},
  url = {https://doi.org/10.1007/s00595-026-03419-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Radiologic–pathologic discrepancy in the tumor size assessment of pancreatic ductal adenocarcinoma in the era of preoperative therapy
AU  - Kazuki Kobayashi
AU  - Kaya Ijiri
AU  - Takazumi Tsunenari
AU  - Naoto Yonamine
AU  - Mikiya Takao
AU  - Takahiro Einama
AU  - Hironori Tsujimoto
AU  - Hideki Ueno
AU  - Sho Ogata
AU  - Yoji Kishi
PY  - 2026
DA  - 2026/07/20
JO  - Surgery Today
DO  - 10.1007/s00595-026-03419-5
UR  - https://doi.org/10.1007/s00595-026-03419-5
AB  - Tumor size plays a central role in the staging, resectability assessment, and response evaluation of pancreatic ductal adenocarcinoma (PDAC). However, radiologic tumor size does not necessarily correspond to pathologic tumor size, and this discrepancy has become more clinically relevant in the preoperative therapy era. PDAC is characterized by infiltrative growth, abundant desmoplastic stroma, and ill-defined tumor borders, all of which complicate accurate size assessment on imaging. After preoperative therapy, fibrosis, necrosis, and scattered residual tumor cells further obscure the relationship between radiologic abnormalities and viable tumor burden. This review summarizes the mechanisms underlying radiologic–pathologic discrepancies in tumor size assessment of PDAC, with a focus on computed tomography, magnetic resonance imaging, ultrasound, and pathologic evaluation after preoperative therapy. We also discuss the prognostic implications of imaging-based and pathological tumor sizes and highlight the limitations of size-based response assessment. Finally, we review emerging approaches beyond conventional size metrics, including functional imaging, radiomics, and pathological standardization. Recognizing the biological and treatment-related basis of tumor size discrepancy is essential for improving tumor assessment and refining staging strategies in contemporary PDAC management.
SN  - 0941-1291
SN  - 1436-2813
ER  -