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Pancreatic cancer (PCa) has a high mortality rate, and early and precision detection is vital to improve the survival rate of PCa. However, current imaging modalities such as ultrasound, CT, MRI, and 18F-FDG PET/CT are limited in diagnosing distant metastatic lesions and specific visualization. In recent years, small molecule tracers targeting tumor stroma or antigens have made significant progress in preclinical applications for preoperative PCa diagnosis and image-guided intraoperative resection. Tracers targeting integrins (avb6) in tumor stroma and NTR1 in tumor antigens have been undergoing clinical safety validation. This review summarized small-molecule radioactive probes targeting tumor stroma or antigens in PCa, evaluated their imaging characteristics, clinical potential, and the advantages of multi-targeted probe combinations. Additionally, it explored the potential of novel probes for fluorescence imaging-guided intraoperative resection.
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