Clinical Management of Pancreatic Premalignant Lesions

Søreide, Kjetil; Marchegiani, Giovanni

doi:10.1053/j.gastro.2021.09.073

Cited by 9 publications

(7 citation statements)

References 29 publications

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“… 14 , 15 However, most premalignant lesions are detected as incidental pancreatic cysts on conventional imaging. 16 …”

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

“…Certain risk-groups with hereditary syndromes ( Table 1 ) and familial pancreatic cancer are included in ongoing programs for early detection. 33 Persons with pancreatic cystic lesions is another risk group, 16 for which some need surveillance while others may need resection.…”

Section: The Challenge With Cancer Screeningmentioning

confidence: 99%

“…However, pancreatic cystic precursors such as IPMNs or premalignant mucinous cystic lesions are detectable with imaging studies. 16 , 45 An increasing number of individuals are diagnosed with incidental pancreatic cysts. 16 , 46 Notably, the guidelines for surveillance or resection are conflicting, with considerable variation in the recommendations of observation vs resection.…”

Section: Cross-section Imaging For Detectionmentioning

confidence: 99%

“… 16 , 45 An increasing number of individuals are diagnosed with incidental pancreatic cysts. 16 , 46 Notably, the guidelines for surveillance or resection are conflicting, with considerable variation in the recommendations of observation vs resection. 16 , 46 - 50 However, individuals with cystic lesions represent a defined risk population for exploring biomarkers to assess risk and define progression from precursor to invasive cancer.…”

Section: Cross-section Imaging For Detectionmentioning

confidence: 99%

“…14,15 However, most premalignant lesions are detected as incidental pancreatic cysts on conventional imaging. 16 Early-onset cancers has been called an emerging global epidemic, also for pancreatic cancer. 17 Also, more patients are diagnosed with early-stage cancers (stage IA), suggesting that closer surveillance of high-risk groups may contribute to an earlier diagnosis.…”

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

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Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

et al. 2023

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Background The overall poor prognosis in pancreatic cancer is related to late clinical detection. Early diagnosis remains a considerable challenge in pancreatic cancer. Unfortunately, the onset of clinical symptoms in patients usually indicate advanced disease or presence of metastasis. Analysis and Results Currently, there are no designated diagnostic or screening tests for pancreatic cancer in clinical use. Thus, identifying risk groups, preclinical risk factors or surveillance strategies to facilitate early detection is a target for ongoing research. Hereditary genetic syndromes are a obvious, but small group at risk, and warrants close surveillance as suggested by society guidelines. Screening for pancreatic cancer in asymptomatic individuals is currently associated with the risk of false positive tests and, thus, risk of harms that outweigh benefits. The promise of cancer biomarkers and use of ‘omics’ technology (genomic, transcriptomics, metabolomics etc.) has yet to see a clinical breakthrough. Several proposed biomarker studies for early cancer detection lack external validation or, when externally validated, have shown considerably lower accuracy than in the original data. Biopsies or tissues are often taken at the time of diagnosis in research studies, hence invalidating the value of a time-dependent lag of the biomarker to detect a pre-clinical, asymptomatic yet operable cancer. New technologies will be essential for early diagnosis, with emerging data from image-based radiomics approaches, artificial intelligence and machine learning suggesting avenues for improved detection. Conclusions Early detection may come from analytics of various body fluids (eg ‘liquid biopsies’ from blood or urine). In this review we present some the technological platforms that are explored for their ability to detect pancreatic cancer, some of which may eventually change the prospects and outcomes of patients with pancreatic cancer.

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“… 14 , 15 However, most premalignant lesions are detected as incidental pancreatic cysts on conventional imaging. 16 …”

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

Section: The Challenge With Cancer Screeningmentioning

confidence: 99%

Section: Cross-section Imaging For Detectionmentioning

confidence: 99%

Section: Cross-section Imaging For Detectionmentioning

confidence: 99%

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

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Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

et al. 2023

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Machine learning to guide clinical decision-making in abdominal surgery—a systematic literature review

Henn

Buneß

Schmid

et al. 2021

Langenbecks Arch Surg

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Purpose An indication for surgical therapy includes balancing benefits against risk, which remains a key task in all surgical disciplines. Decisions are oftentimes based on clinical experience while guidelines lack evidence-based background. Various medical fields capitalized the application of machine learning (ML), and preliminary research suggests promising implications in surgeons’ workflow. Hence, we evaluated ML’s contemporary and possible future role in clinical decision-making (CDM) focusing on abdominal surgery. Methods Using the PICO framework, relevant keywords and research questions were identified. Following the PRISMA guidelines, a systemic search strategy in the PubMed database was conducted. Results were filtered by distinct criteria and selected articles were manually full text reviewed. Results Literature review revealed 4,396 articles, of which 47 matched the search criteria. The mean number of patients included was 55,843. A total of eight distinct ML techniques were evaluated whereas AUROC was applied by most authors for comparing ML predictions vs. conventional CDM routines. Most authors (N = 30/47, 63.8%) stated ML’s superiority in the prediction of benefits and risks of surgery. The identification of highly relevant parameters to be integrated into algorithms allowing a more precise prognosis was emphasized as the main advantage of ML in CDM. Conclusions A potential value of ML for surgical decision-making was demonstrated in several scientific articles. However, the low number of publications with only few collaborative studies between surgeons and computer scientists underpins the early phase of this highly promising field. Interdisciplinary research initiatives combining existing clinical datasets and emerging techniques of data processing may likely improve CDM in abdominal surgery in the future.

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Surgical treatment for pancreatic cystic lesions—implications from the multi-center and prospective German StuDoQ|Pancreas registry

Henn

Wyzlic

Espósito

et al. 2023

Langenbecks Arch Surg

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Purpose The detection of pancreatic cystic lesions (PCL) causes uncertainty for physicians and patients, and international guidelines are based on low evidence. The extent and perioperative risk of resections of PCL in Germany needs comparison with these guidelines to highlight controversies and derive recommendations. Methods Clinical data of 1137 patients who underwent surgery for PCL between 2014 and 2019 were retrieved from the German StuDoQ|Pancreas registry. Relevant features for preoperative evaluation and predictive factors for adverse outcomes were statistically identified. Results Patients with intraductal papillary mucinous neoplasms (IPMN) represented the largest PCL subgroup (N = 689; 60.6%) while other entities (mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN), neuroendocrine tumors, pseudocysts) were less frequently resected. Symptoms of pancreatitis were associated with IPMN (OR, 1.8; P = 0.012) and pseudocysts (OR, 4.78; P < 0.001), but likewise lowered the likelihood of MCN (OR, 0.49; P = 0.046) and SCN (OR, 0.15, P = 0.002). A total of 639 (57.2%) patients received endoscopic ultrasound before resection, as recommended by guidelines. Malignancy was histologically confirmed in 137 patients (12.0%), while jaundice (OR, 5.1; P < 0.001) and weight loss (OR, 2.0; P = 0.002) were independent predictors. Most resections were performed by open surgery (N = 847, 74.5%), while distal lesions were in majority treated using minimally invasive approaches (P < 0.001). Severe morbidity was 28.4% (N = 323) and 30d mortality was 2.6% (N = 29). Increased age (P = 0.004), higher BMI (P = 0.002), liver cirrhosis (P < 0.001), and esophageal varices (P = 0.002) were independent risk factors for 30d mortality. Conclusion With respect to unclear findings frequently present in PCL, diagnostic means recommended in guidelines should always be considered in the preoperative phase. The therapy of PCL should be decided upon in the light of patient-specific factors, and the surgical strategy needs to be adapted accordingly.

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Clinical Management of Pancreatic Premalignant Lesions

Cited by 9 publications

References 29 publications

Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

Machine learning to guide clinical decision-making in abdominal surgery—a systematic literature review

Surgical treatment for pancreatic cystic lesions—implications from the multi-center and prospective German StuDoQ|Pancreas registry

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