Frequent Detection of Pancreatic Lesions in Asymptomatic High-Risk Individuals

Abstract

BACKGROUND & AIMS The risk of pancreatic cancer is increased in patients with a strong family history of pancreatic cancer or a predisposing germline mutation. Screening can detect curable, non-invasive pancreatic neoplasms, but the optimal imaging approach is not known. We determined the baseline prevalence and characteristics of pancreatic abnormalities using 3 imaging tests to screen asymptomatic, high-risk individuals (HRI). METHODS We screened 225 asymptomatic adult HRI at 5 academic US medical centers once, using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). We compared results in a blinded, independent fashion. RESULTS Ninety-two of 216 HRI (42%) were found to have at least 1 pancreatic mass (84 cystic, 3 solid) or a dilated pancreatic duct (n=5) by any of the imaging modalities. Fifty-one of the 84 HRI with a cyst (60.7%) had multiple lesions, typically small (mean 0.55 cm, range 2–39 mm), in multiple locations. The prevalence of pancreatic lesions increased with age; they were detected in 14% of subjects <50 years old, 34% of subjects 50–59 years old, and 53% of subjects 60–69 years old (P<.0001). CT, MRI, and EUS detected a pancreatic abnormality in 11%, 33.3%, and 42.6% of the HRI, respectively. Among these abnormalities, proven or suspected neoplasms were identified in 85 HRI (82 intraductal papillary mucinous neoplasms [IPMN] and 3 pancreatic endocrine tumors). Three of 5 HRI who underwent pancreatic resection had high-grade dysplasia in <3 cm IPMNs and in multiple intraepithelial neoplasias. CONCLUSIONS Screening of asymptomatic HRI frequently detects small pancreatic cysts, including curable, non-invasive high-grade neoplasms. EUS and MRI detect pancreatic lesions better than CT.

Early diagnosis of pancreatic cancer: Current trends and concerns

“…CT, MRI, and EUS detected an abnormal pancreatic finding (pancreatic cysts or a dilated pancreatic duct) in 11%, 33.3%, and 43.6% of the high‐risk cases, respectively. Three cases with high‐grade dysplasia in IPMN or multiple intraepithelial neoplasms were finally diagnosed 52. A German study (FaPaCa) enrolled 76 high‐risk cases in a screening program using annual EUS, magnetic resonance cholangiopancreatography (MRCP), and laboratory tests for 5 years.…”

Diagnostic strategies for early pancreatic cancer

“…These abnormal findings were proven or suspected neoplasms in 85 patients. Among these patients, three had high-grade dysplasia in IPMNs or multiple intraepithelial neoplasms [27]. These results suggested that screening of asymptomatic high-risk individuals for PC may frequently reveal small cystic lesions, including curable noninvasive neoplasms, and that EUS and MRI may be better than CT for the early diagnosis of pancreatic neoplasms [28].…”

The importance of a well-structured pancreatic screening program for familial and hereditary pancreatic cancer

“…Most studies involved FPC families, while a few included carriers of a PDAC-associated gene defect [12,[14][15][16]. The screening protocols used in these studies varied widely, including MRI only, both MRI and endoscopic ultrasound (EUS), or MRI with optional EUS.…”